Contact dermatitis allergic L23.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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ACD; Allergic contact dermatitis; Allergic contact eczema; Contact allergic dermatitis; Contact allergic eczema; Contact allergy; Contact dermatitis allergic; Contact eczema allergic; Eczema contact allergic

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Acute, sub-acute or chronic dermatitis caused by contact with topical allergens (usually in type IV allergy, see allergy). In contrast to toxic contact dermatitis, allergic contact dermatitis requires sensitization. The extent of the skin inflammation depends on the degree of sensitization and the intensity (duration, occlusion, moisture, pressure, localization) of the allergen contact.

Rarely does an immediate type reaction (atopy patch test, type IV reaction to type I allergens) trigger an allergic contact allergy.

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A distinction must be made:

  • Acute allergic contact dermatitis
  • Chronic allergic contact dermatitis (caused by repetitive contact)

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The disease is one of the most common skin diseases in Germany. Prevalence for Germany/Europe: 5-27% (depending on method) of the total population (Uter W et al. 2018).

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Clinical features
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24-48 hours after contact with the allergen, a usually blurred, clearly itchy, slightly elevated plaque forms at the site of contact, later extending beyond the contact area, which is interspersed with tiny blisters or nodules. Even after removal of the contact allergen, the inflammatory reaction can become even stronger(crescendo reaction). Severe contact allergic eczema is characterised by large blisters, after which they burst, by extensive erosion, weeping and crust formation. Healing takes place under a rather coarse lamellar scaling of the skin. If the allergen is not known and repeated contact with the allergen occurs, this leads to a chronic eczema with initially local scattering phenomena; in the case of strong sensitization, generalized dermatitic reactions may also occur. The picture of chronic contact allergic dermatitis differs significantly from the acute reaction. Now, a rather multiform picture is impressive with flat, lichenified, scaly, greyish-red plaques interspersed with erosions, scaly crusts and rhagades.

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Avoid the triggering noxious agent. Testing of ointment compatibility as soon as possible (epicutaneous, lapping test, quadrant test), avoidance of incompatible ingredients, e.g. in cosmetics (see INCI labelling below). If possible, indifferent basics. Especially avoid wool wax and wool wax alcohols.

External therapy
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Acute contact dermatitis: Depending on the stage of eczema initial medium to strong glucocorticoids in an aqueous base such as 0.1% amcinonide as cream or lotio (e.g. Amciderm), 0.1% hydrocortisone butyrate (e.g. Laticort cream), 0.25% prednicarbate (e.g.Dermatop cream/ointment), 0.1% mometasone (e.g. Ecural cream/ointment), furthermore moist compresses with NaCl-solution, in case of persistent superinfection with antiseptic additives like quinolinol (e.g. Chinosol 1:1000), R042 or potassium permanganate (light pink).
In the vesicular stage, a more lipid-moist treatment with e.g. hydrocortisone 1% in Vaselinum alb. (hydrocortisone ointment 1%)and moist compresses, cotton gloves if necessary.

Chronic contact dermatitis: Initial glucocorticoids externally with medium to strong efficacy in as fatty a base as possible such as 0.1% amcinonide (e.g. Amciderm ointment/fatty ointment), 0.25% prednicarbate (e.g. Dermatop ointment/fatty ointment), 0.1% hydrocortisone butyrate (e.g. Laticort cream), in the case of strongly scaly hyperkeratotic forms also under occlusion. S.a.u. eczema, hand eczema.
Leave out soaps and detergents, cleaning with oil-containing baths (Balneum Hermal, Balmandol, Linola grease oil bath). Try antiphlogistic topicals such as Pix lithanthracis 2%. After-treatment with replenishing externa in a compatible basis (Alfason repair, Linola Fett, Vaselinum alb., Excipial Almond oil ointment), if necessary addition of 2-10% urea (e.g. Eucerin Urea, Basodexan fat cream/ointment, R102 ). If necessary also use Zarzenda cream (internationally known as Atopiclair). This is a steroid-free multi-component cream with a strong anti-itching, anti-inflammatory effect (apply 2 times/day).

Internal therapy
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Acute contact dermatitis: In the case of highly acute courses of glucocorticoids as in medium to high dosages, e.g. prednisone 100-150 mg/day i.v. Change to oral therapy, rapid dosage reduction and balancing according to the clinical findings within 1 week. Additional antihistamines such as desloratadine (e.g. Aerius) 1-2 tbl/day or levocetirizine (e.g. Xusal) 1-2 tbl/day.

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Last updated on: 29.10.2020