Contact Allergy in Atopic Dermatitis and Psoriasis: A Retrospective Study

Abstract

Background/Objectives: The correlation between contact allergy (CA), atopic dermatitis (AD) and psoriasis is still debated. Therefore, the present study aims to retrospectively analyze the frequency of contact sensitization among patients with psoriasis and AD compared to controls, in order to further investigate the relationship between CA and the underlying immunological background. Methods: All data concerning patients who underwent patch testing from 2016 to 2022 in the dermatology clinic of a tertiary center in Southern Italy have been retrospectively collected. Only patients who underwent patch testing with the S.I.D.A.PA. standard series have been selected and divided into three groups: AD group, psoriasis group and control group. Acquired data were organized into database and underwent statistical examination. Results: A total of 2287 patients have been enrolled, including 377 AD patients, 127 psoriatic patients and 1783 controls. The most frequent allergens were nickel and balsam of Peru. Methylisothiazolinone (4.2% vs. 2.2%), paraben mix (0.3% vs. 0%) and neomycin (1.3% vs. 0.4%) significantly provided more positive reactions (PSR) in the AD group compared to the control one, and fragrance mix II displayed a higher rate of positivity in the atopic group compared to the psoriatic one (3.2% vs. 0%). Conclusions: Psoriasis turned out to be a possible protective factor for CA (odds ratio = 0.6), while AD seems to facilitate its development (odds ratio: 1.42). The limitations of this study mainly rely upon its retrospective nature which limited the acquisition of clinical relevance for PSR. Further studies are required to better investigate this topic.

Keywords: allergic contact dermatitis; atopic dermatitis; contact allergy; patch test; psoriasis.

Figure 1

Schematic representation of possible correlations between allergic contact dermatitis (ACD), psoriasis and both intrinsic and extrinsic atopic dermatitis (AD). Colored inner boxes illustrate the most relevant immune-pathogenetic aspects of psoriasis and AD (both intrinsic and extrinsic); external dashed frames indicate possible immunological similarities and correlations between intrinsic AD, psoriasis and ACD on one hand, and between extrinsic AD and ACD on the other hand. Different colors (green and red) are used to highlight the pivotal role of the hapten’s nature (e.g., nickel or fragrances) in determining the immune-polarization of ACD response (EOS. = eosinophils; DCs = dendritic cells).

Figure 2

Graphical representation of relative frequencies of positive skin reactions (PSRs) for each tested substance in the three examined groups (AD = atopic dermatitis, PSO = psoriasis); data extracted from Table 1.