The Role of Patch Testing in Perineal Disorders Affecting Women

Abstract

Background: Many different materials are used in the perineal area, making it liable to contact sensitisation. Objective: We report the results of a retrospective study of patients with perineal dermatoses involving the vulva investigated for possible contact allergy. Methods: 240 female patients with dermatoses in the perineal area, specifically including the vulva, were patch tested to our standard series and a special patch test series devised for perineal problems. Results: 79 out of 240 patients (32.9%) demonstrated relevant positive results. These related to medicaments (49 patients), perfumes (22 patients), cosmetics (5 patients), dyes (4 patients) and rubber (4 patients). Conclusions: Perineal dermatoses involving the vulva may require patch testing to identify suspected and unanticipated contact allergy. An extended comprehensive series of patch test allergens will be necessary in these cases.

Sodium metabisulfite allergy is common but is it relevant?

“…This along with the many topical preparations including Aureocort ® , Aureomycin ® (now discontinued in the UK), Nizoral ® , Nystatin ® , and Lustra ® creams and Psoradrate ® ointment contain SMB as a preservative. Contact allergy to SMB from some of these sources has previously been reported (8, 9, 11–16). SMB allergy has also been described in patients receiving local anaesthetic injections (17) and ophthalmic preparations (18) that contain this agent.…”

A systematic review of allergic and irritant contact dermatitis of the vulva: The most important allergens/irritants and the role of patch testing

“…Of the included studies, 16 studies had a cross‐sectional design, of which nine were retrospective in which databases were used to conduct the study 13–21 . One randomized controlled trial was included 22 .…”

“…The mean age of the total study population was not always provided. The mean age ranged between 35.3 and 59.4 years in the studies that provided this information ( n = 13) 13–20,23,25,27–29 . Of all studies, 14 included post‐menopausal women 13–23,25,28,29 .…”

“…The duration of the symptoms was mentioned in seven studies, with symptoms often lasting for several years 13,14,20,23,27–29 . Some patients had a pre‐existing vulvar disease of which the most prevalent diagnoses were: vulvar dermatitis, lichen sclerosus, lichen planus, lichen simplex chronicus, vulvodynia, candidiasis and psoriasis 14–16,18–21,23,25,27–29 …”

“…The results of the risk of bias assessment can be found in Figure 2 for the cross‐sectional studies and Figure 3 for the RCT. In none of the cross‐sectional studies was the sample size justified by the authors 13–21,23–29 . The sampling frame was considered not representative for the total population in 11 of the 16 cross‐sectional studies 13,15–20,23,25,27,29 .…”