Forgotten skin: What do our geriatric patch test findings reveal?
Main Article Content
Keywords
Allergen, Dermatitis, Geriatric Population, Patch Test
Abstract
Allergic contact dermatitis (ACD) in the elderly is influenced by age-related immunological changes, cumulative exposure, and skin barrier alterations. However, data comparing sensitization profiles among different geriatric populations remains limited. We aimed to evaluate and compare the patterns and severity of patch test reactions in patients aged 65–74 (young– old group) and those aged 75 years or older (old–old group), using the European Standard Series (ESS). A total of 128 patients aged 65 years or older were retrospectively analyzed. Patch testing was performed with the ESS, and reactions were assessed at 48 and 96 hours according to the International Contact Dermatitis Research Group (ICDRG) criteria. Of the patients, 106 were classified as young–old and 22 as old–old. The most frequent allergens in the young–old group were propolis (20%), fragrance mix I (17%), methyldibromo glutaroni-trile (16%), peru balsam (15.1%), and nickel sulfate (14.2%), while methylchloroisothiazolinone/ methylisothiazolinone (22.7%), methylisothiazolinone (13.6%), propolis (13.6%), and textile dye mix (13.6%) were the most common that in the old–old group. Across both groups, preservative and fragrance-related allergens predominated. According to ICDRG grading, most reactions were weak positive (+), whereas moderate positive (++) and strong positive (+++) reactions were less frequent, particularly in the old–old group. In conclusion, preservatives, propolis and fragrance-related allergens remain the leading causes of contact sensitization in the elderly, while metal sensitization decreases with advancing age. The reduced frequency and intensity of positive reactions in the old–old group may reflect immunosenescence and diminished T-cell responsiveness in advanced age.
References
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24. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M57. https://doi.org/10.1093/gerona/56.3.M146
25. Burns SD, Crimmins EM, Zhang M, Ailshire JA. Psychosocial well-being differences between the young old, old-old, and oldest old: A global comparison. J Aging Health. 2024:08982643241264587. https://doi.org/10.1177/08982643241264587
26. Bruze M, Svedman C. Clarification and modification of the International Contact Dermatitis Research Group Classification of patch test reactions on behalf of the International Contact Dermatitis Research Group. Dermatitis. 2025;36(5):440–6. https://doi.org/10.1089/derm.2024.0365
27. Bruze M, Ale I, Andersen KE, Elsner P, Goh CL, Goossens A, et al. Are we reading patch test reactions in a uniform way? An International Contact Dermatitis Research Group Study. Dermatitis. 2025;36:352–7. https://doi.org/10.1089/derm.2024.0364
28. Weisshaar E. Chronic hand eczema. Am J Clin Dermatol. 2024;25:909–26. https://doi.org/10.1007/s40257-024-00890-z
29. Pesqué D, Silvestre‐Salvador JF, Figueiredo AC, Pujol RM, Gonçalo M, Giménez‐Arnau AM. A review of hand eczema subtypes: Clinical features, biomarkers and treatment strategies. Cont Dermatitis. 2025;92:421–35. https://doi.org/10.1111/cod.14775
30. Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization in the elderly. Clin Dermatol. 2011;29:24–30. https://doi.org/10.1016/j.clindermatol.2010.07.003
31. Piaserico S, Larese F, Recchia GP, Corradin MT, Scardigli F, Gennaro F, et al. Allergic contact sensitivity in elderly patients. Aging Clin Exp Res. 2004;16:221–5. https://doi.org/10.1007/BF03327387
32. Frosch PJ, Duus Johansen J, Schuttelaar MLA, Silvestre JF, Sánchez‐Pérez J, Weisshaar E, et al. Patch test results with fragrance markers of the baseline series–analysis of the European Surveillance System on Contact Allergies (ESSCA) network 2009–2012. Cont Dermatitis. 2015;73:163–71. https://doi.org/10.1111/cod.12420
33. Uter W, Amario‐Hita J, Balato A, Ballmer‐Weber B, Bauer A, Belloni Fortina A, et al. European Surveillance System on Contact Allergies (ESSCA): Results with the European baseline series, 2013/14. J Eur Acad Dermatol Venereol. 2017;31:1516–25. https://doi.org/10.1111/jdv.14423
