Donna M. Richardson

Retrospective Evaluation of Patch Testing Before or After Metal Device Implantation

OBJECTIVE To review the results of patch testing before or after metal device implantation. DESIGN Retrospective medical chart review. SETTING Tertiary care academic medical center. PATIENTS All patients who underwent patch testing before or after metal device implantation. INTERVENTIONS Patch testing. RESULTS From January 1999 through March 2006, 44 patients underwent patch testing in conjunction with metal device implantation, 22 preoperatively and 22 postoperatively. The reason for preoperative patch testing was a history of allergy to metals. Five patients had positive results for a component of the proposed device. The reasons for postoperative patch testing were unexplained skin eruptions at the implantation site (13 patients), chronic joint pain (8 patients), and joint loosening (1 patient). None of the patients had positive patch test results to a component of the previously implanted device. CONCLUSIONS Although the numbers of patients in this study were small, patch testing performed before metal device implantation was helpful in guiding the choice of device selected. Patch testing after implantation was of limited value.

Delayed patch test reading after 5 days: The Mayo Clinic experience

BACKGROUND Some patients may have delayed allergic patch test reactions that are not identified with a typical 5-day reading protocol. OBJECTIVE To identify allergens with delayed-positive reactions and to determine whether a late reading (day 7-9) can be substituted for the day-5 reading. METHODS We retrospectively reviewed medical records of patients who underwent patch testing for suspected allergic contact dermatitis from October 1997 through December 2006 and returned for delayed readings between days 7 and 10 or beyond. (This cohort was predominantly patients with suspected allergies to metals and corticosteroids). RESULTS A total of 36,064 individual reactions (471 allergens, 372 patients) were interpreted on day 5 and at least once during days 7 through 21. We analyzed the 170 allergens that were each tested in at least 50 patients. The 4 allergens with the highest percentage of delayed-positive reactions were gold sodium thiosulfate 0.5% (delayed-positive reactions in 22/353 patients), dodecyl gallate 0.25% (6/105), palladium chloride 2% (8/194), and neomycin sulfate 20% (10/253). We observed a low number of delayed-positive readings for p-phenylenediamine 1% (1/251) and for corticosteroids. Reactions to certain preservative and fragrance allergens dissipated after the day-5 reading. Most reactions that dissipated after day 5 were mild, whereas the reactions that became apparent after day 5 were strong. LIMITATIONS This was a retrospective study. Most patients had suspected allergies to metals and corticosteroids. CONCLUSION Late patch test readings (day 7 or beyond) were useful when interpreting reactions to metals and topical antibiotics, but it was not useful in the diagnosis of reactions to other allergens, including topical corticosteroids. Because reactions to certain fragrance and preservative allergens may dissipate after 5 days, patch test reactions therefore are optimally read at days 3 and 5, but an additional reading on day 7 or beyond is useful if patch tests to metals and topical antibiotics are performed.

The Hazards of Moist Toilet Paper: Allergy to the Preservative Methylchloroisothiazolinone/Methylisothiazolinone

BACKGROUND Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), a common preservative in some brands of moist toilet paper (baby wipes and moist towelettes), has been reported to be a cause of allergic contact dermatitis. However, few cases have been reported in the United States. OBSERVATIONS We report the cases of 4 adult patients with severe perianal and perineal allergic contact dermatitis seen at our institution during a 6-month period. With patch testing, we identified allergy to MCI/MI, and we determined that all 4 patients were using moist toilet paper. The dermatitis resolved after use of the moist toilet paper was discontinued. CONCLUSION This study highlights that the MCI/MI in moist toilet paper can be a cause of perianal and perineal allergic contact dermatitis.

Low yield for extended reading of patch tests with topical corticosteroids.

Background: On the basis of reports that up to 30% of patch‐test reactions are missed if an extended reading is not performed, we required that patients who were being patch‐tested with the corticosteroid series return for a reading at least 1 week after placement of the allergens. Objective: To report our institutional experience with extended readings (day 7 or beyond) of patch‐test reactions to the corticosteroid series. Methods: We retrospectively reviewed patch‐test reactions to corticosteroids since extended readings were implemented (April 2001 to June 2004). Results: A total of 135 patients were patch‐tested with 1,656 corticosteroid allergens. On day 5, five patients had five positive patch‐test reactions; by the time of the extended reading, no new reactions had developed in these patients. Of the patients with no reactions on day 5, two had a positive result at the extended reading: each had a relevant reaction to budesonide 0.1%, one on day 7 and the other on day 9. Conclusions: Only 2 reactions (to 1,656 corticosteroids) became apparent at the extended reading. Extended readings were of limited value in our experience.

Results of patch testing in 10 patients with peristomal dermatitis.

BACKGROUND Peristomal dermatitis is a common problem in patients with ostomies that is a source of considerable morbidity. Irritant contact dermatitis is most common, but allergic contact dermatitis can also occur. Because of the lack of published reports on patch testing for this indication, we undertook a retrospective study of patch testing results in patients with suspected peristomal allergic contact dermatitis. OBJECTIVE We sought to describe our patch testing experience with patients referred with peristomal dermatitis. METHODS This was a retrospective review of medical records of patients with ostomies and peristomal dermatitis who underwent patch testing in the Mayo Clinic Departments of Dermatology in Jacksonville, FL; Rochester, MN; and Scottsdale, AZ, during a 10-year period (2000-2010). RESULTS Ten patients with peristomal dermatitis were referred for patch testing (6 in Minnesota, 2 in Florida, and 2 in Arizona). Patients were patch tested to the materials used in their stoma devices, to the standard series, and in some cases to supplemental series. All 10 had at least one allergic patch test reaction, most commonly to stoma paste (3 of 10 patients). LIMITATIONS Retrospective nature of study via chart review is a limitation. CONCLUSION Patch testing is a useful tool for identification of allergens in patients with peristomal dermatitis.

Patch test results may vary depending on where testing is performed: a comparison of patch test results from three geographically distinct sites in the USA

Background  Do patch test results vary from one part of the USA to another? Few reports directly compare the results of patch testing across centers within the USA.