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Allergic Contact Dermatitis in Older Adults

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Abstract

Purpose of Review

Allergic contact dermatitis (ACD) is a common skin condition in older adults. This article discusses the relationship between aging skin and the development of ACD, with close attention paid to the allergens that are currently the most relevant to the age group.

Recent Findings

The prevalence of at least one positive patch test in older adults ranges from 60–80%. Relevant contact allergens include fragrances, topical medicaments, preservatives, lanolin, and metals.

Summary

Dermatologists must be able to recognize ACD in the older adult and refer for patch testing when needed. Patch testing can elucidate causative allergens and guide an avoidance strategy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rudnicka E, Napierała P, Podfigurna A, et al. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020;139:6–11.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Castelo-Branco C, Soveral I. The immune system and aging: a review. Gynecol Endocrinol. 2014;30(1):16–22. https://doi.org/10.3109/09513590.2013.852531. Epub 2013 Nov 12.

    Article  PubMed  CAS  Google Scholar 

  3. Aw D, Silva AB, Palmer DB. Immunosenescence: emerging challenges for an ageing population. Immunology. 2007;120(4):435–46. https://doi.org/10.1111/j.1365-2567.2007.02555.x. Epub 2007 Feb 15.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. • Chen B, Yang J, Song Y, et al. Skin Immunosenescence and Type 2 Inflammation: A Mini-Review With an Inflammaging Perspective. Front Cell Dev Biol. 2022;10:835675. https://doi.org/10.3389/fcell.2022.835675. Review of current evidence on immunosenescence and “inflamm-aging” in the elderly.

  5. Lazuardi L, Jenewein B, Wolf AM, et al. Age-related loss of naïve T cells and dysregulation of T-cell/B-cell interactions in human lymph nodes. Immunology. 2005;114(1):37–43. https://doi.org/10.1111/j.1365-2567.2004.02006.x.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Zhang S, Duan E. Fighting against Skin Aging: The Way from Bench to Bedside. Cell Transplant. 2018;27(5):729–38. https://doi.org/10.1177/0963689717725755. Epub 2018 Apr 25.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chambers ES, Vukmanovic-Stejic M. Skin barrier immunity and ageing. Immunology. 2020;160(2):116–25. https://doi.org/10.1111/imm.13152. Epub 2019 Dec 4.

    Article  PubMed  CAS  Google Scholar 

  8. Lima AL, Timmermann V, Illing T, et al. Contact dermatitis in the elderly: predisposing factors, diagnosis, and management. Drugs Aging. 2019;36(5):411–7. https://doi.org/10.1007/s40266-019-00641-4.

    Article  PubMed  Google Scholar 

  9. Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol. 2010;11(6):373–81. https://doi.org/10.2165/11319290-000000000-00000.

    Article  PubMed  Google Scholar 

  10. Goh CL. Prevalence of contact allergy by sex, race and age. Contact Derm. 1986;14(4):237–40. https://doi.org/10.1111/j.1600-0536.1986.tb01232.x. PMID: 3487413.

    Article  CAS  Google Scholar 

  11. Wantke F, Hemmer W, Jarisch R, et al. Patch test reactions in children, adults and the elderly. A comparative study in patients with suspected allergic contact dermatitis. Contact Derm. 1996;34(5):316–9. https://doi.org/10.1111/j.1600-0536.1996.tb02214.x.

  12. Schäfer T, Böhler E, Ruhdorfer S, et al. Epidemiology of contact allergy in adults. Allergy. 2001;56(12):1192–6. https://doi.org/10.1034/j.1398-9995.2001.00086.x.Erratum.In:Allergy2002Feb;57(2):178.

    Article  PubMed  Google Scholar 

  13. Wöhrl S, Hemmer W, Focke M, et al. Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns. Pediatr Dermatol. 2003;20(2):119–23. https://doi.org/10.1046/j.1525-1470.2003.20204.x.

  14. Tosti A, Pazzaglia M, Silvani S, et al. The spectrum of allergic contact dermatitis in the elderly. Contact Derm. 2004;50(6):379–81. https://doi.org/10.1111/j.0105-1873.2004.0350g.x.

    Article  Google Scholar 

  15. Piaserico S, Larese F, Recchia GP, et al. Allergic contact sensitivity in elderly patients. Aging Clin Exp Res. 2004;16(3):221–5. https://doi.org/10.1007/BF03327387.

    Article  PubMed  Google Scholar 

  16. Warshaw EM, Raju SI, Fowler JF Jr, et al. Positive patch test reactions in older individuals: retrospective analysis from the North American Contact Dermatitis Group, 1994–2008. J Am Acad Dermatol. 2012;66(2):229–40. https://doi.org/10.1016/j.jaad.2010.12.022. Epub 2011 May 19.

    Article  PubMed  Google Scholar 

  17. •• Woodruff CM, Kollhoff A, Butler DC, et al. Update on contact sensitization in the older adult population. Dermatitis. 2022;33(2):122–128. https://doi.org/10.1097/DER.0000000000000763. Recent retrospective study analyzing patch test results in 169 older adults.

  18. •• Slodownik D, Mousa M, Bar J. Allergic contact dermatitis in the older adults: a comparative cross-sectional study. Dermatitis. 2023;19. https://doi.org/10.1089/derm.2022.0004. Epub ahead of print. Recent large retrospective controlled study analyzing the proportion of positive patch tests and relevant positive patch tests in older adults compared to younger age groups.

