The Angry Back

Have you had patients with an ‘Angry Back’ showing positive reaction to several patch test allergens? Or do you have stasis dermatitis patients sensitive to several allergens?[1] 

English: 2+ patch test reaction
English: 2+ patch test reaction (Photo credit: Wikipedia)

“Polysensitisation” (PS) is usually defined as contact sensitisation to 3 or more unrelated haptens of the baseline patch test series. It is debatable whether the PS phenotype represents a distinct genotype or a natural staggered progression from a uni to oligo to polysensitisation process. Statistical modelling for identifying risk factors for this ill defined PS phenomena to 3 or more ‘unrelated’ haptens is difficult. Bivariate analysis and logical regression models were unsatisfactory.

This recent article [2] in BJD explores the concept of Polysensitisation (PS) in contact dermatitis using an interesting and novel methodology using a colossal central European dataset of about 140,000 patch test results. They have used a negative binomial hurdle regression method for count data to independently estimate risk to be sensitised at all and the risk of having several contact allergies, i.e., to be polysensitised.

The axillae and the feet were found to be strong PS risk factors along with increasing age and female sex. In comparison, atopic eczema and occupational dermatitis were less important risk factors.

The size of their dataset and the novel methodology makes this the most authoritative study of this unique phenomenon.

Special thanks to Dr. Wolfgang Uter and the rest of the team for the details.


1. OD – CoD – (Object Database for Contact Dermatitis)

2. Schwitulla, J et al. “Risk factors of polysensitisation to contact allergens.” British Journal of Dermatology (2013).

Bell Eapen
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About Bell Eapen 247 Articles
Techie Dermatologist, Information Systems PhD, Supporter of Open-Source Software, Machine Learning and AI geek, loves cricket, Canadian wine and beer. [Resume]

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