Allergic Contact Dermatitis

Recommendations

Identify and Treat the Cause
1 Determine exposure to potential allergens in patients with suspected allergic contact dermatitis. Level of Evidence
Not Assessed
2 Perform patch testing, if necessary, to confirm diagnosis. Level of Evidence
Not Assessed


Address Patient-centered Concerns
3 Provide information and advice on prevention and treatment options. Level of Evidence
Not Assessed


Provide Local Care
4 Prevent development of allergic contact dermatitis by maintaining skin integrity in patients with wounds, ostomies or incontinence by selecting hypoallergenic skin care and treatment products whenever possible. Level of Evidence
Not Assessed
5 Prevent additional exposure to allergen. Level of Evidence
Not Assessed
6 Treat affected skin to restore barrier function. Anti-inflammatory medications may be helpful. Level of Evidence
Not Assessed


Provide Organizational Support
7 Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information. Level of Evidence
Not Assessed


Background

Allergic contact dermatitis develops over time and requires penetration of the allergen through an impaired skin barrier to allow sensitization and re-exposure to generate the allergic reaction. Allergic contact dermatitis is usually a local reaction, manifested as itching, pain, redness, swelling, and wheals. Severe cases may be associated with more generalized symptoms. Symptoms usually begin within 12 hours of exposure, peak within 3–4 days, and subside within a week, once the allergen has been removed.

Predisposing factors include dermatoses, such as irritant contact dermatitis; skin trauma, including cuts, scratches, and abrasions from friction; environmental factors, such as dryness and sweating; and the nature, amount and concentration of the allergen. Leg ulcers are the most common diagnosis associated with allergic contact dermatitis.

Various products, such as cleansers, skin barriers, and protectants, may contain allergens, including perfumes, preservatives, and other chemicals used in product formulation. Other common allergens associated with allergic contact dermatitis include nickel, latex, hair dyes, chromates, and poison ivy and related plants.

Diagnosis and evaluation of allergic contact dermatitis includes identification of the allergens. Location and distribution of the allergic reaction may assist in identification. Patch testing is confirmatory. Management is directed toward avoiding further exposure, protecting affected skin from additional trauma, and restoring skin integrity. Gentle cleansers, moisturizers and, possibly, anti-inflammatory medications may be useful.

In most cases, allergic contact dermatitis can be prevented by avoiding the use of products and treatments that contain potential allergens in patients with risk factors for barrier disruption.

References

Essential Publications
1 Sensitization in atopic dermatitis Quality Indicator
 Type: Prospective Correlation study
Belhadjali H, Mohamed M, Youssef M, Mandhouj S, Chakroun M and Zili J. (2008). Contact sensitization in atopic dermatitis: results of a prospective study of 89 cases in Tunisia. Contact Dermatitis 58, 188-189.
In this prospective study, the frequency of contact sensitization was evaluated in the course of atopic dermatitis (AD) in a sample from the Tunisian population. Risk of sensitization was associated with duration of contact (p=0.017). Positive patch tests were associated with severe more often than moderate or mild AD, indicating the importance of removing the allergen.
2 Photoallergic contact dermatitis Quality Indicator
 Type: Retrospective Analysis
Devleeschouwer V, Roelandts R, Garmyn M and Goossens A. (2008). Allergic and photoallergic contact dermatitis from ketoprofen: results of (photo) patch testing and follow-up of 42 patients. Contact Dermatitis 58, 159-166.
In this study, photo contact allergic reaction to ketoprofen and other on steroidal antiinflammatory drugs, sunscreens and fragrance components, and the presence of prolonged photosensitivity related to it were investigated. Photoallegic contact dermatitis following ketoprofen is common. Frequently it presents much later and the dermatitis is persistent. Therefore, the patient my not mention ketoprofen in the history of ketoprofen-related (photo) allergic contact dermatitis.
3 Allergic contact dermatitis Quality Indicator
 Type: Cohort study (2 groups)
Kim JE, Park HJ, Cho BK and Lee JY. (2008). Influence of skin peeling procedure in allergic contact dermatitis. Contact Dermatitis 58, 142-146.
In this study, the frequency of positive patch test reactions for patients with a history of peeling was compared with a control group with no history of peeling. The peeling group had an odd ration of 1.957 (95% CI 1.048-3.653) for a positive patch test reaction compared with the control group (p<0.05). Despite hypotheses to the contrary, peeling appears not to affect the development of contact sensitization.


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