What are the guideline sources, guidelines and references for Contact dermatitis ?
Guideline sources The following summarized guidelines for the evaluation and management of contact dermatitis (CD) are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2020), the British Association of Dermatologists (BAD 2017), the American Academy of Allergy, Asthma & Immunology (AAAAI/ACAAI 2015), and the German Society of Dermatology (DDG/BVDD/DKG/DGAKI/AeDA/IVDK 2014). 1 2 3 4 5 5 5 6 Definition CD is an inflammatory intolerance response characterized by successive and coexistent erythema, blisters, exudation, papules, and flaking. 5 Epidemiology CD is caused by allergens (triggered by environmental factors and genetic mutations, such as filaggrin mutation), irritants (chemical and physical agents, plants, photoxic agents, airborne irritants) or microbials, and intrinsic factors (autoimmune responses). 5 Disease course https://web.pathway.md/diseases/recsEea1nq45pFRxo 1/5 6/23/23, 3:35 AM Contact dermatitis Pathway The contact of allergens and irritants lead to an autoimmune inflammatory response that results in CD, which causes clinical manifestations of erythema, blisters, skin edema, pustules, hemorrhage, crusts, scales, erosions, pruritus, pain, dryness of skin, scaly patches and plaques with lichenification and desquamation. Disease progression in chronic irritant CD may result in paronychia and chronic allergic CD in acute allergic CD with distant lesions. 5 Prognosis and risk of recurrence CD is not associated with increased mortality. 6 Guidelines 1. Screening and diagnosis Clinical presentation: Recognize that allergic CD affects all age groups with a high prevalence and incidence rates. E Recognize that skin reactions to external contact agents can sometimes produce a clinical picture not suggestive of dermatitis at first glance. E 2. Diagnostic investigations General principles: Elicit patient history, perform clinical examination, and obtain skin testing for the diagnosis of CD. Consider obtaining additional investigations if necessary. E Recognize that dermatitis is a final common pathway of different conditions affected by multiple variables. Use a differentiated approach for the diagnosis of CD, usually involving patch testing. E Indications for evaluation: include allergic CD in the differential diagnosis of patients with chronic eczematous and non-eczematous dermatitis. B Show 6 more Evaluation for specific allergens (personal products/cosmetics): suspect cosmetics and personal hygiene products that are directly applied to involved skin or ectopically transferred from uninvolved skin as potential sources of allergens in patients with allergic CD. B Show 7 more Evaluation for specific allergens (occupational): suspect the diagnosis of irritant and allergic CD in patients with dermatitis associated with workplace exposure (occupational CD). B Show 2 more Evaluation for specific allergens (pollen): evaluate patients with recurrent dermatitis on exposed skin surfaces during airborne pollen seasons for contact sensitization to seasonal pollen allergens. B Evaluation for systemic contact dermatitis: https://web.pathway.md/diseases/recsEea1nq45pFRxo 2/5 6/23/23, 3:35 AM Contact dermatitis Pathway Suspect the diagnosis of systemic CD following systemic exposure (such as ingestion, infusion, or transcutaneous exposure) to a known contact sensitizer in patients presenting with: generalized dermatitis intertriginous and flexural exanthema (Baboon syndrome) flare at previous cutaneous sites of exposure. B Recognize that axillary dermatitis could be a manifestation of systemic CD (Baboon syndrome). B Patch testing, indications: As per BAD 2017 guidelines, obtain patch testing with a baseline series of allergens in patients with suspected CD. A Consider obtaining testing for additional series depending on allergen exposure. B As per AAAAI/ACAAI 2015 guidelines, obtain patch testing as the gold standard for the diagnosis of allergic CD. B Show 9 more Patch testing (technical considerations): Consider obtaining patch testing either using a preloaded thin-layer rapid use epicutaneous testing kit of 36 chambers or with a panel of antigens loaded individually in a chamber system recommended by the NACDG Research Group or the ACDS. C Avoid using or reduce doses of immunosuppressant medications, such as systemic corticosteroids and systemic immunosuppressants, before patch testing. Avoid using topical corticosteroids, topical calcineurin inhibitors, or UV radiation to the site of patch testing, because these may reduce allergic patch test responses. D Patch testing, interpreting results: As per BAD 2017 guidelines, consider obtaining additional readings at day 6 or 7 if the results are unexpectedly negative at day 4. C As per AAAAI/ACAAI 2015 guidelines, determine the relevance of the results of patch testing