Practice Parameter
Contact Dermatitis: A Practice Parameter–Update 2015

https://doi.org/10.1016/j.jaip.2015.02.009Get rights and content

This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing “Contact Dermatitis: A Practice Parameter–Update 2015.” This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.

Section snippets

Preface

The Practice Parameter on Contact Dermatitis (CD) was last updated in 2006, and focused primarily on the basics of CD and patch testing for the allergist. In the ensuing years, there has been considerable interest by the allergist in allergic skin diseases due to increasing numbers of referrals for CD. With the ease of application, the use of the preloaded commercially available T.R.U.E. Test patch testing method has increased among allergists, as has the use of patch testing with individually

Glossary

“Angry back” syndrome or “excited skin” syndrome: defined as false-positive patch test (PT) reactions usually adjacent to large true-positive reactions that induce contiguous skin inflammation and irritability.

Ectopic allergic contact dermatitis: contact allergy lesions manifested in locations distant from or indirectly in contact with the original skin sites directly exposed to allergens due to inadvertent transfer by the patient (eg, transfer of sensitizers in nail polish to the eyelids) or

Compilation of Summary Statements

Summary Statement 1: Consider ACD in the differential diagnosis of patients with chronic eczematous or noneczematous dermatitis. [Strength of Recommendation: Strong; C Evidence]

Summary Statement 2: In patients suspected of ACD, patch testing is the gold standard to confirm the diagnosis. [Strength of Recommendation: Strong; C Evidence]

Summary Statement 3: In addition to personal products used by a patient suspected of ACD, review the home and workplace for other sources of contact allergens.

Executive Summary

Contact dermatitis may be suspected on the basis of the clinical appearance of the cutaneous lesions, the distribution of the dermatitis, and the absence of other etiologies. Acute CD is characterized by erythematous papules, vesicles, and crusted lesions. There are other dermatological conditions that may resemble the clinical and/or histological appearance of CD, and these should be considered in the differential diagnosis. The suspicion of ACD is the first step in making the diagnosis. Patch

Clinical evaluation

Summary Statement 1: Consider ACD in the differential diagnosis of patients with chronic eczematous or noneczematous dermatitis. [Strength of Recommendation: Strong; C Evidence]

Contact dermatitis may be suspected on the basis of the clinical appearance of the lesions, the distribution of the dermatitis, and the absence of other etiologies or lack of associated systemic manifestations. Acute CD is characterized by erythematous papules, vesicles, and crusted lesions. Recurrent or persistent

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    See Appendix A for members of the Joint Task Force Contact Dermatitis Parameter Workgroup, reviewers of this Practice Parameter, and members of the Joint Task Force on Practice Parameters.

    Disclosure of potential conflict of interest: L. Fonacier has received research and educational grants (made to Winthrop University Hospital) from Genentech, Merck, and Baxter; is in the Speaker's Bureau/Honoraria of Baxter; and is on the Board of Directors, Joint Council of Allergy, Asthma and Immunology (JCAAI) 2012-2015. D. Bernstein is the consultant in Merck, Genentech, Proctor and Gamble, Sanofi, and TEVA; and has received research grants from Amgen, GlaxoSmithKline, Greer, Johnson & Johnson, Merck, Teva, Pfizer, Genentech, Array, Cephalon, Novartis, Boeringer Ingelheim, and Medimmune. The rest of the authors declare that they have no relevant conflicts of interest.

    The Joint Task Force recognizes that experts in a field are likely to have interests that could come into conflict with the development of a completely unbiased and objective practice parameter. To take advantage of that expertise, a process has been developed to prevent potential conflicts from influencing the final document in a negative way.

    At the workgroup level, members who have a potential conflict of interest either do not participate in discussions concerning topics related to the potential conflict or if they do write a section on that topic, the workgroup completely rewrites it without their involvement to remove potential bias. In addition, the entire document is then reviewed by the Joint Task Force and any apparent bias is removed at that level. Finally, the practice parameter is sent for review both by invited reviewers and by anyone with an interest in the topic by posting the document on the web sites of the ACAAI and the AAAAI.

    Corresponding author: Joint Task Force on Practice Parameters, 59 N Brockway St, #304, Palatine, IL 60067. E-mail: [email protected].

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