A holistic view on dermatitis: Patch testing should be considered in patients with atopic dermatitis

摘要

Although the authors acknowledge that allergic contact dermatitis (ACD) should be considered in the differential diagnosis of atopic dermatitis (AD) and state that contact allergy to topical corticosteroids should sometimes be ruled out, patch testing for delayed-type hypersensitivity was excluded from the flowchart of the diagnosis and management of AD.We believe that a more holistic view of dermatitis, taking the critical role of ACD in AD morbidity into account, would optimize patient care and that the 2 disorders are likely to be much more closely related clinically and pathomechanistically than previously thought. The former general "consensus" on the inverse relationship between ACD and AD is explained, at least in part, by a well-conducted study that clearly showed that experimental induction of contact allergy to irritating chemical allergens was compromised in patients with AD in a dose-dependent manner.2 Furthermore, because clinical epidemiologic studies have often rejected an association between AD and ACD, the logical conclusion drawn by many physicians has been to omit patch testing from the routine diagnostic work-up of patients with AD.