Francisco Javier Ortiz de Frutos

Background: Current relevance of positive patch‐test reactions guides management in allergic contact dermatitis (ACD), yet its clinical predictors and the use of predictive models in clinical practice remain underused. Objectives: To identify demographic and clinical factors associated with current relevance in ACD and to develop overall and allergen‐specific predictive models. Methods: A multicentric REIDAC study included data from patch‐tested patients with the Spanish baseline series. Exposure history, anatomical sites, atopic status, and occupational data were recorded. Logistic regression (LR) models were trained and internally validated to predict current relevance overall and for top frequent allergens. Model discrimination was assessed with area under the receiver‐operating characteristic curve (AUC). Results: Among 17 005 patients, 4077 (24.0%) had at least one currently relevant reaction. The final overall LR model achieved an AUC for the validation sample of 0.679. Allergen‐specific AUC parameters (LR) varied among allergens but performed best for nickel (AUC = 0.770). The independent factors associated with current relevance were female gender, specific body sites (hand, neck, head, leg, feet) and two occupations (hairdresser and construction workers). The use of other models (LASSO, gradient boosting) revealed similar results. Conclusions: Prediction modelling may moderately predict current relevance in ACD and several clinical variables are associated with current relevance in ACD.

Background: Allergic contact dermatitis (ACD) is increasingly common in children, with age-related variations suggesting changing exposure patterns. Objective: Updating clinical and epidemiological characteristics, sensitization frequency, and relevance of positive patch tests in pediatric patients. Methods: This prospective multicenter study analyzed data from the Spanish Contact Dermatitis Research Group registry (REIDAC) for patients aged 0–16 years, stratified into 2 groups: 0–5 and 6–16 years. Participants were patch tested with the GEIDAC baseline and extended series from January 2019 to December 2023. Results: Patch tests were performed on 508 children, of whom 179 (35.2%) were sensitized. Among children aged 0–5 years (n = 41), 10 (24.4%) had positive patch tests, with lesions predominantly affecting the face (51.2%), hands (17.0%), and legs (4.9%). Atopic dermatitis (AD) was present in 36.6%, with linalool and limonene hydroperoxides as top sensitizers. In the 6–16 years group (n = 467), 169 patients (36.2%) were sensitized. AD was present in 45.0%, with lesions involving the face (24.0%), hands (23%), and legs (7.0%). Top allergens were linalool hydroperoxide and methylisothiazolinone. Conclusions: High sensitization proportions in both age groups highlight the importance of patch testing. Hydroperoxides of linalool and limonene are emerging as key sensitizers. Age-specific considerations may improve pediatric ACD management.

Background: Budesonide and tixocortol pivalate as markers of contact allergy to corticosteroids have been questioned, as they are not able to detect a significant percentage of allergic patients.Objectives: To investigate the potential role of clobetasol propionate in enhancing corticosteroid sensitisation detection.Methods: Between January 2022 and December 2023, patients who attended centres involved in the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy were tested with an extended baseline series that included budesonide, tixocortol pivalate, clobetasol propionate 0.1% in ethanol and 1% in petrolatum.Results: A total of 4338 patients were tested. Twenty‐four patients were allergic to budesonide (0.55%, 95% CI: 0.37–0.82); nine patients were allergic to tixocortol pivalate (0.21%, 95% CI: 0.11–0.39); and 23 patients were allergic to clobetasol (0.53%, 95% CI: 0.35–0.79). Only four of those patients allergic to clobetasol were detected by budesonide and one by tixocortol pivalate. No significant differences in the number of positive tests were found between clobetasol in petrolatum or ethanol.Conclusions: In Spain budesonide remains the main corticosteroid allergy marker whereas the role of tixocortol pivalate is questionable. The addition of clobetasol propionate to the Spanish baseline series would improve the ability to detect patients allergic to corticosteroids.

Atopic dermatitis is a cutaneous inflammatory disease characterized by intense pruritus, which is often underestimated despite its direct impact on patients’ health-related quality of life and the high burden it poses. The authors’ goal was to design a qualitative tool to guide patients and healthcare professionals in their assessment and interpretation of pruritus intensity using a numerical rating scale. The draft of this tool, henceforth “guideline”, was developed based on a systematic literature review and focus groups comprising patients and a scientific committee. This draft was validated with an independent group of patients and the final version was designed following their feedback. According to the results of the systematic review, pruritus impacts 6 health-related quality of life domains: sleep quality; emotional status; overall health-related quality of life; physical function; social/sexual activity; productivity, particularly affecting sleep quality and the emotional domain. Patients considered that physical function was the most strongly affected domain, followed by sleep quality and emotional well-being, establishing that a minimum pruritus intensity of 4 and 7 points impacts moderately and severely, respectively, on the different domains of patients’ health- related quality of life. The guideline may help patients and healthcare professionals to interpret and assess pruritus intensity using a numerical rating scale and to understand the impact of pruritus on patients’ health-related quality of life.