Patch Testing and Psychosocial Burden in Adults With Facial Dermatitis: A Cross-Sectional Observational Study

Background Facial dermatitis is a common inflammatory dermatosis with multifactorial etiology and occurs due to repeated exposure to cosmetic, environmental, and occupational triggers. Because of its visible nature and chronic relapsing course, it may substantially impair psychosocial well-being and quality of life.  Objective The primary objective was to study the clinical profile of patients with facial dermatitis and identify clinically relevant contact allergens. Secondary objectives were to assess psychosocial burden using the Skindex-16 questionnaire, evaluate its association with relevant clinical features, and explore associations between patch-test positivity and socio-demographic and clinical factors. Methodology This tertiary hospital-based cross-sectional observational study included 50 adults with facial dermatitis attending the dermatology outpatient department at Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, India. Detailed exposure history and clinical evaluation were followed by patch testing with the Contact and Occupational Dermatoses Forum of India (CODFI)-approved Indian Standard Battery, Cosmetic Series, and Fragrance Series. Reactions were interpreted according to International Contact Dermatitis Research Group criteria, and clinical relevance was assessed using the C=Current Relevance, O=Occupational, A=Accidental, D=Doubtful Relevance, E=Exposed, X=Unknown (COADEX) system. Psychosocial burden was evaluated using the Skindex-16 questionnaire. Results Of the 50 participants, 37 (74%) were female, and the most common age group was 31-40 years (40%). Disease duration of more than six months was present in 32 (64%) patients. Cheeks (84%), forehead (76%), and eyelids (68%) were the most frequently involved sites. Pruritus was reported by all patients. Sun exposure (92%), heat/sweating (56%), seasonal variation (54%), and hair-dye exposure (50%) were common aggravating factors. Positive patch-test reactions were observed in 12 (24%) patients, with 15 reactions involving nine distinct allergens. Paraphenylenediamine was the most frequent allergen (26.7%), followed by benzyl alcohol, benzyl salicylate, and bronopol (13.3% each). 8/9 distinct allergen types (88.9%) were classified as having cosmetic/topical relevance as per COADEX. Patch-test positivity was significantly associated with hyperpigmentation, hair-dye use, and history of atopy (p < 0.001, p = 0.002, and p = 0.023, respectively). The mean total Skindex-16 score was 39.4 ± 18.7, with the emotional domain showing the highest mean score (18.8 ± 8.9). Patch-test-positive patients had significantly higher Skindex-16 scores than patch-test-negative patients (median 69 vs. 34, p < 0.001). Patients with hyperpigmentation also had significantly higher total Skindex-16 scores (60.7 ± 14.7 vs. 28.4 ± 8.0, p < 0.001). Conclusion Patch testing is a useful diagnostic tool in facial dermatitis for identifying clinically relevant allergens, particularly those related to cosmetics and hair dye exposure. Facial dermatitis was also associated with substantial psychosocial burden, especially in the emotional domain. Comprehensive management should therefore include allergen identification, avoidance counselling, and psychosocial support. A comprehensive approach incorporating detailed clinical evaluation, exposure history, patch testing, allergen avoidance counselling, and psychosocial support may help optimize patient management.