Atopic dermatitis

Abstract

Previous atopic hand dermatitis and/or flexural eczema increases the risk of developing irritant contact dermatitis at least twofold in individuals exposed to irritants and wet work. In contrast to allergic contact dermatitis to haptens, individuals suffering from atopic dermatitis are prone to protein contact dermatitis and contact urticaria to occupational allergens like food stuff or latex proteins. It is often difficult to decide whether occupational exposure or constitutional factors have a greater impact for the development of hand eczema in atopic individuals. The diagnostic workup should therefore lead to a distinct diagnosis and allow to quantify the impact of occupational and nonoccupational factors. An exposure-independent course and persistence of eczema after discontinuation of work suggest a preponderance of atopic skin disposition over occupational exposure. With regard to atopy and dependent on the morphology of skin lesions as well as the course of the disease, hand eczema may be classified as chronic irritant contact dermatitis with atopic skin disposition, irritant-induced atopic hand eczema, or atopic hand eczema. It is a matter of debate whether “dyshidrotic” vesicular hand eczema without a strict exposure-dependent course, with no relevant contact sensitization and normal IgE levels represents “intrinsic” atopic hand eczema or a distinct entity. Since several factors contribute to the development of occupational contact dermatitis, a general exclusion of persons with atopic skin disposition or atopic dermatitis from risk occupations is not effective in terms of primary prevention. Instead, individual advice should rather be given to persons at risk and technical, organizational, and personal protection measures, as well as repeated follow-up examinations have to be considered.