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Dermatitis. 28(4):261–264, JUL 2017

DOI: 10.1097/DER.0000000000000282,  PMID: 28538006
Issn Print: 1710-3568
Publication Date: 2017/07/01

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Evaluation and Management of Patch Test-Negative Patients With

Generalized Dermatitis
Alison Spiker; Christen M. Mowad

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Abstract
Background
Patients with generalized dermatitis are common in dermatology practices. Allergic contact dermatitis
is often suspected, and patients frequently undergo patch testing. When the patch testing result is
negative, further evaluation and management of these patients are challenging.
Objective
The purpose of this study was to survey members of the American Contact Dermatitis Society
regarding the evaluation and management of patch test–negative patients with generalized dermatitis.
Results
Generalized dermatitis was the most common term identified for patch test–negative patients with
diffuse dermatitis. After having negative expanded patch testing results, most physicians proceeded
with additional testing including skin biopsy, complete blood cell count with differential, and liver and
renal function tests. The most commonly used systemic treatment is prednisone, followed by
methotrexate. Narrow-band ultraviolet B (UVB) is the most commonly used light source.
Antihistamines are frequently prescribed. Food allergy is not felt to be causative. This cohort of
patients experiences significant impairment in quality of life, stress on personal relationships, and
time off work.
Conclusions
The management of patch test–negative patients with generalized dermatitis is challenging. This study
provides insight into management of these complex patients. It also demonstrates practice gaps in
the management of these patients, indicating a need for further studies to direct the evaluation and
management of this patient population.
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Related Topics
 Atopic dermatitis and skin disease

 Dermatitis/Atopic Dermatitis

 Food allergy and food intolerance

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