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Brief Report
November 27, 2019

Evaluation of Patch Test Findings in Patients With Anogenital Dermatitis

Author Affiliations
  • 1Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
  • 2Department of Dermatology, University of Minnesota, Minneapolis
  • 3University of Minnesota Medical School, Minneapolis
  • 4Feinberg School of Medicine, Department of Dermatology, Northwestern University, Chicago, Illinois
  • 5Department of Dermatology, Columbia University, New York, New York
  • 6Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  • 7Department of Dermatology, University of California, San Francisco
  • 8Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 9Department of Dermatology, Duke University, Durham, North Carolina
  • 10Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
  • 11Division of Dermatology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
  • 12Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
  • 13Department of Dermatology, Pennsylvania State University, State College
  • 14Department of Dermatology, University of Wisconsin Medical School, Madison
  • 15Department of Dermatology, Keck School of Medicine, Los Angeles, California
  • 16Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
  • 17Department of Dermatology, The Ohio State University, Columbus
  • 18Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
  • 19Associates in Dermatology, Fort Myers, Florida
JAMA Dermatol. 2020;156(1):85-91. doi:10.1001/jamadermatol.2019.3844
Key Points

Question  For patients with anogenital dermatitis referred for patch testing, what are common relevant allergens?

Findings  In this analysis of cross-sectional data from the North American Contact Dermatitis Group from 2005 to 2016, most individuals with anogenital involvement only referred for patch testing had relevant allergic reactions. Compared with individuals without anogenital involvement, those with anogenital dermatitis had significantly more reactions to balsam of Peru, methylchloroisothiazolinone and methylisothiazolinone, dibucaine, benzocaine, triamcinolone acetonide, budesonide, ethylenediamine dihydrochloride, lidocaine, and desoximetasone.

Meaning  It is important that individuals with anogenital skin disease undergo patch testing, especially for reactions to preservatives, fragrances, topical anesthetics, and topical corticosteroids.


Importance  Contact dermatitis in the anogenital area is associated with sleep disturbance and dyspareunia and can profoundly affect quality of life. The literature on anogenital contact dermatitis and culprit allergens is limited. The last large-scale study on common, relevant allergens in patients with anogenital dermatitis was published in 2008.

Objectives  To characterize patients with anogenital dermatitis referred for patch testing by the North American Contact Dermatitis Group, to identify common allergens, and to explore sex-associated differences between anogenital dermatitis and allergens.

Design, Setting, and Participants  A retrospective, cross-sectional analysis was conducted of the North American Contact Dermatitis Group database among 28 481 patients who underwent patch testing from January 1, 2005, to December 31, 2016, at outpatient referral clinics in the United States and Canada.

Exposure  Patch testing for allergens.

Main Outcomes and Measures  Currently relevant allergic patch test reactions in patients with anogenital dermatitis.

Results  Of 28 481 patients tested during the study period, 832 patients (336 men and 496 women; mean [SD] age, 50.1 [26.5] years) had anogenital involvement and 449 patients (177 men and 272 women; mean [SD] age, 49.6 [17.4] years) had anogenital dermatitis only. Compared with those without anogenital involvement, there were significantly more male patients in the group with anogenital dermatitis (177 [39.4%] vs 8857 of 27 649 [32.0%]; relative risk, 1.37; 95% CI, 1.14-1.66; P < .001). In the group with anogenital involvement, female patients were significantly less likely than male patients to have allergic contact dermatitis as a final diagnosis (130 [47.8%] vs 107 [60.5%]; relative risk, 0.78; 95% CI, 0.64-0.94; P = .01), whereas a final diagnosis of other dermatoses (eg, lichen planus, lichen sclerosus, or lichen simplex chronicus) was more frequent for female patients than for male patients (67 [24.6%] vs 28 [15.8%]; relative risk, 1.54; 95% CI, 1.02-2.31; P = .03). Of the 449 patients in the group with anogenital involvement only, 227 (50.6%) had 1 or more relevant reaction with patch testing. Allergens that were statistically significantly more common in patients with anogenital involvement compared with those without anogenital involvement included medicaments such as dibucaine (10 of 250 patients tested [4.0%] vs 32 of 17 494 patients tested [0.2%]; relative risk, 22.74; 95% CI, 11.05-46.78; P < .001) and preservatives such as methylchloroisothiazolinone and methylisothiazolinone (30 of 449 patients tested [6.7%] vs 1143 of 27 599 patients tested [4.1%]; relative risk, 1.61; 95% CI, 1.14-2.41; P = .008). A total of 152 patients met the definition for anogenital allergic contact dermatitis, which is defined as anogenital involvement only, allergic contact dermatitis as the only diagnosis, and 1 or more positive reaction of current clinical relevance.

Conclusions and Relevance  For patients with anogenital involvement only who were referred for patch testing, male patients were more likely to have allergic contact dermatitis, whereas female patients were more likely to have other dermatoses. Common allergens or sources consisted of those likely to contact the anogenital area. For individuals with anogenital involvement suspected of having allergic contact dermatitis, reactions to preservatives, fragrances, medications (particularly topical anesthetics), and topical corticosteroids should be tested.

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