Allergic Contact Dermatitis With Extensive Patch Testing in a 29-Year-Old Female — Village Dermatology, Katy & Houston, Texas
Patient Overview
A 29-year-old female presented to Village Dermatology as a new patient with a chronic, itchy, red rash affecting the arms, hands, and right leg, present for several years. The patient reported that the rash significantly worsened over the past year, particularly on the hands, and often flared after exposure to cleaning products or during nail salon visits, raising concerns about possible allergies.
She had previously used triamcinolone and clobetasol without improvement.
Clinical Examination
A focused dermatologic exam was performed on the head, face, and back.
The patient appeared well developed, well nourished, alert, and in no distress.
Findings:
Well-demarcated, geometric eczematous patches consistent with allergic contact dermatitis (ACD)
Rash distribution and worsening with product exposure suggested a strong allergic trigger
Given chronicity and treatment resistance, patch testing was indicated
Assessment: Allergic Contact Dermatitis
The patient’s clinical presentation was most consistent with allergic contact dermatitis of unknown/unspecified cause, with probable exacerbation from environmental and chemical exposures.
Because she had failed two high-potency topical steroids, the next step was comprehensive patch testing.
⭐ Patch Testing: Core ACDS Series (88 Allergens)
A full ACDS Core Patch Test Panel was applied to the patient’s back, totaling 88 allergens, including:
Metals (Nickel, Cobalt, Gold compounds)
Preservatives (MI/MCI, Parabens, Formaldehyde, Germall II, Bronopol)
Fragrances (Fragrance Mix I & II, Balsam of Peru, Lavender Oil, Ylang Ylang, Peppermint Oil)
Rubbers and adhesives (Carba mix, Thiuram mix, PPD, Epoxy resin, BPA)
Surfactants (Cocamidopropyl betaine, Decyl glucoside, Oleamidopropyl dimethylamine)
Antibiotics (Neomycin, Bacitracin, Polymyxin B)
Sunscreen ingredients (Octinoxate, Benzophenone-4)
Hair product allergens (Acrylates, DMAPA)
Corticosteroid markers (Tixocortol, Budesonide, Clobetasol)
Botanical allergens (Propolis, Tea tree oil, Shellac)
And many others included in the ACDS Standard Series
Risks reviewed: itch, rash, allergic reaction, blistering, systemic reaction, rare anaphylaxis.
Verbal consent obtained.
Patient Instructions (Critical for Accuracy)
The patient was given strict instructions to ensure valid patch test results:
Back Care Instructions:
Do NOT get the back wet (no sweating, showering, or humid environments for 96 hours)
Avoid scratching or disturbing the patches
Leave patches in place for 48 hours, then remove them at home
Continue avoiding moisture until the 4-day follow-up visit
Do not apply topical steroids or ice to the back
May use OTC antihistamines (Zyrtec, Claritin, Allegra, Xyzal) if needed
At follow-up, she will receive a printed list of allergens to which she reacted.
Counseling Provided
The dermatologist discussed:
The nature of Allergic Contact Dermatitis—a delayed hypersensitivity reaction
Importance of identifying allergen triggers
How avoidance leads to significant long-term improvement
How irritant exposure (cleaners, salon chemicals) likely contributed to worsening symptoms
Future skin-care planning after results are reviewed
Follow-Up
The patient will return in 4 days for:
Patch test reading
Allergen identification
Personalized avoidance plan
Updated treatment regimen for long-term eczema and ACD control
🌟 Takeaway
This case highlights the importance of patch testing in patients with chronic, treatment-resistant eczema, particularly when symptoms worsen with product exposure.
At Village Dermatology in Katy, Texas and Houston, Texas, we provide advanced diagnostic services such as patch testing to accurately identify allergens and create targeted, effective treatment plans.
