Personal care products play important role in facial, anogenital dermatitis across genders

Personal care products are the source of most allergic and irritant contact dermatitis in male patients with facial dermatitis, according to a study published in JAMA Dermatology.

In a separate study that also used the North American Contact Dermatitis Group database, patients suspected of having allergic contact dermatitis with anogenital involvement should have reactions to preservatives, fragrances, topical anesthetics and topical corticosteroids evaluated.

“If physicians do not test for all of the potential culprits, they will miss the diagnosis of allergic contact dermatitis,” Susan T. Nedorost, MD, of the department of dermatology and population and quantitative health sciences at Case Western Reserve University and the department of dermatology at University Hospitals Cleveland Medical Center, wrote in an accompanying editorial. “Patch testing must be comprehensive to be of value, such that there is no ‘magic number’ of patch tests that are appropriate for any given patient.”

The facial dermatitis retrospective study spanned 22 years of analysis and included 1,332 male patients in the male facial dermatitis group and 13,732 male participants without facial dermatitis. The most common facial sites were on the general face in 817 patients, eyelids in 392 and lips in 210 patients. Patients with facial dermatitis were significantly younger and less likely to be white than those without facial dermatitis. Occupationally related skin disease was more common in the facial dermatitis group (RR = 0.49; 95% CI, –0.42 to 0.58), with manufacturing of durable goods being the most common occupation involved.

In facial dermatitis, common allergens causing relevant reactions included methylisothiazolinone, which is common in liquid-based care products, fragrance mix and balsam of Peru.

Dermatologists should be aware of the possible implications of male grooming products to appropriately identify and treat patients as the frequency for male patients with facial dermatitis referred for patching testing has doubled in the past 20 years.

Additionally, the researchers recommended inquiring with male patients about whether they use hair dye and/or facial personal care products.

In patients with anogenital dermatitis, out of 28,481 patients in the database from 2005 to 2016, 832 patients had anogenital involvement and 449 patients had anogenital dermatitis only. There were more male patients in the group with anogenital dermatitis (39.4%) compared with those without anogenital involvement (32%) (RR = 1.37; 95% CI, 1.14-1.66).

In those with anogenital involvement, female patients were significantly less likely to have allergic contact dermatitis as a final diagnosis, 47.8% vs 60.5% (RR = 0.78; 95% CI, 0.64-0.94). For female patients, a final diagnosis of other dermatoses was more frequent than for male patients.

Researchers identified allergens that were significantly more common in patients with anogenital involvement as balsam of Peru, dibucaine, methylchloroisothiazolinone and methylisothiazolinone, benzocaine, triamcinolone acetonide, budesonide, ethylenediamine dihydrochloride, lidocaine and desoximetasone.

In anogenital dermatitis, food was the third most common source of allergens, which accounted for 8.5% of all cases.

“This finding is remarkable given that foods are rarely patch tested,” Nedorost wrote. “Patch tests for foods, sometimes referred to as atopy patch test, require more research focus.”

Nedorost recommended minimizing the use of any personal care product that is not necessary.

“Patch test results in the general population with dermatitis may not reflect those in specific subpopulations because of both cutaneous immunology and exposure patterns,” Nedorost wrote. – by Abigail Sutton

References:

Nedorost ST, et al. JAMA Dermatol. 2019:doi:10.1001/jamadermatol.2019.3464.

Warshaw EM, et al. JAMA Dermatol. 2019:doi:10.1001/jamadermatol.2019.3531.

Warshaw EM, et al. JAMA Dermatol. 2019:doi:10.1001/jamadermatol.2019.3844.

Disclosures: Nedorost reports receiving grants from Ohio Dermatological Association and Pfizer and personal fees from Pfizer and Leo Pharma. Warshaw reports receiving grants from Wen. Please see the studies for all other authors’ relevant financial disclosures.