34. Safiri S, Jaberinezhad M, Mousavi SE, Motlagh Asghari K, Shamekh A, Nejadghaderi SA, et al. The burden of dermatitis from 1990–2019 in the Middle East and North Africa region. BMC Public Health. 2024;24:399. https://doi.org/10.1186/s12889-024-17836-z
35. Arribas M, Soro P, Silvestre J. Allergic contact dermatitis to fragrances: Part 2. Actas Dermo-Sifiliogr. 2013;104:29–37. https://doi.org/10.1016/j.ad.2012.03.005
36. Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel allergy in adults in the US: 1962 to 2015. Dermatitis. 2015;26:216–23. https://doi.org/10.1097/DER.0000000000000130
37. Ahlström MG, Thyssen JP, Menné T, Johansen JD. Prevalence of nickel allergy in Europe following the EU Nickel Directive—A review. Cont Dermatitis. 2017;77:193–200. https://doi.org/10.1111/cod.12846
38. Thyssen JP, Menné T. Metal Allergy: A review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol. 2010;23:309–18. https://doi.org/10.1021/tx9002726
39. Mukovozov IM, Kashetsky N, de Gannes G. Prevalence of contact allergy to nickel: A retrospective chart review. Dermatitis. 2022;33:355–61. https://doi.org/10.1097/DER.0000000000000812
40. de Groot AC. Propolis: A review of properties, applications, chemical composition, contact allergy, and other adverse effects. Dermatitis. 2013;24:263–82. https://doi.org/10.1097/DER.0000000000000011
41. Oršolić N. Allergic inflammation: Effect of propolis and its flavonoids. Molecules. 2022;27:6694. https://doi.org/10.3390/molecules27196694
42. Mendonça I, Medeiros M, Penteado R, Parolia A, Porto I. An overview of the toxic effects and allergic reactions caused by propolis. Pharmacol Ach. 2:96–105.
43. Giusti F, Miglietta R, Pepe P, Seidenari S. Sensitization to propolis in 1255 children undergoing patch testing. Cont Dermatitis. 2004;51:255–8. https://doi.org/10.1111/j.0105-1873.2004.00455.x
44. Slomski A. Almost all “natural” skin care products contain contact allergens. JAMA. 2022;328:1677. https://doi.org/10.1001/jama.2022.18441
45. Kwong HL, Lim SPR. Prevalence of propolis allergy in Singapore. JAAD international. 2020;1:39. https://doi.org/10.1016/j.jdin.2020.04.001
46. Kocabas G, Ipenburg NA, de Groot A, Rustemeyer T. Results of patch testing propolis in the European baseline series: A 4‐year retrospective study. Cont Dermatitis. 2024;91:375–8. https://doi.org/10.1111/cod.14678
47. Bachevski D, Damevska K, Simeonovski V, Dimova M. Back to the basics: Propolis and COVID‐19. Dermatol Ther. 2020;33:e13780. https://doi.org/10.1111/dth.13780
48. Ali AM, Kunugi H. Propolis, bee honey, and their components protect against coronavirus disease 2019 (COVID-19): A review of in silico, in vitro, and clinical studies. Molecules. 2021;26:1232. https://doi.org/10.3390/molecules26051232
49. Aparecida Berretta A, Duarte Silveira MA, Condor Capcha JM, De Jong D. Propolis and its potential against SARS-CoV-2 infection mechanisms and COVID-19 disease. Biomed Pharmacother. 2020;131:110622. https://doi.org/10.1016/j.biopha.2020.110622
50. Uter W, Aalto‐Korte K, Agner T, Andersen KE, Bircher AJ, Brans R, et al. The epidemic of methylisothiazolinone contact allergy in Europe: Follow‐up on changing exposures. J Eur Acad Dermatol Venereol. 2020;34:333–9. https://doi.org/10.1111/jdv.15875
51. Lundov M, Krongaard T, Menné T, Johansen J. Methylisothiazolinone contact allergy: A review. Br J Dermatol. 2011;165:1178–82. https://doi.org/10.1111/j.1365-2133.2011.10523.x
52. Sukakul T, Limphoka P, Boonchai W. Methylchloroisothiazolinone and/or methylisothiazolinone contact allergies in Thailand. Dermatitis. 2021;32:375–80. https://doi.org/10.1097/DER.0000000000000537
53. Ryberg K, Agner T, Andersen KE, Bircher A, Diepgen T, Foti C, et al. Patch testing with a textile dye mix–a multicentre study. Cont Dermatitis. 2014;71:215–23. https://doi.org/10.1111/cod.12244
54. Silverberg JI, Hou A, Warshaw EM, DeKoven JG, Maibach HI, Belsito DV, et al. Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001–2018. J Eur Acad Dermatol Venereol. 2022;86:818–26. https://doi.org/10.1016/j.jaad.2021.07.030
2. Patel K, Nixon R. Irritant contact dermatitis—A review. Curr Dermatol Rep. 2022;11:41–51. https://doi.org/10.1007/s13671-021-00351-4
3. Li Y, Li L. Contact dermatitis: Classifications and management. Clin Rev Allergy Immunol. 2021;61:245–81. https://doi.org/10.1007/s12016-021-08875-0
