Last reviewed: 21 Aug 2021
Last updated: 14 May 2019

Summary

Definition

History and exam

Key diagnostic factors

  • occupational history of exposure
  • history of atopic dermatitis
  • previous episodes of similar dermatitis
  • acute onset
  • affecting hands and face
  • affecting sun-exposed skin
  • sparing of non-exposed areas of skin
  • pruritus
  • burning
  • erythema
  • vesicles and bullae
  • urticaria
  • lichenoid lesions
  • corrosion or ulceration
  • pustules and acneiform lesions

Other diagnostic factors

  • social history of exposure
  • persistence of symptoms
  • scaling
  • lichenification
  • crusting
  • erythema multiforme
  • cellulitic lesions
  • leukoderma
  • hypopigmentation
  • hyperpigmentation
  • purpura
  • miliaria
  • alopecia
  • granulomatous lesions

Risk factors

  • occupation with frequent exposure to water or caustic material
  • atopic dermatitis

Diagnostic investigations

1st investigations to order

  • patch testing
  • repeated open application test (ROAT) or provocative use test (PUT)

Emerging tests

  • reflectance confocal microscopy (RCM)

Treatment algorithm

Contributors

Authors

Gerard Guillet, MD

Professor of Dermatology

Department of Dermatology and Allergology

University Hospital Poitiers

Poitiers

France

Disclosures

GG declares that he has no competing interests.

Acknowledgements

Dr Gerard Guillet would like to gratefully acknowledge Dr David M. Ozog and Dr Snehal Desai, previous contributors to this topic.

Disclosures

DMO and SD declare that they have no competing interests.

Peer reviewers

Christen Mowad, MD

Assistant Professor

Department of Dermatology

Geisinger Medical Center

Danville

PA

Disclosures

CM declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals

Nottingham

UK

Disclosures

JE declares that he has no competing interests.

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