Prognosis of Irritant Contact Dermatitis

  • Peter ElsnerEmail author
  • Kaija Lammintausta
Reference work entry


Acute irritant contact dermatitis heals if exposure is excluded.

Chronic irritant contact dermatitis is caused by chronic exposure, and multiple factors are contributing to the prognosis.

Hand dermatitis is often multifactorial thus making it difficult to judge the prognosis of irritant dermatitis as a single factor.

A history of atopic dermatitis is an apparent negative prognostic factor.

Concurrent contact sensitivities seem to decrease chances for healing of a chronic irritant contact dermatitis.

Patient guidance and education are crucial for a favorable prognosis.


Irritant dermatitis Prognosis Hand dermatitis 


  1. Agner T, Andersen KE, Brandao FM et al (2008) Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients. Contact Dermatitis 59:43–47PubMedCrossRefGoogle Scholar
  2. Apfelbacher CJ, Soder S, Diepgen TL, Weisshaar E (2009) The impact of measures for secondary individual prevention of work-related skin diseases in health care workers: 1-year follow-up study. Contact Dermatitis 60:144–149PubMedCrossRefGoogle Scholar
  3. Bock M, Schmidt A, Bruckner T et al (2003) Occupational skin disease in the construction industry. Br J Dermatol 149:1165–1171PubMedCrossRefGoogle Scholar
  4. Bourke J, Coulson I, English J (2009) Guidelines for the management of contact dermatitis: an update. Br J Dermatol 160:946–954PubMedCrossRefGoogle Scholar
  5. Brans R, Skudlik C, Weisshaar E, Scheidt R, Ofenloch R, Elsner P, Wulfhorst B, Schönfeld M, John SM, Diepgen TL (2016) ROQ study group. Multicentre cohort study ‘Rehabilitation of occupational skin diseases – optimization and quality Assurance of Inpatient Management (ROQ)’: results from a 3-year follow-up. Contact Dermatitis 75(4):205–212PubMedCrossRefGoogle Scholar
  6. Bryld LE, Hindsberger C, Kyvik KO et al (2003) Risk factors influencing the development of hand eczema in a population-based twin sample. Br J Dermatol 149:1214–1220PubMedCrossRefGoogle Scholar
  7. Carlsen BC, Menne T, Johansen JD (2007) Twenty years of standard patch testing in an eczema population with focus on patients with multiple contact allergies. Contact Dermatitis 57:76–83PubMedCrossRefGoogle Scholar
  8. Carlsen BC, Andersen KE, Menné T et al (2009) Sites of dermatitis in a patch test population: hand dermatitis is associated with polysensitization. Br J Dermatol 161:808–813PubMedCrossRefGoogle Scholar
  9. Cork MJ, Danby SG, Vasilopoulos Y et al (2009) Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol 129:1892–1908PubMedCrossRefGoogle Scholar
  10. Cvetkovski RS, Rothman KJ, Olsen J et al (2005) Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol 152:93–98PubMedCrossRefGoogle Scholar
  11. Cvetkovski RS, Zachariae R, Jensen H et al (2006) Prognosis of occupational hand eczema: a follow-up study. Arch Dermatol 142:305–311PubMedCrossRefGoogle Scholar
  12. Darr-Foit S, Tittelbach J, Elsner P (2014) Posttraumatic irritant contact dermatitis – an underdiagnosed entity? J Dtsch Dermatol Ges 12(4):347–348PubMedGoogle Scholar
  13. de Groot AC, Flyvholm MA, Lensen G, Menné T, Coenraads PJ (2009) Formaldehyde-releasers: relationship to formaldehyde contact allergy. Contact allergy to formaldehyde and inventory of formaldehyde-releasers. Contact Dermatitis 61:63–85PubMedCrossRefGoogle Scholar
  14. de Jongh CM, Khrenova L, Verberk MM et al (2008) Loss-of-function polymorphisms in the filaggrin gene are associated with an increased susceptibility to chronic irritant contact dermatitis: a case–control study. Br J Dermatol 159:621–627PubMedCrossRefGoogle Scholar
  15. Dickel H, Bruckner TM, Schmidt A et al (2003) Impact of atopic skin diathesis on occupational skin disease incidence in a working population. J Invest Dermatol 121:37–40PubMedCrossRefGoogle Scholar
