Taking assessment and documentation of clinical relevance one step further:a suggestion to improve individual documentation and epidemiological usability

BACKGROUND: Full assessment of patients with (occupational) contact dermatitis should ideally include a standardized investigation of irritant exposures in addition to information pertaining to possible allergy guiding the selection of allergens (haptens) to be tested. Positive results of skin tests, performed according to current guidelines, are evaluated in terms of their clinical relevance. However, such diagnostic information is hitherto ill-represented in clinical documentation systems (patch test software) serving departmental documentation needs, and also in surveillance registries based upon these. OBJECTIVES: To develop, implement as a pilot study, and analyse concerning feasibility and contents a new concept of representing a full scope of diagnostic information utilized when diagnosing patients with (occupational) contact dermatitis. METHODS: Based on a European working group discussion on items to document and catalogue lists to use for this purpose, an online documentation system to collect data was set up, followed by a pilot use involving 9 dermatology departments across Europe. RESULTS: Data on 176 patients with suspected occupational hand dermatitis were included. Data were analysed with regard to occupations, product categories, substances (haptens), source of information the evaluation was based upon, and various combinations of these factors, to illustrate the usefulness of the proposed data representation. CONCLUSIONS: An improved method of data collection is presented which more accurately links allergen to exposure and to clinical disease and patient history, and thus better represents clinical relevance. This enables more precise analysis of causation of contact dermatitis, occupational or non-occupational, and thereby better targeting of prevention on an individual basis. In addition to the benefits for individual documentation, the surveillance of contact dermatitis is expected to be enhanced by the suggested concept, allowing a more in-depth investigation of profiles of patients at risk for certain allergies, while still serving other well-proven purposes, eg time trend analyses