engleski

Irritant dermatitis, occupational dermatitis, contact allergy: Differential diagnosis and pitfalls

Contact dermatitis occurs as a result of multiple contributing factors including personal susceptibility, irritant and allergic delayed type hypersensitivity mechanisms, as well as factors such as intensity and duration of environmental exposure to causative agents. Contact dermatitis most commonly presents as hand eczema, although face, skin folds or generalized dermatitis can also occur. A definite classification of chronic hand dermatitis is still missing due to diversity of etiological factors, clinical presentations and course as well as different response to available therapeutic modalities. Classification of hand dermatitis will be reviewed, including irritant and allergic contact dermatitis, atopic hand dermatitis, vesicular, frictional, hyperkeratotic and other types. Apart from differentiation of the various subtypes of hand dermatitis, diagnoses such as psoriasis, palmoplantar pustulosis, lichen planus, tinea, mycosis fungoides and numerous other possibilities should be considered in the differential diagnosis. Patients with suspected contact dermatitis should be patch-tested to baseline series of allergens, relevant professional allergen series as well as their own samples including work-related, personal-use and cosmetic products. In certain patients prick test and total serum IgE should also be employed. In the assessment of patients with suspected contact dermatitis we should be aware of potential pitfalls in the exposure assessment (inadequate product labelling), in the performance of patch test (preparation of allergens, doses, concentrations, reading times) and, finally, in the evaluation of relevance of patch test results.

contact dermatitis; exposure assessment; diagnostic workup; pitfalls

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