Management of allergic contact dermatitis
- Bruce A Brod, MD
Bruce A Brod, MD
- Clinical Professor of Dermatology
- University of Pennsylvania School of Medicine
Allergic contact dermatitis (ACD) is commonly encountered by the practicing clinician. The most common clinical expression is an eczematous dermatitis that can be mild to severe, acute and short lived, or chronic. The management of ACD is based upon the identification of the offending allergen, avoidance of exposure, use of safe alternatives, and treatment of symptoms.
This topic will discuss the management of ACD. The basic mechanisms, clinical manifestations, and diagnosis of ACD are discussed separately. (See "Basic mechanisms and pathophysiology of allergic contact dermatitis" and "Clinical features and diagnosis of allergic contact dermatitis" and "Patch testing".)
The optimal management of ACD requires a multipronged approach :
●Identification and avoidance of the offending allergen
●Alternatives to offending products
- Bikowski JB. Hand eczema: diagnosis and management. Cutis 2008; 82:9.
- Mowad CM, Anderson B, Scheinman P, et al. Allergic contact dermatitis: Patient management and education. J Am Acad Dermatol 2016; 74:1043.
- Jensen P, Hamann D, Hamann CR, et al. Nickel and cobalt release from children's toys purchased in Denmark and the United States. Dermatitis 2014; 25:356.
- Jensen P, Johansen JD, Zachariae C, et al. Excessive nickel release from mobile phones--a persistent cause of nickel allergy and dermatitis. Contact Dermatitis 2011; 65:354.
- Jacob SE, Admani S. iPad--increasing nickel exposure in children. Pediatrics 2014; 134:e580.
- Thyssen JP, Skare L, Lundgren L, et al. Sensitivity and specificity of the nickel spot (dimethylglyoxime) test. Contact Dermatitis 2010; 62:279.
- Lu LK, Warshaw EM, Dunnick CA. Prevention of nickel allergy: the case for regulation? Dermatol Clin 2009; 27:155.
- Suneja T, Flanagan KH, Glaser DA. Blue-jean button nickel: prevalence and prevention of its release from buttons. Dermatitis 2007; 18:208.
- van Ketel WG, Bruynzeel DP. Chelating effect of EDTA on nickel. Contact Dermatitis 1984; 11:311.
- Wöhrl S, Kriechbaumer N, Hemmer W, et al. A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals. Contact Dermatitis 2001; 44:224.
- American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol 2006; 97:S1.
- Madsen JT, Andersen KE. Further evidence of the methylisothiazolinone epidemic. Contact Dermatitis 2014; 70:246.
- Scheman A, Jacob S, Zirwas M, et al. Contact Allergy: alternatives for the 2007 North American contact dermatitis group (NACDG) Standard Screening Tray. Dis Mon 2008; 54:7.
- Scheman A, Jacob S, Katta R, et al. Part 1 of a 4-part series Facial Cosmetics: Trends and Alternatives: Data from the American Contact Alternatives Group. J Clin Aesthet Dermatol 2011; 4:25.
- Scheman A, Jacob S, Katta R, et al. Part 2 of a 4-part series Hair Products: Trends and Alternatives: Data from the American Contact Alternatives Group. J Clin Aesthet Dermatol 2011; 4:42.
- Forsberg K, Van den Borre A, Henry N, et al. Quick selection guide to chemical protective clothing, 6th ed, John Wiley and Sons, Inc., Hoboken, NJ 2014.
- Bauer A, Schmitt J, Bennett C, et al. Interventions for preventing occupational irritant hand dermatitis. Cochrane Database Syst Rev 2010; :CD004414.
- Bourke J, Coulson I, English J, British Association of Dermatologists Therapy Guidelines and Audit Subcommittee. Guidelines for the management of contact dermatitis: an update. Br J Dermatol 2009; 160:946.
- Williams C, Wilkinson SM, McShane P, et al. A double-blind, randomized study to assess the effectiveness of different moisturizers in preventing dermatitis induced by hand washing to simulate healthcare use. Br J Dermatol 2010; 162:1088.
- Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000; 4:1.
- Belsito D, Wilson DC, Warshaw E, et al. A prospective randomized clinical trial of 0.1% tacrolimus ointment in a model of chronic allergic contact dermatitis. J Am Acad Dermatol 2006; 55:40.
- Pacor ML, Di Lorenzo G, Martinelli N, et al. Tacrolimus ointment in nickel sulphate-induced steroid-resistant allergic contact dermatitis. Allergy Asthma Proc 2006; 27:527.
- Schempp CM, Müller H, Czech W, et al. Treatment of chronic palmoplantar eczema with local bath-PUVA therapy. J Am Acad Dermatol 1997; 36:733.
- van Coevorden AM, Kamphof WG, van Sonderen E, et al. Comparison of oral psoralen-UV-A with a portable tanning unit at home vs hospital-administered bath psoralen-UV-A in patients with chronic hand eczema: an open-label randomized controlled trial of efficacy. Arch Dermatol 2004; 140:1463.
- Sezer E, Etikan I. Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema. Photodermatol Photoimmunol Photomed 2007; 23:10.
- Veien NK, Olholm Larsen P, Thestrup-Pedersen K, Schou G. Long-term, intermittent treatment of chronic hand eczema with mometasone furoate. Br J Dermatol 1999; 140:882.
- Common contact allergens
- - Plants
- - Nickel
- - Cosmetics and personal care products
- Alternative products
- Patient education
- Occupational avoidance measures
- Skin protection
- ACTIVE TREATMENT
- Therapeutic options
- ACD involving the face or flexural areas
- ACD involving the hands, feet, or nonflexural areas
- Chronic ACD
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