Prognosis and Therapy

Abstract

The course of contact dermatitis is variable: the condition may resolve, or recur in the same site, or else spread and become unpredictably chronic. Although rarely, it can be complicated by erythroderma, which is often irreversible, has a poor prognosis and can even be fatal. With the exception of the last complication, the prognosis of contact dermatitis in its various clinical expressions is favorable. The course of the disease can be stopped only if contact with the agent or agents responsible is avoided. Topical or systemic treatments are useful only to reduce the duration of the clinical episode. Topical treatment and in part, systemic treatment are largerly similar in the two different forms of irritant and allergic contact dermatitits. Local treatment relies on Galenic products (solutions or antiseptic tinctures, emulsions and soothing lotions, powders, pastes and creams), that must be used considering the clinical phase of the disease (acute, subacute, chronic) and the relative manifestations. Apart from these very useful products, topical corticosteroids can be used with some important criteria, such as time and modality of use. Systemic antihistamines can be used for short or long periods to calm the pruritus. Systemic corticosteroids are used only in forms that are highly refractory to other treatments, and in diffuse and erythrodermic forms. Various other physical (ultraviolet light, Grenz rays) and chemical (antimetabolites, such as methotrexate, azathioprine, mycophenolate mofetil; IFN-γ antagonists, such as cyclosporin, apremilast; TNF-α antagonists, such as infliximab, etanercept; IL-4 receptor-α antagonists, such as dupilumab; calcineurin inhibitors, such as tacrolimus and pimecrolimus) substances can be used as attempts of immunotolerance. Many attempts have been also provided to induce specific oral tolerance to nickel in nickel-allergic subjects.