4. Murphy PB, Atwater AR, Mueller M. Allergic contact dermatitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018.
5. Fonacier L, Noor I. Contact dermatitis and patch testing for the allergist. Ann Allergy Asthma Immunol. 2018;120:592–8. https://doi.org/10.1016/j.anai.2018.03.003
6. Wantke F, Hemmer W, Jahisch R, Götz M. Patch test reactions in children, adults and the elderly: A comparative study in patients with suspected allergic contact dermatitis. Cont Dermatitis. 1996;34:316–9. https://doi.org/10.1111/j.1600-0536.1996.tb02214.x
7. Uter W, Hegewald J, Aberer W, Ayala F, Bircher AJ, Brasch J, et al. The European standard series in 9 European countries, 2002/2003–first results of the European Surveillance System on Contact Allergies. Cont Dermatitis. 2005;53:136–45. https://doi.org/10.1111/j.0105-1873.2005.00673.x
8. Uter W, Wilkinson SM, Aerts O, Bauer A, Borrego L, Brans R, et al. Patch test results with the European baseline series, 2019/20—Joint European results of the ESSCA and the EBS working groups of the ESCD, and the GEIDAC. Cont Dermatitis. 2022;87:343–55. https://doi.org/10.1111/cod.14170
9. Jacob SE, Elsaie ML, Castanedo-Tardan MP, Stechschulte S, Kaufman J. Aging and contact dermatitis: A review. Curr Aging Sci. 2009;2:121–6. https://doi.org/10.2174/1874609810902020121
10. Farage M, Miller K, Elsner P, Maibach H. Intrinsic and extrinsic factors in skin ageing: A review. Int J Cosmet Sci. 2008;30:87–95. https://doi.org/10.1111/j.1468-2494.2007.00415.x
11. Prakash AV, Davis MD. Contact dermatitis in older adults: A review of the literature. Am J Clin Dermatol. 2010;11:373–81. https://doi.org/10.2165/11319290-000000000-00000
12. Zhai H, Meier-Davis SR, Cayme B, Shudo J, Maibach H. Irritant contact dermatitis: Effect of age. Cutan Ocul Toxicol. 2012;31:138–43. https://doi.org/10.3109/15569527.2011.595749
13. Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J. Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: A multi-center prevalence and correlational study. BMC Geriatrics. 2017;17:263. https://doi.org/10.1186/s12877-017-0655-5
14. Cardona V, Guilarte M, Luengo O, Labrador-Horrillo M, Sala-Cunill A, Garriga T. Allergic diseases in the elderly. Clin Transl Allergy. 2011;1:11. https://doi.org/10.1186/2045-7022-1-11
15. Lima AL, Timmermann V, Illing T, Elsner P. Contact dermatitis in the elderly: Predisposing factors, diagnosis, and management. Drugs & Aging. 2019;36:411–7. https://doi.org/10.1007/s40266-019-00641-4
16. Bocheva GS, Slominski RM, Slominski AT. Immunological aspects of skin aging in atopic dermatitis. Int J Mol Sci. 2021;22:5729. https://doi.org/10.3390/ijms22115729
17. Wang RF, Kaffenberger BH, Kaffenberger JA. A retrospective review of new-onset dermatitis in patients aged 60 years or older. J Clin Aesthet Dermatol. 2018;11(1):19–20.
