Current Treatment Options in Allergy

, Volume 5, Issue 4, pp 319–332 | Cite as

Scope and Efficacy of Preventive Measures in Contact Dermatitis

  • Jose Hernán AlfonsoEmail author
Contact Dermatitis (A Gimenez-Arnau, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Contact Dermatitis


Purpose of review

To describe the scope and review the efficacy of interventions to prevent contact dermatitis.

Recent findings

Universal measures to prevent contact dermatitis start at the population level with legislation regulating exposure to skin irritants and sensitizers. Primary measures include health education on skin care and protection, use of moisturisers and proper use of protective gloves. The overall epidemiological evidence regarding the efficacy of such preventive measures varies from low to moderate. Secondary prevention comprises the application of specific diagnostic procedures and early intervention. Tertiary prevention measures focus on medical, psychosocial, and occupational rehabilitation of patients with a chronic form. Education on risk factors and skin protection is an essential element at all the levels of prevention.


Evidence-based recommendations and international standards for prevention, diagnosis and management of contact dermatitis are available. The low evidence on the efficacy of several primary measures can be due to limitations in study designs and low comparability of the studies.

Stakeholders should address shortcomings of the current legislation. Randomised control trials studies including a homogenous assessment of the outcome measure, a longer follow-up and better adjustment for potential bias can enhance the current level of evidence for the efficacy of preventive measures.


Primary prevention Secondary prevention Tertiary prevention Occupational Legislation Moisturisers Gloves Legislation 



