Contact Dermatitis and Eczema Clinical Pearls

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Matthew Zirwas, MD

Dr Zirwas provides us with important clinical pearls from his presentation on contact dermatitis and eczema…

  1. If a patient with facial dermatitis is patch tested with the TRUE Test, the likelihood that patch testing will get them better is 1%. (30% chance they have contact dermatitis x 20% chance it will accurately diagnose them x 50% chance they will remember their allergies x 50% chance they will be able to avoid them if they remember them = 1.5% chance they will get better).
  1. TRUE Test is great for diagnosing allergic contact dermatitis to common metals, rubber, and active ingredients in OTC and Rx products. It is very bad at diagnosing ACD to personal care products.
  1. If there isn’t somebody in your area who does comprehensive patch testing, at the very least you should add these ten allergens to the TRUE Test: Methylisothiazolinone 2000 ppm, Formaldehyde 2%, Propylene Glycol 100%, Fragrance Mix 2, Cocamidopropyl Betaine, Amidoaminde, Dimethylaminopropylamine, Hydroxyethyl methacrylate, Mixed dialkyl thioureas, Chloroxylenol.
  1. Patients can be accurately patch tested while on 10 mg of prednisone.
  1. Every allergen you tell someone they are allergic to decreases they chances they will remember what they’re allergic to by 50%. (Allergic to 0 allergens à100% chance of remembering, Allergic to 1 à50% likelihood of remembering, Allergic to 2 à 25% likelihood of remembering, Allergic to 3 à 12% chance of remembering what they are allergic to).