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Diagnosing Allergic Contact Dermatitis Through Elimination, Perception, Detection and Deduction

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Abstract

Several authors have commented upon the skills of detection required in making a diagnosis of allergic contact dermatitis. Here, we emphasise the search for clues in a systematic manner. We describe four stages as part of a systematic method for diagnosing allergic contact dermatitis. Firstly, elimination (or inclusion) of non-allergic diagnoses. Secondly, perception: the pre-patch test diagnosis and the ‘three scenarios’ principle. Thirdly, detection: optimising the sensitivity of the patch test process. Fourthly, deduction: diagnosing allergic contact dermatitis by associating the dermatitis with the allergen exposure. We further compare and contrast the pre-patch test history and examination with the markedly different one (‘microhistory’ and ‘microexamination’) used after patch testing. The importance of knowledge of contact dermatitis literature is emphasised with a review of recent publications. Finally, we also highlight the use of contact allergy profiling as an investigative tool in the diagnosis of allergic contact dermatitis.

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Acknowledgements

The authors would like to thank David A. Basketter for his valuable comments.

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Authors and Affiliations

  1. Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand

    Korbkarn Pongpairoj

  2. Institute of Dermatology, Bangkok, Thailand

    Pailin Puangpet

  3. Division of Medicine, Dermatologic Department, Phramongkutklao Hospital, Bangkok, Thailand

    Supitchaya Thaiwat

  4. Department of Cutaneous Allergy, St. John’s Institute of Dermatology, Guy’s Hospital, King’s College, London, UK

    John P. McFadden

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  1. Korbkarn Pongpairoj
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  2. Pailin Puangpet
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  4. John P. McFadden
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Corresponding author

Correspondence to Korbkarn Pongpairoj.

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No funding was received for the preparation of this review.

Conflict of interest

Korbkarn Pongpairoj, Pailin Puangpet, Supitchaya Thaiwat and John McFadden have no conflicts of interest.

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Pongpairoj, K., Puangpet, P., Thaiwat, S. et al. Diagnosing Allergic Contact Dermatitis Through Elimination, Perception, Detection and Deduction. Am J Clin Dermatol 18, 651–661 (2017). https://doi.org/10.1007/s40257-017-0287-8

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  • DOI: https://doi.org/10.1007/s40257-017-0287-8

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