The author is grateful to Benedicte Mohr, librarian at the National Institute of Occupational Health, Norway (STAMI) for the assistance with the systematic review of the literature.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • GBD 2016. Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–59 Present worldwide measures of occurrence and burden of disease.CrossRefGoogle Scholar
  2. 2.
    • Diepgen TL, Ofenloch RH, Bruze M, Bertuccio P, Cazzaniga S, Coenraads PJ, et al. Prevalence of contact allergy in the general population- prevalence and main findings. Br J Dermatol. 2016;174:312–29 First population-based study to show prevalence figures of contact allergy among several European countries.CrossRefGoogle Scholar
  3. 3.
    • European Agency for Safety and Health at Work. Occupational skin diseases and dermal exposure in the European Union (EU-25): policy and practice review. 2008.Google Scholar
  4. 4.
    Gordon RS Jr. An operational classification of disease prevention. Public Health Rep. 1983;98:107–9.PubMedPubMedCentralGoogle Scholar
  5. 5.
    •• Nicholson PJ, Llewellyn D, English JS, on behalf of the Guidelines Development Group. Evidence-based guidelines for the prevention, identification and management of occupational contact dermatitis and urticaria. Contact Dermatitis. 2010;63:177–86 Evidence-based recommendations for the management of occupational contact dermatitis and urticaria.CrossRefGoogle Scholar
  6. 6.
    •• Alfonso JH, Bauer A, Bensefa-Colas L, Boman A, Bubas M, Constandt L, et al. Minimum standards on prevention, diagnosis and treatment of occupational and work-related skin diseases in Europe. Position paper of the COST Action StanDerm (TD 1206). J Eur Acad Dermatol Venereol. 2017;31:31–43 Consensus-based standards on prevention focusing on the primary, secondary and tertiary prevention of work-related and occupational hand dermatitis. It defines unmet needs for prevention.CrossRefGoogle Scholar
  7. 7.
    Wulfhorts R, John SM, Strunk M. Worker’s protection: gloves and cream. In: Duus Johansen J, Lepoittevin JP, Thyssen JP, editors. Quick guide to contact dermatitis. Berlin: Springer-Verlag; 2016. p. 275–87.CrossRefGoogle Scholar
  8. 8.
    •• Julander A, Boman A, Johanson G, Lidén Carola. Occupational skin exposure to chemicals. Arbete och Hälsa (Work and Health) Scientific Serial. 2018; 52(3). Accessed on 10.07.2018.Gives an overview of the current legislation to reduce occupational skin exposure to chemicals, its shortcomings, methods to assess skin exposure, and recommendations for future research.
  9. 9.
    ECHA. Guidance on the application of the CLP criteria. Guidance to Regulation (EC) No 1272/2008 on classification, labelling and packaging (CLP) of substances and mixtures. Version 5.0 July 2017. Helsinki, Finland: European Chemicals Agency, 2017.Google Scholar
  10. 10.
    European Parliament and Council of the European Union. Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006. 2008R1272 — EN — 01.06.2015 — 005.001 — 1. EN/TXT/PDF/?uri = CELEX:02008R1272–20,150,601&from = E (accessed August 2018). Brussels, Belgium: European Parliament and Council of the European Union, 2015.
  11. 11.
    NIOSH. Current intelligence bulletin 61: a strategy for assigning new NIOSH skin notations. 80 pp. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 2009.Google Scholar
  12. 12.
    European Parliament and the Council of the European Union. Regulation (EC) No 1907/2006 of the European Parliament and of the Council of 18 December 2006 concerning the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH), establishing a European Chemicals Agency, amending Directive 1999/45/EC and repealing Council Regulation (EEC) No 793/93 and Commission Regulation (EC) No 1488/94 as well as Council Directive 76/769/EEC and Commission Directives 91/155/EEC, 93/67/EEC, 93/105/EC and 2000/21/EC. 2006R1907 — EN — 01.06.2015 — 023.001 — 1 (accessed August 2018). Brussels, Belgium: European Parliament and the Council of the European Union, 2015.
  13. 13.
    • Schwensen JF, Bregnbak D, Johansen JD. Recent trends in epidemiology, sensitization and legal requirements of selected relevant contact allergens. Expert Rev Clin Immunol. 2016;12:289–300. Summarise the impact of legislation on the occurrence of sensitization and contact allergy of the most common allergens.CrossRefPubMedGoogle Scholar
  14. 14.
