Inpatient care rarely is required for ACD unless the dermatitis is so severe that patients cannot care for themselves. Examples may include severe ACD with marked eyelid swelling that impairs vision or severe ACD of the penis, which may impede urination. If patients develop chronic severe allergic reactions to their home or workplace, they may require a temporary change of environment until the cause of the dermatitis is identified.
Further Outpatient Care:
Individuals may develop new allergies. An individual who develops a relapse or a worsening of the dermatitis may require further history and, possibly, further patch testing.
To prevent recurrence of ACD, instruct patients thoroughly concerning allergen(s) and the types of products likely to contain allergen(s).
For many patients with allergic reactions to fragrances, preservatives, vehicles, and medicaments, reading cosmetic labels and package inserts of topical/systemic medicaments may be sufficient to avoid allergens.
For patients allergic to nickel, the dimethylgloxime test can alert them the presence of the metal.
For many other patients with allergic reactions to chemicals that are unlikely to be labeled on consumer products (eg, rubber accelerators), suitable allergen alternatives (eg, gloves specifically known to be accelerator free) must be provided by the practitioner.
Many cases of ACD, especially of the hands, occur in the occupational setting. Proper worker education and hygiene may prevent allergic reactions. For example, glutaraldehyde is a known sensitizer with widespread use as a cold sterilizing agent in medicine and dentistry. Needless cases of ACD to this biocide occur because of the lack of proper education regarding the appropriate use of gloves and other barriers to cutaneous contact.
Advise patients to avoid identified chemicals to which they are allergic to minimize the risk of relapse, the risk of chronic contact dermatitis, and the risk of adverse effects from chronic use of nonspecific suppressive treatments (eg, topical and systemic corticosteroids, cyclosporine).
Occasionally, ACD is complicated by secondary bacterial infection, which may be treated by the appropriate systemic antibiotic.
Darkly pigmented individuals may develop areas of hyperpigmentation or hypopigmentation from ACD. Occasionally, they may develop depigmentation at sites of ACD to certain chemicals.
Individuals with ACD may have persistent or relapsing dermatitis, particularly if the material(s) to which they are allergic is not identified or if they continue to practice skin care that is no longer appropriate (ie, they continue to use harsh chemicals to wash their skin, they do not apply bland emollients to protect their skin).
The longer an individual has severe dermatitis, the longer it is believed it will take the dermatitis to resolve once the cause is identified.
Some individuals have persistent dermatitis following ACD, which appears to be true especially in individuals allergic to chrome.
A particular problem is neurodermatitis (lichen simplex chronicus), in which individuals repeatedly rub or scratch an area initially affected by ACD.
The TRUE test can provide accurate basic information on common allergens (T.R.U.E. TEST). The Contact Allergan Replacement Database of the American Contact Dermatitis Society is particularly valuable for allergens to topical skin care products (database restricted to American Contact Dermatitis Society members).