Assessment and Clinical Management of Patients With Atopic Dermatitis Undergoing Patch Testing: Recommendations From an International Electronic Delphi Consensus

BACKGROUND: Individuals with atopic dermatitis (AD) may be referred for patch testing to rule out allergic contact dermatitis (ACD). While past expert consensus outlines when and how to patch test these patients, clinical management and measurement of meaningful clinical improvement is particularly challenging in this population. OBJECTIVE: To develop practical clinical recommendations in the assessment and management of patients with AD undergoing patch testing. METHODS: An international modified electronic (e)Delphi consensus exercise was conducted among 18 AD and ACD experts. RESULTS: Following 4 rounds, a total of 21/24 (87.5%) clinical management statements and 15/18 (83.3%) clinical assessment statements reached consensus. Avoidance of cutaneous sources of allergens with positive (+, ++, and +++) and doubtful (+/-) reactions, use of hyporeactive products, and strict adherence to a "safe products list" of allergen-free products were recommended. Follow-up at approximately 3 months with assessment via both (1) patient-reported outcomes (PRO) and (2) clinician-reported outcomes (ClinRO) validated measurement tools were recommended to guide therapeutic decision-making. CONCLUSION: This eDelphi exercise establishes clear recommendations to manage, evaluate, and further treat patients with AD following patch testing.