  16. Diepgen TL, Andersen KE, Brandao FM et al (2009) Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema. Br J Dermatol 160:353–358PubMedCrossRefGoogle Scholar
  17. ESSCA Writing Group The European Surveillance System of Contact Allergies (ESSCA) (2008) Results of patch testing the standard series, 2004. J Eur Acad Dermatol Venereol 22:174–181Google Scholar
  18. Fluhr JW, Praessler J, Akengin A et al (2005a) Air flow at different temperatures increases sodium lauryl sulphate-induced barrier disruption and irritation in vivo. Br J Dermatol 152:1228–1234PubMedCrossRefGoogle Scholar
  19. Fluhr JW, Akengin A, Bornkessel A, Fuchs S, Praessler J, Norgauer J, Grieshaber R, Kleesz P, Elsner P (2005b) Additive impairment of the barrier function by mechanical irritation, occlusion and sodium lauryl sulphate in vivo. Br J Dermatol 153(1):125–131PubMedCrossRefGoogle Scholar
  20. Foureur N, Vanzo B, Meaume S et al (2006) Prospective aetiological study of diaper dermatitis in the elderly. Br J Dermatol 155:941–946PubMedCrossRefGoogle Scholar
  21. Fowler JF, Ghosh A, Sung J et al (2006) Impact of chronic hand dermatitis on quality of life, work productivity, activity impairment, and medical costs. J Am Acad Dermatol 54:448–457PubMedCrossRefGoogle Scholar
  22. Fregert S (1975) Occupational dermatitis in a 10-year material. Contact Dermatitis 1:96–107PubMedCrossRefGoogle Scholar
  23. Garg S, McDonagh AJ, Gawkrodger DJ (2009) Age- and sex-related variations in allergic contact dermatitis to common allergens. Contact Dermatitis 61:46–47PubMedCrossRefGoogle Scholar
  24. Hald M, Agner T, Blands J et al (2009a) Clinical severity and prognosis of hand eczema. Br J Dermatol 160:1229–1236PubMedCrossRefGoogle Scholar
  25. Hald M, Agner T, Blands J et al (2009b) Allergens associated with severe symptoms of hand eczema and a poor prognosis. Contact Dermatitis 61:101–108PubMedCrossRefGoogle Scholar
  26. Hald M, Agner T, Blands J et al (2009c) Delay in medical attention to hand eczema: a follow-up study. Br J Dermatol 161:1294–1300PubMedCrossRefGoogle Scholar
  27. Haslund P, Bangsgaard N, Jarløv JO et al (2009) Staphylococcus aureus and hand eczema severity. Br J Dermatol 161:772–777PubMedCrossRefGoogle Scholar
  28. Heinemann C, Paschold C, Fluhr J, Wigger-Alberti W, Schliemann-Willers S, Farwanah H, Raith K, Neubert R, Elsner P (2005) Induction of a hardening phenomenon by repeated application of SLS: analysis of lipid changes in the stratum corneum. Acta Derm Venereol 85(4):290–295PubMedCrossRefGoogle Scholar
  29. Held E, Skoet R, Johansen JD et al (2005) The hand eczema severity index (HECSI): a scoring system for clinical assessment of hand eczema. A study of inter- and intraobserver reliability. Br J Dermatol 152:302–307PubMedCrossRefGoogle Scholar
  30. Jensen JM, Pfeiffer S, Witt M et al (2009) Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis. J Allergy Clin Immunol 124((Suppl 2)):R19–R28PubMedCrossRefGoogle Scholar
  31. Johansen J, Menné T, Christophersen J et al (2000) Changes in the pattern of sensitization to common contact allergens in Denmark between 1985–86 and 1997–98, with a special view to the effect of preventive strategies. Br J Dermatol 142:490–495PubMedCrossRefGoogle Scholar
  32. Jungbauer FH, van der Vleuten P, Groothoff JW et al (2004) Irritant hand dermatitis: severity of disease, occupational exposure to skin irritants and preventive measures 5 years after initial diagnosis. Contact Dermatitis 50:245–251PubMedCrossRefGoogle Scholar
  33. Keczkes K, Bhate SM, Wyatt EH (1983) The outcome of primary irritant hand dermatitis. Br J Dermatol 109:665–668PubMedCrossRefGoogle Scholar
