Making a Diagnosis

  • Ryan W. Toholka
  • Rosemary L. NixonEmail author


Patch testing is part of a diagnostic journey, an investigative process to identify factors contributing to a patient’s dermatitis. Some of this assessment is objective, with investigations such as patch testing and prick testing, yet this assessment is also partly subjective. There is no routine diagnostic test for irritant contact dermatitis, so this is often a default diagnosis made after the exclusion of allergy, together with a history of exposure to skin irritants. It is important to diagnose all the factors contributing to a patient’s dermatitis and to explain the diagnostic process to patients after completion of patch testing. We believe that identification of all these contributing factors is essential to optimize patient outcomes.


Atopic Eczema Contact Dermatitis Patch Testing Allergic Contact Dermatitis Tinea Pedis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Lachapelle JM, Maibach HI, editors. Patch testing and prick testing. 3rd ed. Berlin: Springer; 2012.Google Scholar
  2. 2.
    Wolff K, Goldsmith LA, Katz SI, Gilchrist B, Paller A, Leffell DJ, editors. Fitzpatrick’s dermatology in general medicine. 7th ed. New York: McGraw Hill; 2008.Google Scholar
  3. 3.
    Rietschel RL, Fowler Jr JF, editors. Fisher’s contact dermatitis. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2008.Google Scholar
  4. 4.
    Judge MR, Griffiths HA, Basketter DA, White IR, Rycroft RJ, McFadden JP. Variation in response of human skin to irritant challenge. Contact Dermatitis. 1996;34:115–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Frosche PJ, Menne T, Lepoittevin JP, editors. Contact dermatitis. 4th ed. Berlin: Springer; 2006.Google Scholar
  6. 6.
    Gimenez-Arnau A, Maurer M, De La Cuadra J, Maibach H. Immediate contact skin reactions, an update of contact urticaria, contact urticaria syndrome and protein contact dermatitis – “a never ending story”. Eur J Dermatol. 2010;20:552–62. Scholar
  7. 7.
    Lahti A. Non-immunologic contact urticaria. Acta Derm Venereol Suppl (Stock). 1980;Suppl 91:1–49.Google Scholar
  8. 8.
    Makhija M, O’Gorman MR. Chapter 31: Common in vitro tests for allergy and immunology. Allergy Asthma Proc. 2012;33 Suppl 1:S108–11.PubMedCrossRefGoogle Scholar
  9. 9.
    Sohn A, Frankel A, Patel RV, Goldenberg G. Eczema. Mt Sinai J Med. 2011;78:730–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee HJ, Ha SJ, Ahn WK, Kim D, Park YM, Byun DG, et al. Clinical evaluation of atopic hand-foot dermatitis. Pediatr Dermatol. 2001;18:102–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Burns T, Breathnach S, Cox N, Griffiths C. Rook’s textbook of dermatology. 8th ed. West Sussex: John Wiley and Sons; 2010.Google Scholar
  12. 12.
    Hersle K, Mobacken H. Hyperkeratotic dermatitis of the palms. Br J Dermatol. 1982;107:195–201.PubMedCrossRefGoogle Scholar
  13. 13.
    Dickel H, Bruckner TM, Schmidt A, Diepgen TL. Impact of atopic skin diathesis on occupational skin disease incidence in a working population. J Invest Dermatol. 2003;121:37–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Böhme M, Wickman M, Lennart Nordvall S, Svartengren M, Wahlgren CF. Family history and risk of atopic dermatitis in children up to 4 years. Clin Exp Allergy. 2003;33:1226–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Jankovic S, Raznatovic M, Marinkovic J, Jankovic J, Maksimovic N. Risk factors for psoriasis: a case–control study. J Dermatol. 2009;36:328–34.PubMedCrossRefGoogle Scholar
  16. 16.
    Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, et al. Family history, smoking habits, alcohol consumption and risk of psoriasis. Br J Dermatol. 1992;127:212–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Carlsen BC, Andersen KE, Menné T, Johansen JD. Patients with multiple contact allergies: a review. Contact Dermatitis. 2008;58:1–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Thyssen JP, Linneberg A, Menné T, Nielsen NH, Johansen JD. The effect of tobacco smoking and alcohol consumption on the prevalence of self-reported hand eczema: a cross-sectional population-based study. Br J Dermatol. 2010;162:619–26.PubMedCrossRefGoogle Scholar
  19. 19.
    Jain VK, Aggarwal K, Passi S, Gupta S. Role of contact allergens in pompholyx. J Dermatol. 2004;31:188–93.PubMedGoogle Scholar
  20. 20.
    Kanerva L, Henriks-Eckerman ML, Estlander T, Jolanki R. Dentists’s occupational allergic paronychia and contact dermatitis caused by acrylics. Eur J Dermatol. 1997;7:177–80.Google Scholar
  21. 21.
    Tosti A, Guerra L, Morelli R, Bardazzi F, Fanti PA. Role of food in the pathogenesis of chronic paronychia. J Am Acad Dermatol. 1992;27:706–10.PubMedCrossRefGoogle Scholar
  22. 22.
    Bhahba F, Palmer A, Nixon R. Are reusable rubber gloves associated with latex allergy? Contact Dermatitis. 2012;67:381–2.CrossRefGoogle Scholar
  23. 23.
    Bhaba F, Nixon R. Occupational exposure to laboratory animals causing a severe exacerbation of atopic eczema. Australas J Dermatol. 2012;53:154–5.Google Scholar
  24. 24.
    Laske N, Niggemann B. Does the severity of atopic dermatitis correlate with serum IgE levels? Pediatr Allergy Immunol. 2004;15:86–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Phelps RG, Miller MK, Singh F. The varieties of “eczema”: clinicopathologic correlation. Clin Dermatol. 2003;21:95–100.PubMedCrossRefGoogle Scholar
  26. 26.
    Meding B, Swanbeck G. Predictive factors for hand eczema. Contact Dermatitis. 1990;23:154–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Diepgen TL, Andersen KE, Brandao FM, Bruze M, Bruynzeel DP, Frosch P, et al. Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema. Br J Dermatol. 2009;160:353–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Williams JDL, Lee AYL, Matheson MC, Frowen KE, Noonan AM, Nixon RL. Occupational contact urticaria: Australian data. Br J Dermatol. 2008;159:125–31.PubMedCrossRefGoogle Scholar
  29. 29.
    Doutre MS. Occupational contact urticaria and protein contact dermatitis. Eur J Dermatol. 2005;15:419–24.PubMedGoogle Scholar
  30. 30.
    Williams J, Cahill J, Nixon R. Occupational autoeczematization or atopic eczema precipitated by occupational contact dermatitis? Contact Dermatitis. 2007;56:21–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Lysdal SH, Søsted H, Andersen KE, Johansen JD. Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences. Contact Dermatitis. 2011;65:151–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Holness DL, Nethercott JR. Is a worker’s understanding of their diagnosis an important determinant of outcome in occupational contact dermatitis? Contact Dermatitis. 1991;25:296–301.PubMedCrossRefGoogle Scholar
  33. 33.
    Kalimo K, Kautiainen H, Niskanen T, Niemi L. ‘Eczema school’ to improve compliance in an occupational dermatology clinic. Contact Dermatitis. 1999;41:315–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Nixon R, Williams J, Matheson M, Palmer A, Frowen K, Dharmage S. Describing outcomes in occupational dermatitis. Recent Adv Recent Updat. 2010;11:71–82.Google Scholar
  35. 35.
    Wall L, Gebauer KA. A follow-up study of occupational skin disease in Western Australia. Contact Dermatitis. 1991;24:241–3.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Occupational Dermatology Research and Education CentreSkin and Cancer Foundation Inc.CarltonAustralia

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