    Bregnbak D, Johansen JD, Jellesen MS, Zachariae C, Menné T, Thyssen JP. Chromium allergy and dermatitis: prevalence and main findings. Contact Dermatitis. 2015;73:261–80.CrossRefGoogle Scholar
  15. 15.
    European Commission. Commission Regulation (EU) No 301/2014 of 25 March 2014 amending Annex XVII to Regulation (EC) No 1907/2006 of the European Parliament and of the Council on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) as regards chromium VI compounds (Text with EEA relevance). Official Journal of the European Union L 90/1, 26.3.2014.Google Scholar
  16. 16.
    Ahlström MG, Thyssen JP, Menné T, Johansen JD. Prevalence of nickel allergy in Europe following the EU Nickel Directive – a review. Contact Dermatitis. 2017;77:193–200. Scholar
  17. 17.
    Svedman C, Andersen KE, Brandao FM, Bruynzeel DP, Diepgen TL, Frosch PJ, et al. Follow-up of the monitored levels of preservative sensitivity in Europe: overview of the years 2001–2008. Contact Dermatitis. 2012;67:312–4.CrossRefGoogle Scholar
  18. 18.
    Schwensen JF, Uter W, Bruze M, Svedman C, Goossens A, Wilkinson M, et al. The epidemic of methylisothiazolinone: a European prospective study. Contact Dermatitis. 2017;76:272–9. Scholar
  19. 19.
    EUR-Lex - 32017R1224 - EN - EUR-Lex [Internet].;toc = OJ%3AL%3A2017%3A174%3ATOC&uri = uriserv%3AOJ.L_.2017.174.01.0016.01.ENG. Accessed August 23, 2018.
  20. 20.
    Flury U, Palmer A, Nixon R. The methylisothiazolinone contact allergy epidemic in Australia. Contact Dermatitis. 2018;79:189–91. Scholar
  21. 21.
    Urwin R, Craig S, Latheef F, Wilkinson M. Methylisothiazolinone: the epidemic is declining—but not gone. Contact Dermatitis. 2017;76:301–2.CrossRefGoogle Scholar
  22. 22.
    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.CrossRefGoogle Scholar
  23. 23.
    Russo JP, Nardelli A, Hinny ML, Consigli C. Frequency of methylisothiazolinone and fragrance-related contact allergy in Argentina: a multicentre study. ESCD Abstracts: Posters. Contact Dermatitis. 2016;75:60–106. Scholar
  24. 24.
    Basketter DA, White IR, Burleson FG, Burleson GR, Kimber I. Dimethylfumarate: potency prediction and clinical experience. Contact Dermatitis. 2013;68:269–72.CrossRefGoogle Scholar
  25. 25.
    European Commission. Commission decision of 17 March 2009 requiring Member States to ensure that products containing the biocide dimethylfumarate are not placed or made available on the market (notified under document number C(2009) 1723) (Text with EEA relevance) (2009/251/EC). Official Journal of the European Communities L 74/32, 20.3.2009.Google Scholar
  26. 26.
    Milanesi N, Bartolini G, Francalanci S, Gola M. Commission Regulation (EU) No. 412/2012: is dimethyl fumarate still present in products imported from countries outside the European Union? J Eur Acad Dermatol Venereol. 2017;31:e246–7.CrossRefGoogle Scholar
  27. 27.
    Montgomery R, Stocks SJ, Wilkinson SM. Contact allergy resulting from the use of acrylate nails is increasing in both users and those who are occupationally exposed. Contact Dermatitis. 2016;74:120–2.CrossRefGoogle Scholar
  28. 28.
    Gonçalo M, Pinho A, Agner T, Andersen KE, Bruze M, Diepgen T, et al. Allergic contact dermatitis caused by nail acrylates in Europe. An EECDRG study. Contact Dermatitis 2018: 78: 254–260. doi: CrossRefGoogle Scholar
  29. 29.
    European Parliament and the Council of the European Union Regulation (EC) No 648/2004 of the European Parliament and of the Council of 31 March 2004 on detergents. 2004R0648 — EN — 19.04.2012 — 006.001 — 1. EN/TXT/PDF/?uri = CELEX:02004R0648–20,120,419&from = EN (accessed August 2018). Brussels, Belgium: European Parliament and the Council of the European Union, 2012.
  30. 30.
    European Parliament and the Council of the European Union. Regulation (EC) No 1223/2009 of the European Parliament and of the Council of 30 November 2009 on cosmetic products (recast). 2009R1223 — EN — 16.04.2015 — 006.001. EN/TXT/HTML/?uri = CELEX:02009R1223–20,150,416&from = EN (accessed October 2017). Brussels, Belgium: European Parliament and the Council of the European Union, 2015.
  31. 31.
    Allmers H, Schmengler J, John SM. Decreasing incidence of occupational contact urticaria caused by natural rubber latex allergy in German health care workers. J Allergy Clin Immunol. 2004;114:347–51.CrossRefGoogle Scholar
  32. 32.
    Bensefa-Colas L, Telle-Lamberton M, Faye S, Bourrain JL, Crépy MN, Lasfargues G, et al. Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P). Br J Dermatol. 2015;173:1453–61.CrossRefGoogle Scholar
