GUIDELINES IN DERMATOLOGY

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CONTACT DERMATITIS

Andaç Salman1
Özlem Akın Çakıcı2

1Acıbadem Mehmet Ali Aydınlar University, Faculty of Medicine, Acıbadem Altunizade Hospital, Department of Dermatology, İstanbul, Türkiye
2Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Department of Dermatology, İstanbul, Türkiye

Salman A, Akın Çakıcı Ö. Contact Dermatitis. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.111-120.

ABSTRACT

Contact dermatitis is classified into two main forms are irritant contact dermatitis and allergic contact dermatitis. The former results from damage to the epidermal barrier caused by irritants, while the latter is typically associated with delayed-type (type 4) sensitization and involves re-exposure to a previously sensitized allergen. In current guidelines, contact dermatitis is generally categorized into five subtypes, with phototoxic, photoallergic, and protein contact dermatitis included in the classification alongside these two main groups. Its impact on the daily lives of affected individuals can be substantial, especially if occupational. Hand eczema is classified based on its duration, etiology, and clinical appearance. Medical history, clinical examination, and selected of appropriate tests based on the suspected subtype of contact dermatitis support the diagnosis. Particularly, patch testing is a crucial procedure applied to identify the presence of contact sensitivity in patients with eczema. Patch testing should be considered in cases of suspected acute or chronic contact dermatitis, eczemas unresponsive to conventional treatments, and rashes thought to be caused by delayed-type hypersensitivity reactions. Each positive reaction after patch testing should be evaluated for clinical relevance to the patient’s current dermatitis. Patients should be provided with written documentation regarding allergens, their sources, and instructions on how to avoid them. In the differential diagnosis, if necessary, skin biopsy, microbiological tests and further diagnostic workup should be considered. Treatment for contact dermatitis should be individualized for each case and adjusted according to the stage of the eczema. The fundamental step in the treatment of contact dermatitis is to avoid allergens and irritants. Additionally, taking protective measures, replacing the materials used whenever possible, and organizing comprehensive educational programs are crucial steps in preventing and managing eczema. In contact dermatitis, if the desired outcomes are not achieved with topical treatments applied alongside measures to avoid triggers, or if these treatments are not feasible, systemic therapy options may be considered. Comprehensive guidelines for managing contact dermatitis are limited in number. In this chapter, we will examine and consolidate the recommendations provided in four current guidelines: S2k guideline on the diagnosis, prevention, and therapy of hand eczema, German S1 guideline on Contact dermatitis, British Association of Dermatologists’ guidelines for the management of contact dermatitis in 2017, European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice.

Keywords: Dermatitis; Contact; Eczema; Patch tests; Hand dermatoses; Skin diseases, Eczematous

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