based on the clinical and exposure history when interpreting patch testing. B Show 5 more Investigational tests: Insufficient evidence to support the routine use of in vitro tests for delayed hypersensitivity to contact allergens (such as metals and bone cement). I Avoid obtaining lymphocyte transformation testing (lymphocyte stimulation testing) in the evaluation of contact allergies. D 3. Medical management General principles: Offer appropriate adjunct medical treatment in addition to avoidance of exposure in patients with allergic CD. B https://web.pathway.md/diseases/recsEea1nq45pFRxo 3/5 6/23/23, 3:35 AM Contact dermatitis Pathway Consider offering individually tailored systemic therapy if topical therapy is ineffective or unfeasible. E Corticosteroids: administer topical corticosteroids as first-line therapy for symptomatic treatment of patients with CD. E Topical tacrolimus: consider offering topical tacrolimus in patients with CD if topical steroids are unsuitable or ineffective. C Retinoids: offer alitretinoin in patients with severe chronic hand dermatitis. A 4. Nonpharmacologic interventions Allergen and irritant avoidance: Advise avoiding exposure to irritants and allergens to prevent CD. B Advise avoiding contact with the offending agent if the allergen or irritant has been identified, and inform about any cross-reactivity concerns. B Advise avoiding diagnostically determined noxae. E Skin care: Consider advising skin care and skin protection creams to prevent occupational dermatitis. C Advise using appropriate skin protection to prevent CD. B 5. Therapeutic procedures Phototherapy: consider performing psoralen-UV A therapy in patients with chronic hand dermatitis. C 6. Perioperative care Perioperative patch testing: Consider obtaining preoperative patch testing for metal sensitization in patients with a significant history of metal allergy. C Consider obtaining patch testing to the components of the joint implant in patients with joint replacement failure, after infection and biomechanical causes have been excluded. C 7. Specific circumstances Patients with vulvar contact dermatitis: counsel patients with vulvar CD regarding vulvar care and removal of vulvar irritants and allergens. B Show 2 more https://web.pathway.md/diseases/recsEea1nq45pFRxo 4/5 6/23/23, 3:35 AM Contact dermatitis Pathway 8. Patient education Patient education: Consider providing education in patients with occupational CD. C Educate worker patients with allergic or irritant CD about prognosis of their disease and inform that it may persist and need long-term management even after treatment and workplace modifications. B References 1. Luz Fonacier, David I Bernstein, Karin Pacheco et al. Contact dermatitis: a practice parameter-update 2015. J Allergy Clin Immunol Pract. May-Jun 2015;3 3 Suppl):S1 39. Open 2. Jochen Brasch, Detlef Becker, Werner Aberer et al. Guideline contact dermatitis: S1 Guidelines of the German Contact Allergy Group DKG of the German Dermatology Society DDG , the Information Network of Dermatological Clinics IVDK , the German Society for Allergology and Clinical Immunology DGAKI , the Working Group for Occupational and Environmental Dermatology ABD of the DDG, the Medical Association of German Allergologists AeDA , the Professional Association of German Dermatologists BVDD and the DDG. Allergo J Int. 2014;23 4 126 138. Open 3. Johnston GA, Exton LS, Mohd Mustapa MF et al. British Association of Dermatologists' guidelines for the management of contact dermatitis 2017. Br J Dermatol. 2017 Feb;176 2 317 329. Open 4. No authors listed. Diagnosis and Management of Vulvar Skin Disorders: ACOG Practice Bulletin, Number 224. Obstet Gynecol. 2020 Jul;136 1 222 225. Open 5. Gaby Novak-Bili , Majda Vu i , Iva Japund i et al. IRRITANT AND ALLERGIC CONTACT DERMATITIS SKIN LESION CHARACTERISTICS. Acta Clin Croat. 2018 Dec; 57 4 713 720. Open 6. Divya Seth, Khatiya Cheldize, Danielle Brown et al. Global Burden of Skin Disease: Inequities and Innovations. 2017 Sep;6 3 204 210.2017 Sep;6 3 204 210. Open 7. Divya Seth, Khatiya Cheldize, Danielle Brown et al. Global Burden of Skin Disease: Inequities and Innovations. Curr Dermatol Rep. 2017 Sep; 6 3 204 210. Open 8. mer Faruk Elmas, Necmettin Akdeniz, Mustafa Atasoy et al. Contact dermatitis: A great imitator. Clin Dermatol. Mar-Apr 2020;38 2 176 192. Open 9. Christen M Mowad, Bryan Anderson, Pamela Scheinman et al. Allergic contact dermatitis: Patient management and education. J Am Acad Dermatol. 2016 Jun;74 6 1043 54. Open 10. Richard P Usatine, Marcela Riojas. Diagnosis and management of contact dermatitis. 2010 Aug 1;82 3 249 55.2010 Aug 1;82 3 249 55. Open 11. Jeanne D Johansen, Kristiina Aalto-Korte, Tove Agner et al. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis. 2015 Oct;73 4 195 221. Open https://web.pathway.md/diseases/recsEea1nq45pFRxo 5/5