[Improved management of allergic contact eczema]

Allergic contact dermatitis (ACD) is common. Its diagnosis requires patch testing to establish ACD, followed by repeat open application testing (ROAT) to confirm that the putative allergen is in fact responsible for the ACD. The aim of primary management is to eliminate or minimise exposure to the allergen and its cross reactants. To promote healing and ease discomfort, local treatment is given, which in principle always consists of a short course of corticosteroids and an emollient. Sometimes antibiotics may be necessary, as well as systemic corticosteroid treatment for a brief period. In cases of persistent ACD, and sometimes in cases with a multifactorial background, further treatment may be required, first and foremost phototherapy. In isolated cases, treatment with low-energy roentgen (grenz rays), retinoids or cyclosporine may be called for. Desensitisation is not possible, and at present treatment with chelating agents and diet has no place in the management of ACD.