eMedicine Specialties > Dermatology > Allergy & Immunology

Contact Dermatitis, Allergic: Follow-up

Author: Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Contributor Information and Disclosures

Updated: Jul 31, 2009

Follow-up

Further Inpatient Care

  • Inpatient care rarely is required for allergic contact dermatitis (ACD) unless the dermatitis is so severe that patients cannot care for themselves. Examples may include severe allergic contact dermatitis with marked eyelid swelling that impairs vision or severe allergic contact dermatitis of the penis, which may impede urination. If patients develop chronic severe allergic reactions to their home or workplace, they may require a temporary change of environment until the cause of the dermatitis is identified.

Further Outpatient Care

  • Individuals may develop new allergies. An individual who develops a relapse or a worsening of the dermatitis may require further history and, possibly, further patch testing.

Deterrence/Prevention

  • To prevent recurrence of allergic contact dermatitis, instruct patients thoroughly concerning allergen(s) and the types of products likely to contain allergen(s).
    • For many patients with allergic reactions to fragrances, preservatives, vehicles, and medicaments, reading cosmetic labels and package inserts of topical/systemic medicaments may be sufficient to avoid allergens.
    • For patients allergic to nickel, the dimethylgloxime test can alert them the presence of the metal.
    • For many other patients with allergic reactions to chemicals that are unlikely to be labeled on consumer products (eg, rubber accelerators), suitable allergen alternatives (eg, gloves specifically known to be accelerator free) must be provided by the practitioner.
  • Many cases of allergic contact dermatitis, especially of the hands, occur in the occupational setting. Proper worker education and hygiene may prevent allergic reactions. For example, glutaraldehyde is a known sensitizer with widespread use as a cold sterilizing agent in medicine and dentistry.19 Needless cases of allergic contact dermatitis to this biocide occur because of the lack of proper education regarding the appropriate use of gloves and other barriers to cutaneous contact.
  • Advise patients to avoid identified chemicals to which they are allergic to minimize the risk of relapse, the risk of chronic contact dermatitis, and the risk of adverse effects from chronic use of nonspecific suppressive treatments (eg, topical and systemic corticosteroids, cyclosporine).

Complications

  • Occasionally, allergic contact dermatitis is complicated by secondary bacterial infection, which may be treated by the appropriate systemic antibiotic.
  • Darkly pigmented individuals may develop areas of hyperpigmentation or hypopigmentation from allergic contact dermatitis. Occasionally, they may develop depigmentation at sites of allergic contact dermatitis to certain chemicals.

Prognosis

  • Individuals with allergic contact dermatitis may have persistent or relapsing dermatitis, particularly if the material(s) to which they are allergic is not identified or if they continue to practice skin care that is no longer appropriate (ie, they continue to use harsh chemicals to wash their skin, they do not apply bland emollients to protect their skin).
  • The longer an individual has severe dermatitis, the longer it is believed it will take the dermatitis to resolve once the cause is identified.
  • Some individuals have persistent dermatitis following allergic contact dermatitis, which appears to be true especially in individuals allergic to chrome.
  • A particular problem is neurodermatitis (lichen simplex chronicus), in which individuals repeatedly rub or scratch an area initially affected by allergic contact dermatitis.
  • The TRUE test can provide accurate basic information on common allergens (T.R.U.E. TEST). The Contact Allergan Replacement Database of the American Contact Dermatitis Society is particularly valuable for allergens to topical skin care products (database restricted to American Contact Dermatitis Society members).

Patient Education

  • Patients have the best prognosis when they are able to remember the materials to which they are allergic and how to avoid further exposures.
  • Provide patients with as much information as possible concerning the chemical to which they are allergic, including all known names of the chemical.
  • Web sites, standard textbooks, and the TRUE test kit contain basic information about the chemicals.
  • Susceptible individuals need to read the list of ingredients before applying American cosmetic products to their skin, since preservative chemicals are used widely in consumer, medical, and workplace products. The same chemical may have different names when used for consumer or industrial purposes.
  • Provide pamphlets with color pictures of poison ivy to individuals allergic to the plant. The American Academy of Dermatology also has pamphlets on allergic contact dermatitis and hand eczema.
  • For excellent patient education resources, visit eMedicine's Skin, Hair, and Nails Center. Also, see eMedicine's patient education article Contact Dermatitis.

Miscellaneous

Medicolegal Pitfalls

  • Allergic contact dermatitis is a major occupational disease, and individuals may be temporarily unable to work. Many require modification of the workplace to continue working. Hopefully, a thorough history and patch testing minimize the risk of iatrogenic complications from systemic corticosteroids and other immunosuppressives.

Special Concerns

  • The safety of patch testing in pregnancy has not been studied; however, the minute amounts of allergens applied appear unlikely to be absorbed in sufficient amounts to harm the fetus. Nonetheless, as with all treatments in pregnant women, the benefits of testing should be weighed against any potential, albeit undocumented, risk.
  • Intraoral metal contact allergy may result in mucositis that mimics lichen planus, which has an association with intraoral squamous cell carcinoma. Intraoral squamous cell carcinoma adjacent to a dental restoration containing a metal to which the patient was allergic has been reported.20
  • Allergic contact dermatitis may be a direct trigger for skin ulceration in patients with venous insufficiency. Early diagnosis of allergic contact dermatitis may prevent the development of venous ulcers.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Joshua May, BS, and previous Chief Editor, William D. James, MD, to the development and writing of this article.



More on Contact Dermatitis, Allergic

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Differential Diagnoses & Workup: Contact Dermatitis, Allergic
Treatment & Medication: Contact Dermatitis, Allergic
Follow-up: Contact Dermatitis, Allergic
Multimedia: Contact Dermatitis, Allergic
References
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Further Reading

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Keywords

contact dermatitis, allergic contact dermatitis, ACD, allergic dermatitis, skin allergy, contact hypersensitivity

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Contributor Information and Disclosures

Author

Daniel J Hogan, MD, Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center
Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association
Disclosure: Nothing to disclose.

Medical Editor

Donald Belsito, MD, Clinical Professor, Department of Internal Medicine, Division of Dermatology, University of Missouri at Kansas City; Private Practice, American Dermatology Associates, LLC
Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, Kansas Medical Society, Noah Worcester Dermatological Society, Phi Beta Kappa, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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