  34. Kolbe L, Kligman AM, Schreiner V, Stoudemayer T (2001) Corticosteroid-induced atrophy and barrier impairment measured by non-invasive methods in human skin. Skin Res Technol 7(2):73–77PubMedCrossRefGoogle Scholar
  35. Lammintausta K, Kalimo K (1981) Atopy and hand dermatitis in hospital wet work. Contact Dermatitis 7:301–308PubMedCrossRefGoogle Scholar
  36. Lammintausta K, Kalimo K, Aantaa S (1982) Course of hand dermatitis in hospital workers. Contact Dermatitis 8:327–332PubMedCrossRefGoogle Scholar
  37. Lerbaek A, Kyvik KO, Ravn H et al (2008) Clinical characteristics and consequences of hand eczema – an 8-year follow-up study of a population-based twin cohort. Contact Dermatitis 58:210–216PubMedCrossRefGoogle Scholar
  38. Li LF, Liu G, Wang J (2008) Prognosis of unclassified eczema: a follow-up study. Arch Dermatol 144:160–164PubMedCrossRefGoogle Scholar
  39. Lips R, Rast H, Elsner P (1996) Outcome of job change in patients with occupational chromate dermatitis. Contact Dermatitis 34:268–271PubMedCrossRefGoogle Scholar
  40. Mälkönen T, Jolanki R, Alanko K et al (2009) A 6-month follow-up study of 1048 patients diagnosed with an occupational skin disease. Contact Dermatitis 61:261–268CrossRefGoogle Scholar
  41. McMullen E, Gawkrodger DJ (2006) Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis. Br J Dermatol 154:154–156PubMedCrossRefGoogle Scholar
  42. Meding B (1990) Epidemiology of hand eczema in an industrial city. Acta Derm Venereol Suppl (Stockh) 153:1–43Google Scholar
  43. Meding B (2000) Differences between the sexes with regard to work-related skin disease. Contact Dermatitis 43:65–71PubMedCrossRefGoogle Scholar
  44. Meding B, Swanbeck G (1990) Predictive factors for hand eczema. Contact Dermatitis 23:154–161PubMedCrossRefGoogle Scholar
  45. Meding B, Wrangsjö K, Järvholm B (2005a) Fifteen-year follow-up of hand eczema: persistence and consequences. Br J Dermatol 152:975–980PubMedCrossRefGoogle Scholar
  46. Meding B, Wrangsjö K, Järvholm B (2005b) Fifteen-year follow-up of hand eczema: predictive factors. J Invest Dermatol 124:893–897PubMedCrossRefGoogle Scholar
  47. Meding B, Wrangsjö K, Järvholm B (2007) Hand eczema extent and morphology-association and influence on long-term prognosis. J Invest Dermatol 127:2147–2151PubMedCrossRefGoogle Scholar
  48. Molin S, Vollmer S, Weiss EH et al (2009) Filaggrin mutations may confer susceptibility to chronic hand eczema characterized by combined allergic and irritant contact dermatitis. Br J Dermatol 161:801–807PubMedCrossRefGoogle Scholar
  49. Nielsen TK, Kragholm K, Odgaard A et al (2009) Recurrent cyclic hyperkeratotic eczema after occupational alkali burn: traumatic chronic irritant dermatitis. Contact Dermatitis 60:345–346PubMedCrossRefGoogle Scholar
  50. Nybaek H, Lophagen S, Karlsmark T et al (2010) Stratum corneum integrity as a predictor for peristomal skin problems in ostomates. Br J Dermatol 162(2):357–361PubMedCrossRefGoogle Scholar
  51. O’Regan GM, Sandilands A, McLean WH et al (2008) Filaggrin in atopic dermatitis. J Allergy Clin Immunol 122:689–693PubMedCrossRefGoogle Scholar
  52. Pryce DW, Irvine D, English JSC et al (1989) Soluble oil dermatitis: a follow-up study. Contact Dermatitis 21:28–35PubMedCrossRefGoogle Scholar
  53. Rebandel P, Rudzki E (2002) Re-patch testing patients with long-term contact dermatitis. Contact Dermatitis 47:234PubMedCrossRefGoogle Scholar
  54. Rusca C, Hinnen U, Elsner P (1997) Patient’s delay’ – analysis of the preclinical phase of occupational dermatoses. Dermatology 194(1):50–52PubMedCrossRefGoogle Scholar
  55. Ruzicka T, Lynde CW, Jemec GB et al (2008) 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 158:808–817PubMedCrossRefGoogle Scholar
  56. Rystedt I (1985a) Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood. Contact Dermatitis 12:185–191PubMedCrossRefGoogle Scholar