  33. 33.
    BAuA. Risks resulting from skin contact - identification, assessment, measures. TRGS 401.Technical rules for hazardous substances. (accessed May 2018). Dortmund, Germany: Committee on Hazardous Substances (AGS), Bundesanstalt für Arbeitsschutz und Arbeitsmedizin (Federal Institute for Occupational Safety and Health), 2011.
  34. 34.
    Friis UF, Menné T, Flyvholm M, Bonde JP, Johansen JD. Difficulties in using material safety data sheets to analyse occupational exposures to contact allergens. Contact Dermatitis. 2015;72:147–53. Scholar
  35. 35.
    Friis UF, Goosens A, Giménez-Arnau AM, Lidén C, Giménez-Arnau E, White IR, et al. Self-testing for contact allergy to hair dyes – a 5-year follow-up multicentre study. Contact Dermatitis. 2018;78:131–8. Scholar
  36. 36.
    •• Bauer A, Rönsch H, Elsner P, Dittmar D, Bennett C, Schuttelaar MLA, et al. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD004414. DOI: Latest systematic review on the efficacy of primary interventions to prevent occupational irritant hand dermatitis.
  37. 37.
    Alfonso JH. Preventive measures for occupationally induced immediate contact reactions. In: Giménez-Arnau A, Maibach H, editors. Contact urticaria syndrome. Updates in Clinical Dermatology. Cham: Springer; 2018.Google Scholar
  38. 38.
    • Crepy MN. Rubber: new allergens and preventive measures. Eur J Dermatol. 2016;26:523–30 An overview of new allergens in rubber gloves and alternatives for patients with allergy to components of rubber gloves.PubMedGoogle Scholar
  39. 39.
    Hamnerius N, Svedman C, Bergendorff O, Björk J, Engfeldt M, Ponten A. Hand eczema and occupational contact allergies in healthcare workers with a focus on rubber additives. Contact Dermatitis. 2018;79:149–56. Scholar
  40. 40.
    Crepy M, Lecuen J, Ratour-Bigot C, Stocks J, Bensefa-Colas L. Accelerator-free gloves as alternatives in cases of glove allergy in healthcare workers. Contact Dermatitis. 2018;78:28–32. Scholar
  41. 41.
    • Tiedemann D, Clausen ML, John SM, Angelova-Fischer I, Kezic S, Agner T. Effect of glove occlusion on the skin barrier. Contact Dermatitis. 2016;74:2–10 A review focusing on the mechanisms and effects of glove occlusion on the skin barrier.CrossRefGoogle Scholar
  42. 42.
    •• Jacobsen G, Carstensen O, Rasmussen K, Bregnhøj A. Review of causes of irritant (toxic) contact eczema after occupational skin exposure. The Danish Working Environmental Research Fund 2018 Available: Last access: 11.09.2018. A systematic review on causative agents of irritant contact dermatitis due to skin exposures at work.
  43. 43.
    Oreskov KW, Søsted H, Johansen JD. Glove use among hairdressers: difficulties in the correct use of gloves among hairdressers and the effect of education. Contact Dermatitis. 2015;72:362–6.CrossRefGoogle Scholar
  44. 44.
    Suleiman AM. Assessment of suitability of disposable gloves for handling of cleaning chemicals with extreme pH values. Saf Sci. 2018; In press.Google Scholar
  45. 45.
    • Lachapelle JM, Gimenez-Arnau A, Metz M, Peters J, Proksch E. Best practices, new perspectives and the perfect emollient: optimising the management of contact dermatitis. J Dermatolog Treat. 2018;29:241–51. Review the importance of emollients in both primary and secondary prevention of contact dermatitis. Gives perspectives for future research for the “ideal” emollient.CrossRefPubMedGoogle Scholar
  46. 46.
    Saary J, Qureshi R, Palda V, DeKoven J, Pratt M, Skotnicki-Grant S, et al. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol. 2005;53:845–55.CrossRefGoogle Scholar
  47. 47.
    Arbogast JW, Fendler EJ, Hammond BS, Cartner TJ, Dolan MD, Ali Y, Maibach HI. Effectiveness of a hand care regimen with moisturiser in manufacturing facilities where workers are prone to occupational irritant dermatitis. Dermatitis 2004:15:10–17.Google Scholar
  48. 48.
    • Hines J, Wilkinson SM, John SM, Diepgen T, English J, Rustemeyer T, et al. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol. 2017;31:53–64 Suggest a practical model for use of moisturisers in the workplace based on current evidence of mechanisms and prevention.CrossRefGoogle Scholar
  49. 49.
    Hald M, Agner T, Blands J, Johansen J, Danish Contact Dermatitis Group. Delay in medical attention to hand eczema: a follow-up study. Br J Dermatol. 2009;161:1294–300. Scholar