18. Slodownik D, Mousa M, Bar J. Allergic contact dermatitis in the older adults: A comparative cross-sectional study. Dermatitis®. 2023;34:329–33. https://doi.org/10.1089/derm.2022.0004
19. Tosti A, Pazzaglia M, Silvani S, Delorenzi F. The spectrum of allergic contact dermatitis in the elderly. Cont Dermatitis. 2004;50:378–81. https://doi.org/10.1111/j.0105-1873.2004.0350g.x
20. Zhai H, Meier-Davis SR, Cayme B, Shudo J, Maibach H. Allergic contact dermatitis: Effect of age. Cutan Ocul Toxicol. 2012;31:20–5. https://doi.org/10.3109/15569527.2011.595749
21. Erkoç M, Özden G, Çevirme L, Cansunar RS, Basır H, Dik S. Outcomes of the European baseline series patch test in the geriatric population. Allergol Immunopathol. 2025;52:128–33. https://doi.org/10.15586/aei.v53i4.1387
22. Ertam I, Turkmen M, Alper S. Patch-test results of an academic department in Izmir, Turkey. Dermatitis. 2008;19:213–5. https://doi.org/10.2310/6620.2008.08004
23. Koca R, Kocaturk E, Savk E, Baskan EB, Aydin F, Yalcin B, et al. Patch test results to European baseline series in Turkey: A prospective and multicenter study. Dermatitis. 2021;32:397–405. https://doi.org/10.1097/DER.0000000000000631
24. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M57. https://doi.org/10.1093/gerona/56.3.M146
25. Burns SD, Crimmins EM, Zhang M, Ailshire JA. Psychosocial well-being differences between the young old, old-old, and oldest old: A global comparison. J Aging Health. 2024:08982643241264587. https://doi.org/10.1177/08982643241264587
26. Bruze M, Svedman C. Clarification and modification of the International Contact Dermatitis Research Group Classification of patch test reactions on behalf of the International Contact Dermatitis Research Group. Dermatitis. 2025;36(5):440–6. https://doi.org/10.1089/derm.2024.0365
27. Bruze M, Ale I, Andersen KE, Elsner P, Goh CL, Goossens A, et al. Are we reading patch test reactions in a uniform way? An International Contact Dermatitis Research Group Study. Dermatitis. 2025;36:352–7. https://doi.org/10.1089/derm.2024.0364
28. Weisshaar E. Chronic hand eczema. Am J Clin Dermatol. 2024;25:909–26. https://doi.org/10.1007/s40257-024-00890-z
29. Pesqué D, Silvestre‐Salvador JF, Figueiredo AC, Pujol RM, Gonçalo M, Giménez‐Arnau AM. A review of hand eczema subtypes: Clinical features, biomarkers and treatment strategies. Cont Dermatitis. 2025;92:421–35. https://doi.org/10.1111/cod.14775
30. Balato A, Balato N, Di Costanzo L, Ayala F. Contact sensitization in the elderly. Clin Dermatol. 2011;29:24–30. https://doi.org/10.1016/j.clindermatol.2010.07.003
31. Piaserico S, Larese F, Recchia GP, Corradin MT, Scardigli F, Gennaro F, et al. Allergic contact sensitivity in elderly patients. Aging Clin Exp Res. 2004;16:221–5. https://doi.org/10.1007/BF03327387
32. Frosch PJ, Duus Johansen J, Schuttelaar MLA, Silvestre JF, Sánchez‐Pérez J, Weisshaar E, et al. Patch test results with fragrance markers of the baseline series–analysis of the European Surveillance System on Contact Allergies (ESSCA) network 2009–2012. Cont Dermatitis. 2015;73:163–71. https://doi.org/10.1111/cod.12420
33. Uter W, Amario‐Hita J, Balato A, Ballmer‐Weber B, Bauer A, Belloni Fortina A, et al. European Surveillance System on Contact Allergies (ESSCA): Results with the European baseline series, 2013/14. J Eur Acad Dermatol Venereol. 2017;31:1516–25. https://doi.org/10.1111/jdv.14423
34. Safiri S, Jaberinezhad M, Mousavi SE, Motlagh Asghari K, Shamekh A, Nejadghaderi SA, et al. The burden of dermatitis from 1990–2019 in the Middle East and North Africa region. BMC Public Health. 2024;24:399. https://doi.org/10.1186/s12889-024-17836-z
35. Arribas M, Soro P, Silvestre J. Allergic contact dermatitis to fragrances: Part 2. Actas Dermo-Sifiliogr. 2013;104:29–37. https://doi.org/10.1016/j.ad.2012.03.005