  57. Rystedt I (1985b) Contact sensitivity in adults with atopic dermatitis in childhood. Contact Dermatitis 13:1–8PubMedCrossRefGoogle Scholar
  58. Schliemann S, Kelterer D, Bauer A et al (2008) Tacrolimus ointment in the treatment of occupationally induced chronic hand dermatitis. Contact Dermatitis 58:299–306PubMedCrossRefGoogle Scholar
  59. Seyfarth F, Schliemann S, Antonov D, Elsner P (2011a) Dry skin, barrier function, and irritant contact dermatitis in the elderly. Clin Dermatol 29(1):31–36PubMedCrossRefGoogle Scholar
  60. Seyfarth F, Schliemann S, Antonov D, Elsner P (2011b) Teaching interventions in contact dermatitis. Dermatitis 22(1):8–15PubMedCrossRefGoogle Scholar
  61. Skoet R, Olsen J, Mathiesen B et al (2004) A survey of occupational hand eczema in Denmark. Contact Dermatitis 51:159–166PubMedCrossRefGoogle Scholar
  62. Storm A, Benfeldt E, Andersen SE et al (2008) A prospective study of patient adherence to topical treatments: 95% of patients underdose. J Am Acad Dermatol 59:975–980PubMedCrossRefGoogle Scholar
  63. Susitaival P, Hannuksela M (1995) The 12-year prognosis of hand dermatosis in 896 Finnish farmers. Contact Dermatitis 32:233–237PubMedCrossRefGoogle Scholar
  64. Thyssen JP, Linneberg A, Menné T et al (2007) The epidemiology of contact allergy in the general population–prevalence and main findings. Contact Dermatitis 57:287–299PubMedCrossRefGoogle Scholar
  65. Turner S, Carder M, van Tongeren M et al (2007) The incidence of occupational skin disease as reported to the health and occupation reporting (THOR) network between 2002 and 2005. Br J Dermatol 157:713–722PubMedCrossRefGoogle Scholar
  66. Uter W, Gefeller O, Schwanitz HJ (1998) An epidemiological study of the influence of season (cold and dry air) on the occurrence of irritant skin changes of the hands. Br J Dermatol 138:266–272PubMedCrossRefGoogle Scholar
  67. Uter W, Hegewald J, Kränke B, Schnuch A, Gefeller O, Pfahlberg A (2008) The impact of meteorological conditions on patch test results with 12 standard series allergens (fragrances, biocides, topical ingredients). Br J Dermatol 158:734–739PubMedCrossRefGoogle Scholar
  68. Veien NK, Olholm Larsen P et al (1999) Long term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol 140:882–886PubMedCrossRefGoogle Scholar
  69. Veien NK, Hattel T, Laurberg G (2008) Hand eczema: causes, course, and prognosis I. Contact Dermatitis 58:330–334PubMedCrossRefGoogle Scholar
  70. Wall LM, Gebauer KA (1991) A follow-up study of occupational skin disease in Western Australia. Contact Dermatitis 24:241–243PubMedCrossRefGoogle Scholar
  71. Watkins SA, Maibach HI (2009) The hardening phenomenon in irritant contact dermatitis: an interpretative update. Contact Dermatitis 60:123–130PubMedCrossRefGoogle Scholar
  72. Weistenhöfer W, Baumeister T, Drexler H et al (2010) An overview of skin scores used for quantifying hand eczema: a critical update according to the criteria of evidence-based medicine. Br J Dermatol 162(2):239–250PubMedCrossRefGoogle Scholar
  73. Wigger-Alberti W, Krebs A, Elsner P (2000) Experimental irritant contact dermatitis due to cumulative epicutaneous exposure to sodium lauryl sulphate and toluene: single and concurrent application. Br J Dermatol 143:551–556PubMedCrossRefGoogle Scholar
  74. Zug KA, Kornik R, Belsito DV et al (2008) North American contact dermatitis group. Patch-testing North American lip dermatitis patients: data from the North American contact dermatitis group, 2001 to 2004. Dermatitis 19:202–208PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of DermatologyUniversity Hospital JenaJenaGermany
  2. 2.Department of DermatologyTurku University HospitalTurkuFinland

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