By James G. Marks, Jr., MD, Peter Elsner, MD, and Vincent A. Deleo, MD (Auth.)
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Extra resources for Contact & Occupational Dermatology
These relate to physical findings as well as history. Some of the frequent ones that can lead to a low level of suspicion and failure to patch test are listed in Table 2-4. Contact dermatitis is not always equal in severity bilaterally; it can involve the palms and soles. In addition, many of us hold some of the same misconceptions as our patients (see Table 2-3). The physical examination is a routine one for the dermatologist. It is essential to examine the entire skin surface. Many times the true distribution of an eruption can reveal the antigen source for a patient who for any number of reasons has not given full information on the history.
The more educated the clinician becomes, the earlier he or she is likely to recognize the possibility of contact allergy and the more directed the history taking becomes. Frequently this shift occurs only after the physical examination and finding of a well-demarcated dermatitis. I lf allergic contact dermatitis is suspected, schedule enough time for 8 detailed history and complete skin examination. We have included a patch test and occupational history and physical examination form for your use (Figure 2-1).
TAKING THE HISTORY The initial history of a patient who will ultimately be evaluated for allergic contact dermatitis is the standard dermatologic history. At some point when contact allergy becomes suspected, the history naturally shifts to more carefully investigate exposure to possible antigens. If the patient initially complains of a reaction to a specific agent, the shift is an early one. The more educated the clinician becomes, the earlier he or she is likely to recognize the possibility of contact allergy and the more directed the history taking becomes.
Contact & Occupational Dermatology by James G. Marks, Jr., MD, Peter Elsner, MD, and Vincent A. Deleo, MD (Auth.)