  19. Yu J, Johnson H, DeKoven JG, et al. Patch test results among older adults: a retrospective analysis of the north american contact dermatitis group data (2009-2020). Dermatitis. 2023 Aug 17. https://doi.org/10.1089/derm.2023.0130. Epub ahead of print.

  20. • Silverberg JI, Hou A, Warshaw EM, et al. Prevalence and trend of allergen sensitization in patients with a diagnosis of stasis dermatitis referred for patch testing, North American contact dermatitis group data, 2001–2016. Arch Dermatol Res. 2022;314(9):857–67. https://doi.org/10.1007/s00403-021-02295-y. Large retrospective analysis exploring the relationship between stasis dermatitis and allergic contact dermatitis.

  21. Paramsothy Y, Collins M, Smith AG. Contact dermatitis in patients with leg ulcers. The prevalence of late positive reactions and evidence against systemic ampliative allergy. Contact Derm. 1988;18(1):30–6. https://doi.org/10.1111/j.1600-0536.1988.tb05486.x.

  22. Johansen JD. Fragrance contact allergy: a clinical review. Am J Clin Dermatol. 2003;4(11):789–98. https://doi.org/10.2165/00128071-200304110-00006. PMID: 14572300.

    Article  PubMed  Google Scholar 

  23. de Groot AC. Myroxylon pereirae resin (balsam of Peru) - A critical review of the literature and assessment of the significance of positive patch test reactions and the usefulness of restrictive diets. Contact Derm. 2019;80(6):335–53. https://doi.org/10.1111/cod.13263. Epub 2019 Apr 5.

    Article  Google Scholar 

  24. Ng A, Atwater AR, Reeder M. Contact allergy to topical medicaments, part 1: a double-edged sword. Cutis. 2021;108(5):271–5. https://doi.org/10.12788/cutis.0390.

    Article  PubMed  Google Scholar 

  25. Green CM, Holden CR, Gawkrodger DJ. Contact allergy to topical medicaments becomes more common with advancing age: an age-stratified study. Contact Dermatitis. 2007;56(4):229–31. https://doi.org/10.1111/j.1600-0536.2006.01084.x.

    Article  PubMed  Google Scholar 

  26. DeKoven JG, Warshaw EM, Reeder MJ, et al. North American contact dermatitis group patch test results: 2019–2020. Dermatitis. 2023;34(2):90–104. https://doi.org/10.1089/derm.2022.29017.jdk. Epub 2023 Jan 19.

  27. • Jenkins BA, Belsito DV. Lanolin. Dermatitis. 2023;34(1):4–12. https://doi.org/10.1089/derm.2022.0002. PMID: 36917502. Review of lanolin contact allergy with a section dedicated to contact sensitization in the elderly.

  28. Warshaw EM, Aschenbeck KA, DeKoven JG, et al. Piercing and metal sensitivity: extended analysis of the North American contact dermatitis group data, 2007–2014. Dermatitis. 2017;28(6):333–341. https://doi.org/10.1097/DER.0000000000000324.

  29. Steuer MS, Botto NC. Patient Reported Improvement After Patch Testing and Allergen Avoidance Counseling: A Retrospective Analysis. Dermatol Ther (Heidelb). 2018;8(3):435–40. https://doi.org/10.1007/s13555-018-0250-5. Epub 2018 Jul 9.

    Article  PubMed  Google Scholar 

  30. Johnson H, Adler BL, Yu J. Dupilumab for allergic contact dermatitis: An overview of its use and impact on patch testing. Cutis. 2022;109(5):265–267, E4-E5. https://doi.org/10.12788/cutis.0519.

  31. Johnson H, Guenther J, Adler BL, et al. Janus Kinase inhibitors: a promising therapeutic option for allergic contact dermatitis. Cutis. 2023;111(2):92–105. https://doi.org/10.12788/cutis.0705.

    Article  PubMed  Google Scholar 

  32. Onder M, Oztas MO. Contact dermatitis in the elderly. Contact Derm. 2003;48(4):232–3. https://doi.org/10.1034/j.1600-0536.2003.00060.x.

    Article  Google Scholar 

  33. Silverberg JI, Patel N, Warshaw EM, et al. Hand and foot dermatitis in patients referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2001–2018. J Am Acad Dermatol. 2022;87(5):1049–59. https://doi.org/10.1016/j.jaad.2022.07.035. Epub 2022 Aug 5.

    Article  PubMed  Google Scholar 

  34. Matthys E, Zahir A, Ehrlich A. Shoe allergic contact dermatitis. Dermatitis. 2014;25(4):163–71. https://doi.org/10.1097/DER.0000000000000049.

  35. Aquino M, Rosner G. Systemic contact dermatitis. Clin Rev Allergy Immunol. 2019;56(1):9–18. https://doi.org/10.1007/s12016-018-8686-z.

    Article  PubMed  CAS  Google Scholar 

  36. Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br J Dermatol. 2020;182(1):47–54. https://doi.org/10.1111/bjd.17896. Epub 2019 Jul 28.

    Article  PubMed  CAS  Google Scholar 

  37. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol. 2009;89(3):236–44. https://doi.org/10.2340/00015555-0650.

    Article  PubMed  Google Scholar 

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Correspondence to JiaDe Yu.

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Johnson, H., Yu, J. Allergic Contact Dermatitis in Older Adults. Curr Derm Rep 12, 279–284 (2023). https://doi.org/10.1007/s13671-023-00406-8

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