  50. 50.
    Adisesh A, Meyer JD, Cherry NM. Prognosis and work absence due to occupational contact dermatitis. Contact Dermatitis. 2002;46:273–9. Scholar
  51. 51.
    •• Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing—recommendations on best practice. Contact Dermatitis. 2015;73:195–221 An essential guideline for the diagnosis of allergic contact dermatitis.CrossRefGoogle Scholar
  52. 52.
    Bruze M. What is a relevant contact allergy? Contact Dermatitis. 1990;23:224–5.CrossRefGoogle Scholar
  53. 53.
    Lachapelle JM. A proposed relevance scoring system for positive allergic patch test reactions: practical implications and limitations. Contact Dermatitis. 1997;36:39–43.CrossRefGoogle Scholar
  54. 54.
    Fransway AF, Zug KA, Belsito DV, Deleo A, Fowler JF Jr., Maibach HI, et al. North American Contact Dermatitis Group patch test results for 2007–2008. Dermatitis 2013: 24: 10–21. doi: CrossRefGoogle Scholar
  55. 55.
    Uter W, Bauer A, Bensefa-Colas L, Brans R, Crepy MN, Gimenez-Arnau A, et al. Pilot study on a new concept of documenting the clinical relevance of patch test results in contact dermatitis patients. Contact Dermatitis. 2018:1–8. Scholar
  56. 56.
    • Mathias CG. Contact dermatitis and workers’ compensation: criteria for establishing occupational causation and aggravation. J Am Acad Dermatol. 1989;20:842–8 A useful proposal for clinicians to assess whether exposures at work cause or worsen a skin disease.CrossRefGoogle Scholar
  57. 57.
    Uter W, Bauer A, Bensefa-Colas L, et al. Extended documentation for hand dermatitis patients: pilot study on irritant exposures. Contact Dermatitis. 2018;79:168–74. Scholar
  58. 58.
    •• Diepgen TL, Andersen KE, Chosidow O, Coenraads PJ, Elsner P, English J, et al. Guidelines for diagnosis, prevention and treatment of hand eczema–short version. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG 2015: 13:77–85. An essential guideline for the medical treatment of hand dermatitis.Google Scholar
  59. 59.
    Luger T, Loske KD, Elsner P, Kapp A, Kerscher M, Korting HC, et al. Topical skin therapy with glucocorticoids–therapeutic index. J Dtsch Dermatol Ges. 2004;2:629–34.CrossRefGoogle Scholar
  60. 60.
    •• van Zuuren EJ, Fedorowicz Z, Christensen R, Lavrijsen APM, Arents BWM. Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews 2017: Issue 2. Art. No.: CD012119. DOI:
  61. 61.
    Mason JM, Carr J, Buckley C, Hewitt S, Berry P, Taylor J, et al. Improved emollient use reduces atopic eczema symptoms and is cost neutral in infants: before-and-after evaluation of a multifaceted educational support programme. BMC Dermatol. 2013;7:13.Google Scholar
  62. 62.
    Oakley R, Lawton S. Views on unwanted effects of leave-on emollients and experiences surrounding their incidence. Dermatol Nurs. 2016;15:38–43.Google Scholar
  63. 63.
    Balieva F, Kupfer J, Lien L, Gieler U, Finlay A, Tomás-Aragonés L, et al. The burden of common skin diseases assessed with the EQ5D™: a European multicentre study in 13 countries. Br J Dermatol. 2017;176:1170–8. Scholar
  64. 64.
    Breuer K, John SM, Finkeldey F, Boehm D, Skudlik C, Wulfhorst B, et al. Tertiary individual prevention improves mental health in patients with severe occupational hand eczema. J Eur Acad Dermatol Venereol. 2015;29:1724–31.CrossRefGoogle Scholar
  65. 65.
    • Skudlik C, Wulfhorst B, Gediga G, Bock M, Allmers H, John SM. Tertiary individual prevention of occupational skin diseases: a decade’s experience with recalcitrant occupational dermatitis. Int Arch Occup Environ Health 2008: 81: 1059–1064. A clinical model with interventions for medical, psychosocial and occupational rehabilitation of occupational chronic dermatitis.CrossRefGoogle Scholar
  66. 66.
    Mahler V, Aalto-Korte K, Alfonso JH, Bakker JG, Bauer A, Bensefa-Colas L, et al. Occupational skin diseases: actual state analysis of patient management pathways in 28 European countries. J Eur Acad Dermatol Venereol. 2017;31(Suppl. 4):12–30. Scholar
  67. 67.
    Wilke A, Bollmann U, Cazzaniga S, Hübner A, John SM, Karadzinska-Bislimovska J, et al. The implementation of knowledge dissemination in the prevention of occupational skin diseases. J Eur Acad Dermatol Venereol. 2018;(3):449–58. CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Occupational Medicine and EpidemiologyNational Institute of Occupational HealthOsloNorway

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