Practice Clinical updates

Contact dermatitis

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3299 (Published 30 June 2016) Cite this as: BMJ 2016;353:i3299
  1. Rabia Sofia Rashid, specialist registrar,
  2. Tang Ngee Shim, consultant dermatologist
  1. Department of Dermatology, University Hospital, Coventry CV2 2DX, UK
  2. Correspondence to: T N Shim tangngee.shim@uhcw.nhs.uk

What you need to know

  • Florists, hairdressers, beauticians, cooks, metalworkers and other manufacturing occupations, and healthcare related professions are at risk

  • Diagnosis is made clinically or with patch tests in some cases.

  • Interpret patch test results in light of the clinical history to determine relevance

  • Avoidance of allergens and irritants is an important aspect of self management

  • Treatment options include topical corticosteroids, topical calcineurin inhibitors, and systemic therapies if needed

Contact dermatitis accounts for 70-90% of all occupational skin diseases.1 It is an inflammatory skin condition induced by exposure to an external irritant or allergen (table 1). A prevalence of 8.2% was seen in a recent cross sectional study of 12 377 subjects across five European countries, in which a randomly selected group of 3119 patients were patch tested.2 The condition can have a detrimental impact on personal and social relationships, quality of life, and even threaten employment.3 4 5

View this table:
Table 1

Clinical features of atopic dermatitis, irritant contact dermatitis, and allergic contact dermatitis

Methods

We searched PubMed, DynaMed, and the Cochrane Library using the MESH term “contact dermatitis” and various subheadings including epidemiology, classification, diagnosis, and drug therapy. Systematic reviews, meta-analyses, and randomised controlled trials were prioritised, but relevant observational and epidemiological studies were also included. We focused on recent literature, particularly in the past five years. Further references were identified from searching the bibliography of articles. We also incorporated recommendations from guidelines published by the European Society of Contact Dermatitis, the American College of Allergy, Asthma and Immunology, and the British Association of Dermatologists.

What are the different types of contact dermatitis?

Irritant contact dermatitis is a non-immunologic response that occurs as a consequence of direct damage to the skin, by chemicals or physical agents, faster than the skin is able to repair itself.6 7 Approximately 80% of cases of contact dermatitis are irritant contact dermatitis.8 Common irritants include …

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