From the Guidelines
Allergic contact dermatitis is commoner in individuals with a history of atopic dermatitis, occupational exposure to chemicals, or genetic predisposition, and management options include identifying and avoiding the triggering allergen through patch testing, topical corticosteroids, and prevention strategies. The risk factors for allergic contact dermatitis include frequent exposure to common allergens like nickel, fragrances, preservatives, and rubber compounds, as well as having a history of atopic dermatitis, occupational exposure to chemicals, or genetic predisposition 1. Management begins with identifying and avoiding the triggering allergen through patch testing, which is recommended for patients with chronic or persistent dermatitis, as clinical features alone are unreliable in distinguishing allergic contact from irritant and endogenous dermatitis 1. For acute symptoms, topical corticosteroids are the mainstay treatment, with options ranging from low-potency hydrocortisone 1% for mild cases to high-potency fluocinonide 0.05% for severe cases, applied twice daily for 1-2 weeks 1. Calcineurin inhibitors like tacrolimus 0.1% ointment can be used for sensitive areas like the face, and oral antihistamines such as cetirizine 10mg daily may help with itching, while severe or widespread cases might require oral corticosteroids like prednisone 40-60mg daily for 5-7 days with a taper 1. Prevention strategies include using hypoallergenic products, wearing protective gloves when handling potential allergens, and maintaining good skin barrier function through regular moisturizing, which can help soothe the skin and restore its protective function 1. Key considerations in the management of allergic contact dermatitis include:
- Identifying and avoiding the triggering allergen through patch testing
- Using topical corticosteroids and calcineurin inhibitors for acute symptoms
- Implementing prevention strategies, such as using hypoallergenic products and maintaining good skin barrier function
- Considering substitution of products and materials to avoid implicated allergens or irritants
- Using cool compresses, moisturizers, and barrier repair creams to soothe the skin and restore its protective function.
From the FDA Drug Label
5 Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Contact dermatitis The risk factors for allergic contact dermatitis are not explicitly stated in the drug label, but contact dermatitis is mentioned as one of the conditions for which prednisone is indicated.
- Management options for allergic contact dermatitis include the use of prednisone for control of severe or incapacitating allergic conditions. 2
From the Research
Risk Factors for Allergic Contact Dermatitis
- Allergic contact dermatitis (ACD) is one of the most common occupational skin diseases, with its prevalence and causative allergens differing between occupations 3.
- Certain occupations are at higher risk for ACD, including:
- Painters, with a high proportion of face dermatitis (8.1%) and ACD (56.8%) 3.
- Hairdressers, with a high prevalence of ACD (45.8%) and sensitization to chemicals such as (meth)acrylates, glyceryl monothioglycolate, and ammonium persulfate 3, 4, 5.
- Construction workers, with a high frequency of sensitization to cement and rubber vulcanizing agents 6.
- Gardeners/florists and metalworkers, with a significant prevalence of ACD (26.7% and 26.5%, respectively) 3.
- Atopic individuals may have a higher prevalence of leaving their profession due to morbidity associated with hand eczema, but the prevalence of ACD is not significantly different between atopic and non-atopic individuals 5.
Management Options for Allergic Contact Dermatitis
- Patch testing is essential for diagnosing ACD and identifying the responsible allergens, regardless of atopy status 5.
- Modification of the work station and avoidance of exposure to the responsible allergen can lead to resolution or improvement of ACD in some cases 4.
- Strategies to reduce the prevalence of ACD, such as education and prevention programs, are necessary, especially for high-risk occupations 5, 7.
- Common occupational allergens include:
- (Meth)acrylates, commonly found in nail and hair care products 4.
- Methylisothiazolinone, a preservative widely used in various products 4.
- Nickel sulfate, p-phenylenediamine, and fragrance mix I, commonly found in personal care products and other materials 5.
- Cement and rubber vulcanizing agents, commonly found in construction materials 6.