Allergic contact dermatitis to personal care products and topical medications in adults with atopic dermatitis

Background: Atopic dermatitis (AD) is associated with skin-barrier disruption, immune dysregulation, and application of emollients and topical medications that might predispose a person toward developing allergic contact dermatitis. Objective: To determine the predictors of allergic contact dermatitis and relevant allergens in AD. Methods: A retrospective chart review was performed for 502 adults (age ≥18 years) who were patch tested to an expanded allergen series during 2014-2017. Results: Overall, 108 (21.5%) had current AD and 109 (21.7%) had past AD. Patients with and without current AD had similar proportions of any positive (+, ++, or +++ 80 [74.1%] vs 254 [64.5%], respectively, chi-squared P =.06); strong-positive (++ and +++ 34 [31.5%] vs 102 [25.9%], respectively, P =.25); and irritant (56 [51.9%] vs 188 [47.7%], respectively, P =.45) patch-test reactions. AD patients had significantly higher rates of positive reactions to ingredients in their personal care products and topical medications, including fragrance mix II (P =.04), lanolin (P =.03), bacitracin (P =.04), cinnamal (P =.02), budesonide (P =.01), tixocortol (P =.02), and chlorhexidine (P =.001); relevance was established in >90% of these reactions. Polysensitization occurred more commonly in patients with AD than without (35 [32.4%] vs 75 [19.0%]; P =.01). Limitation: Study was performed at a single center. Conclusion: AD patients had more positive patch-test reactions to ingredients in their personal care products, topical steroids, and antibiotics.