36. Goldenberg A, Vassantachart J, Lin EJ, Lampel HP, Jacob SE. Nickel allergy in adults in the US: 1962 to 2015. Dermatitis. 2015;26:216–23. https://doi.org/10.1097/DER.0000000000000130
37. Ahlström MG, Thyssen JP, Menné T, Johansen JD. Prevalence of nickel allergy in Europe following the EU Nickel Directive—A review. Cont Dermatitis. 2017;77:193–200. https://doi.org/10.1111/cod.12846
38. Thyssen JP, Menné T. Metal Allergy: A review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol. 2010;23:309–18. https://doi.org/10.1021/tx9002726
39. Mukovozov IM, Kashetsky N, de Gannes G. Prevalence of contact allergy to nickel: A retrospective chart review. Dermatitis. 2022;33:355–61. https://doi.org/10.1097/DER.0000000000000812
40. de Groot AC. Propolis: A review of properties, applications, chemical composition, contact allergy, and other adverse effects. Dermatitis. 2013;24:263–82. https://doi.org/10.1097/DER.0000000000000011
41. Oršolić N. Allergic inflammation: Effect of propolis and its flavonoids. Molecules. 2022;27:6694. https://doi.org/10.3390/molecules27196694
42. Mendonça I, Medeiros M, Penteado R, Parolia A, Porto I. An overview of the toxic effects and allergic reactions caused by propolis. Pharmacol Ach. 2:96–105.
43. Giusti F, Miglietta R, Pepe P, Seidenari S. Sensitization to propolis in 1255 children undergoing patch testing. Cont Dermatitis. 2004;51:255–8. https://doi.org/10.1111/j.0105-1873.2004.00455.x
44. Slomski A. Almost all “natural” skin care products contain contact allergens. JAMA. 2022;328:1677. https://doi.org/10.1001/jama.2022.18441
45. Kwong HL, Lim SPR. Prevalence of propolis allergy in Singapore. JAAD international. 2020;1:39. https://doi.org/10.1016/j.jdin.2020.04.001
46. Kocabas G, Ipenburg NA, de Groot A, Rustemeyer T. Results of patch testing propolis in the European baseline series: A 4‐year retrospective study. Cont Dermatitis. 2024;91:375–8. https://doi.org/10.1111/cod.14678
47. Bachevski D, Damevska K, Simeonovski V, Dimova M. Back to the basics: Propolis and COVID‐19. Dermatol Ther. 2020;33:e13780. https://doi.org/10.1111/dth.13780
48. Ali AM, Kunugi H. Propolis, bee honey, and their components protect against coronavirus disease 2019 (COVID-19): A review of in silico, in vitro, and clinical studies. Molecules. 2021;26:1232. https://doi.org/10.3390/molecules26051232
49. Aparecida Berretta A, Duarte Silveira MA, Condor Capcha JM, De Jong D. Propolis and its potential against SARS-CoV-2 infection mechanisms and COVID-19 disease. Biomed Pharmacother. 2020;131:110622. https://doi.org/10.1016/j.biopha.2020.110622
50. Uter W, Aalto‐Korte K, Agner T, Andersen KE, Bircher AJ, Brans R, et al. The epidemic of methylisothiazolinone contact allergy in Europe: Follow‐up on changing exposures. J Eur Acad Dermatol Venereol. 2020;34:333–9. https://doi.org/10.1111/jdv.15875
51. Lundov M, Krongaard T, Menné T, Johansen J. Methylisothiazolinone contact allergy: A review. Br J Dermatol. 2011;165:1178–82. https://doi.org/10.1111/j.1365-2133.2011.10523.x
52. Sukakul T, Limphoka P, Boonchai W. Methylchloroisothiazolinone and/or methylisothiazolinone contact allergies in Thailand. Dermatitis. 2021;32:375–80. https://doi.org/10.1097/DER.0000000000000537
53. Ryberg K, Agner T, Andersen KE, Bircher A, Diepgen T, Foti C, et al. Patch testing with a textile dye mix–a multicentre study. Cont Dermatitis. 2014;71:215–23. https://doi.org/10.1111/cod.12244
54. Silverberg JI, Hou A, Warshaw EM, DeKoven JG, Maibach HI, Belsito DV, et al. Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001–2018. J Eur Acad Dermatol Venereol. 2022;86:818–26. https://doi.org/10.1016/j.jaad.2021.07.030