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Contact allergy is specific hypersensitivity reaction of delayed type to low molecular weight substances, referred to as haptens. The hypersensitivity is induced by a direct exposure of the skin to the hapten with a range of co-factors required to breach immune tolerance. Subsequent reactions may be provoked either by direct contact to the skin or by systemic exposure. The most frequent clinical manifestation of contact allergy is allergic contact dermatitis (ACD), which is among the three most common diseases from the spectrum of eczema. As various eczemas frequently co-exist and are very hard (or even impossible) to differentiate based merely upon clinical symptoms, the diagnosis of ACD should be considered in each case of chronic or recurrent eczema, including routine patch testing. The present article discusses the current knowledge on the pathomechanisms and clinical picture of ACD. Patch test is the only method available and a gold standard for the detection of contact allergy and diagnosis of the ACD. In Poland, the mainstay of the routine diagnosis of patients with eczema is the Polish Baseline Series, which is discussed here along with its recent updates. Additional testing according to patient's exposure is always to be considered, with special attention required to patient's own topical drugs and cosmetics, including emollients and moisturizers. Furthermore, the treatment options for ACD are discussed with stressing the importance of avoiding offending haptens as the first line of therapy. Key words: Contact allergy, Allergic contact dermatitis, Pathomechanisms, Clinical manifestations, Diagnosis, Patch tests, Treatment. |
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(English version of the full article will be posted here in the future... if you need it, please contact the author)
Allergic contact dermatitis is the most common condition caused by contact allergy and one of the most common diseases within the entire spectrum of delayed hypersensitivity reactions (type IV allergic reaction). Due to the significant similarity of clinical symptoms and frequent co-occurrence, diagnostic testing for contact allergy and allergic contact dermatitis should be performed in every case of chronic or recurrent eczema, regardless of the suspected etiology. Patch testing with the Polish Baseline Series is the foundation of diagnostic work-up. Cosmetics and topical medications used by the patient, which often turn out to be a source of secondary sensitization, should also be considered in the diagnostic process. The basis of treatment for allergic contact dermatitis is avoidance of the responsible haptens. The first line of pharmacotherapy is topical glucocorticosteroids, followed by a range of immunosuppressive drugs (azathioprine, calcineurin inhibitors, photochemotherapy), none of which are authorized in Poland for use in allergic contact dermatitis (off-label treatment). Antihistamines are not recommended for this indication due to lack of evidence of effectiveness.
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Document created: 8 January 2016, last updated: 7 August 2026.