Allergic Contact Dermatitis Remains Prevalent, Negatively Impacts Quality of Life
Researchers conducted a comprehensive review of allergic contact dermatitis, detailing the condition’s epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, and therapeutic options.
The global burden of allergic contact dermatitis (ACD) is persistently prevalent and has the potential to significantly impact patients’ quality of life (QOL), according to a study published in the Journal of the American Academy of Dermatology Reviews.1 Accurate allergen testing and an evolving therapeutic landscape both have the potential for lessening or ameliorating the global ACD burden going forward.
“ACD is a dermatological condition with significant public health burden,” wrote authors of the study. “Accurate identification of allergens is paramount in preventing recurrence and improving patient QOL. This review focuses on the mechanisms, management, and control of ACD.”
ACD is when patients begin to experience an itchy rash caused by direct contact with or an allergic reaction to a specific substance. According to the Mayo Clinic, cosmetics, fragrances, jewelry, and plants can all cause ACD, which is not contagious but is known to be very uncomfortable and sometimes painful for up to 4 weeks.2
ACD occurs when patients come into contact with specific allergens that cause an itchy rash on the skin. | image credit: Ratchadaporn / stock.adobe.com
With researchers’ goal of assessing mechanisms, management, and control, they began by addressing the overall prevalence of the disease in the US and beyond.
READ MORE: Tapinarof Results in Mild Atopic Dermatitis Activity During Treatment-Free Period
“The prevalence of ACD has been reported to be as high as 20% in the general population, with 5-10% experiencing clinical symptoms at least once a year,” continued the authors.1 “Recently, a study involving 2667 patients in the US found that up to 63.1% had at least one positive reaction, highlighting the prevalence of such reactions.”
According to the researchers, ACD is a hypersensitive reaction occurring in 2 phases known as sensitization and elicitation. During sensitization, antigen-presenting cells (APCs) are transformed and moved throughout a patient’s body, typically lasting up to 15 days. In the elicitation phase, sensitized individuals are re-exposed to inflammatory cells that are then migrated to the skin.
“Diagnosing ACD begins with a thorough medical history, including a detailed timeline of lesion onset, working environment, personal care products, and potential exposures. Direct exposure to allergens through patch testing remains the gold standard for diagnosis,” wrote the authors.1
With patch testing (PT), researchers have been able to identify patient instances of ACD. The test involves the application of allergens directly on the skin. With the help of hypoallergenic chambers containing the allergens applied to the skin, patients are exposed for up to 48 hours and their patches are then tested.
Researchers mentioned a variety of scenarios where a PT would be necessary, including when the ACD-causing allergen aligns with a patient’s clinical history, when patients have suspected dermatitis with an unknown cause, when previously stable dermatitis worsens, or when a patient with a high-risk occupation presents dermatitis symptoms, among many other scenarios.
Finally, the researchers touched on proper management of ACD and the importance of avoiding allergens.
“Topical corticosteroids provide symptomatic relief by reducing pruritus, with short courses of oral corticosteroids reserved for severe cases,” they continued.1 “Antihistamines may also be used for pruritus, though their effectiveness varies. Topical calcineurin inhibitors may also be recommended, especially in areas like the eyelids.”
Throughout their review of ACD management, authors of the study put a significant amount of importance on the idea of allergy avoidance, which is the key to successful treatment according to the researchers. “Providing patients with information about allergen sources and potential cross-reactivity is essential. When avoidance is not feasible, personal protective equipment is recommended.”
Researchers then explored emerging options for ACD diagnosis that could become standard in the future, with many of them focusing on the advancement of technology. One option for improving diagnosis has been presented through the use of deep learning algorithms to provide a more detailed look into patients’ conditions. They’ve also began exploring other artificial intelligence options and photographic approaches to detecting the disease.
In the researchers’ comprehensive look at ACD diagnosis, treatment, and management, they provided a detailed overview of how the disease impacts patients’ QOL. With several challenges identified, more research is needed to better understand the nuances of ACD as experts give a hopeful look to the future.
“The evolving allergen landscape introduces new obstacles in diagnosing and managing ACD, contributing to its public health burden and impact on quality of life. While PT remains the diagnostic gold standard, its application and interpretation present ongoing challenges. Treatment is advancing, with allergen avoidance central, complemented by topical therapies, systemic treatments, and biologics,” concluded authors of the study.1
READ MORE: Dermatology Resource Center
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