Management of contact dermatitis

As a widespread disease, contact dermatitis affects all age groups with a high prevalence and incidence. In addition to a reduction in the quality of life, it causes considerable health and socioeconomic costs. Essentially, five subtypes can be distinguished, namely irritant contact dermatitis, phototoxic contact dermatitis, allergic contact dermatitis with its two special forms of hematogenous and aerogenous contact dermatitis, photoallergic contact dermatitis, and protein contact dermatitis. The diagnosis is based on a detailed history and clinical skin findings as well as the exposure-related performance of allergological in vivo and in vitro tests. Once the contact substance—irritant or allergen—has been identified, the key to therapeutic success lies in its strict avoidance. Symptomatic therapy of contact dermatitis should always be individualized and based on the stage of eczema. Topical glucocorticoids are considered first-line therapy for both irritant and allergic contact dermatitis. The always accompanying basic therapy with skin care products plays a central role for sustainable therapeutic success. Systemic therapy is considered when topical therapy is ineffective or not feasible. In this context, the short-term use of systemic glucocorticoids should be limited to extensive or clinically severe acute contact dermatitis and exacerbations of chronic contact dermatitis. The efficacy of the use of newer biologics and Janus kinase inhibitors in contact dermatitis is currently being evaluated in several clinical trials.