Allergic Contact Dermatitis: Therapeutic Management
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Purpose of Review
Allergic contact dermatitis (ACD) is a common condition and may entail negative impacts on people’s quality of life along with a substantial economic burden. Appropriately managing it through patient education, allergen avoidance, and symptomatic treatment is crucial for its resolution. Our review aims to establish a practical approach to ACD management, based on a comprehensive discussion of available therapeutic options for ACD, a review of the latest findings in this field, and personal insights from our clinical practice experience.
Topical treatments constitute the first-line therapy for ACD. Randomized clinical trials have shown topical corticosteroids to improve clinical and nonclinical outcomes, while tacrolimus has proven effective and safe. Evidence is lacking for oral corticosteroids in ACD sufferers, so recommendations for its use are primarily based on results obtained in dermatitis of other etiologies. In contrast, some studies have assessed azathioprine and phototherapy for ACD.
Patient education and allergen avoidance are paramount for managing ACD. However, individualized symptomatic treatment is warranted in several clinical situations. Although these treatments are widely used in clinical practice, few studies support their use for ACD. Further research is needed.
KeywordsAllergen avoidance Allergic contact dermatitis Allergic dermatitis Therapeutic management Treatment Therapy Management
Compliance with Ethical Standards
Conflict of Interest
Inés Poveda-Montoyo declares that he has no conflict of interest. P. J. Álvarez-Chinchilla declares that he has no conflict of interest. J. F. Silvestre declares that he has no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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- 9.•• Johnston GA, Exton LS, Mohd Mustapa MF, Slack JA, Coulson IH, English JS, et al. British Association of Dermatologists’ guidelines for the management of contact dermatitis. Br J Dermatol. 2017;176:317–29. Guidelines providing up-to-date and evidence-based recommendations for the management of contact dermatitis.CrossRefPubMedGoogle Scholar
- 13.González de Domingo MA, Conde-Salazar Gomez L: Tratamiento de las dermatosis laborales. In: Conde-Salazar L, Ancona-Alayón A editors. Dermatología profesional. Aula Médica;2004.Google Scholar
- 18.Diepgen TL, Elsner P, Schliemann S, Fartasch M, Köllner A, Skudlik C, et al. Guideline on the management of hand eczema ICD-10 Code: L20. L23. L24. L25. L30. J Dtsch Dermatol Ges J Ger SocDermatol JDDG. 2009;7(Suppl 3):S1–16.Google Scholar
- 19.•• De León FJ, Berbegal L, Silvestre JF. Abordaje terapéutico en el eczema crónico de manos. Actas Dermosifilogr. 2015;106:533–44. A thorough review of the management of chronic hand eczema, including the allergic etiology. Practical recommendations about prevention and treatment are provided in this manuscript.CrossRefGoogle Scholar
- 22.•• Brasch J, Becker D, Aberer W, Bircher A, Kränke B, Jung K, et al. Guideline contact dermatitis. S1-Guideline of the German Contact Allergy Group (DKG) of the German Dermatology Society (DDG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo J Int. 2014;23:126–38. Guidelines describing the diagnosis and therapeutic and interventional approaches of contact dermatitis based on the latest scientific evidence.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Quielle-Roussel C, Duteil L, Padilla JM, Poncet M, Czernielewski J. Objective assessment of topical anti-inflammatory drug activity on experimentally induced nickel contact dermatitis: comparison between visual scoring, colorimetry, laser Doppler velocimetry and transepidermal water loss. Skin Pharmacol. 1990;3:248–55.CrossRefGoogle Scholar
- 35.Alomar A, Puig L, Gallardo CM, Valenzuela N. Topical tacrolimus 0.1% ointment (protopic) reverses nickel contact dermatitis elicited by allergen challenge to a similar degree to mometasone furoate 0.1% with greater suppression of late erythema. Contact Dermatitis. 2003;49:185–8.CrossRefPubMedGoogle Scholar
- 38.Gupta AK, Chow M. Pimecrolimus: a review. J Eur Acad Dermatol Venereol. 2003;17:500.Google Scholar
- 42.Rietschel RL, Fowler JF. Fisher’s contact dermatitis. Lippincott Williams Wilkins. Philadelphia. 2001:715–21.Google Scholar
- 47.Ruzicka T, Lynde CW, Jemec GBE, Diepgen T, Berth-Jones J, Coenraads PJ, et al. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: Results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008;158:808–17.CrossRefPubMedGoogle Scholar
- 50.Piguet PF, Grau GE, Hauser C, Vassalli P. TNF is a critical mediator in hapten-induced irritant and contact hypersensitivity reactions. J Exp Med. 1991:173–673-9.Google Scholar
- 54.• Berbegal L, DeLeón FJ, Silvestre JF. Hypersensitivity reactions to corticosteroids. Actas Dermosifiliogr. 2015;106:816–22. Useful manuscript detailing patients’ profiles and management of corticosteroids allergy, a potential complication present in allergic contact dermatitis.CrossRefPubMedGoogle Scholar
- 58.• DeKoven JG, Warshaw EM, Belsito DV, Sasseville D, Maibach HI, Taylor JS, et al. North American Contact Dermatitis Group Patch Test Results 2013–2014. Dermatitis. 2017;28:33–46. Study showing the latest patch testing results in North America. This manuscript identifies the most prevalent allergens and also presents the rate of occupational contact dermatitis.CrossRefPubMedGoogle Scholar
- 59.• Pesonen M, Jolanki R, Larese Filon F, Wilkinson M, Kręcisz B, Kieć-Świerczyńska M, et al. Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe - analyses of the European Surveillance System on Contact Allergy network, 2002–2010. Contact Dermatitis. 2015;72:154–63. Study presenting the latest results of prevalence and most frequent allergens in occupational allergic contact dermatitis in European population.CrossRefPubMedGoogle Scholar
- 61.Weisshaar E, Skudlik C, Scheidt R, Matterne U, Wulfhorst B, Schönfeld M, et al. Multicentre study “rehabilitation of occupational skin diseases -optimization and quality assurance of inpatient management (ROQ)”-Results from 12-month follow-up. Contact Dermatitis. 2013;68:169–74.CrossRefPubMedGoogle Scholar
- 63.•Uter W, Amario-Hita JC, 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;31:1516–1525. A recent study presenting the most prevalent allergens after patch testing in European population. Google Scholar
- 69.• Consuegra-Romero G, Castro-Gutiérrez B, González-López MA. Photoallergic contact dermatitis. Eur J Intern Med. 2017;38:e4–5. Interesting case report and review of photoallergic contact dermatitis, a special type of allergic contact dermatitis that should be taken into accountCrossRefPubMedGoogle Scholar