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A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion

Chen, Jennifer K. MD; Jacob, Sharon E. MD; Nedorost, Susan T. MD; Hanifin, Jon M. MD; Simpson, Eric L. MD, MCR; Boguniewicz, Mark MD; Watsky, Kalman L. MD; Lugo-Somolinos, Aida MD; Hamann, Carsten R. MD; Eberting, Cheryl Lee MD; Silverberg, Jonathan I. MD, PhD, MPH; Thyssen, Jacob P. MD, PhD

doi: 10.1097/DER.0000000000000208

Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.

From the *Department of Dermatology, Stanford University, Redwood City; †Department of Dermatology, Loma Linda University, CA; ‡Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH; §Department of Dermatology, Oregon Health & Science University, Portland; ∥Department of Dermatology, Thomas Jefferson University, Philadelphia, PA; ¶Division of Pediatric Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver; **Department of Dermatology, Yale University, New Haven, CT; ††Department of Dermatology, University of North Carolina, Chapel Hill; ‡‡Department of Internal Medicine, Loma Linda University, CA; §§Alpine Dermatology and Laser, Alpine, UT; ∥∥Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University, Chicago, IL; and ¶¶Department of Dermato-Allergology, Gentofte-Herlev University Hospital, Hellerup, Denmark.

Address reprint requests to: Jennifer K. Chen, MD, 450 Broadway St, Pavilion C 2nd floor, Redwood City, CA 94063. E-mail:

J.K.C., S.E.J., S.T.N., J.M.H., E.L.S., M.B., K.L.W., A.L.-S., C.R.H., J.I.S., and J.P.T. report no relevant conflicts of interest. C.R.H. is the first-degree relative of Curt Hamann, owner of SmartPractice. C.L.E. is the founder and CEO of CherylLeeMD Sensitive Skin Care, as well as AZOVA, Inc. J.K.C. was supported in part by an American Contact Dermatitis Society award.

© 2016 American Contact Dermatitis Society
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