Occupational skin disease is common. It affects workers more often than reported. Contact dermatitis, both irritant and allergic, accounts for the majority of occupational skin diagnoses. Occupational contact dermatitis (OCD) frequently affects the hands and may have a profound impact on an employee's ability to perform a job. Severe OCD can affect a worker's activities of daily living and can even lead to job loss. Numerous irritants have been described in the workplace, from the common (wet work) to the more obscure (warm, dry air). Several contact allergens may be work-related, and the majority of established occupational allergens are also known nonoccupational allergens. Emerging occupational allergens are continually described in the literature. Patch testing is the gold standard for the workup of allergic contact dermatitis. Patch testing in the setting of OCD may require extended or unique allergen trays, as well as a thorough occupational history and collection of workplace Material Safety Data Sheets (MSDS). These MSDS contain valuable information but may not be complete or accurate. Proof of occupational causation can be aided by employing the Mathias criteria. Certain industries and occupations are associated with higher rates of OCD, and as expected, the industries with direct contact with irritants and allergens are highly represented. The differential diagnosis for occupational dermatitis is broad and should be considered when evaluating an employee with suspected OCD. Some other diagnoses to consider include atopic dermatitis, psoriasis, and manifestations of internal disease, as well as an overlap syndrome of more than one diagnosis. OCD treatment should ideally follow the public health hazard controls' stepwise approach. Prevention and early intervention are key to promoting occupational health and preventing OCD. Multidisciplinary teams have been successful in the treatment of OCD, and newly described topical treatments may provide additional modalities for use in the occupational setting.

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Systemic contact dermatitis (SCD) is poorly understood, and its very existence has even been questioned. Allergic contact dermatitis (ACD) is an immune-mediated, delayed-type hypersensitivity (type-IV) reaction, usually manifesting itself as a visible and symptomatic inflammation of the skin. The majority of patients diagnosed with ACD improve clinically with allergen avoidance. The mainstay of avoidance for most allergens is the prevention of skin contact through discontinuation of products that contain the allergen(s), the selection of alternatives from "safe lists," and counseling patients on environmental sources of allergens. While ACD affects a large percentage of the population, relatively few patients have been documented as having had a significant contribution to their allergic state by allergen exposure through sources other than by cutaneous contact. SCD is defined as provocation or exacerbation of dermatitis by non-cutaneous exposure to an allergen in a patient who is already cutaneously sensitized. Exposure routes in SCD are varied, with the most common and frequently documented being oral exposure. Diet may be an important source of exposure to contact allergens in some patients with ACD, and low-allergen diets have been developed for some common allergens, such as nickel, cobalt, and Balsam of Peru (Myroxylon pereirae). When contact avoidance and dietary restriction of allergen fail, escalation from topical treatments to systemic immune-suppressants may be necessary. Emerging therapies such as nickel oral hypo-sensitization may be beneficial in the future.

In 2001, gold was named Contact Allergen of the Year. More than a decade later, we continue to face several challenges in defining the role of gold in contact allergy. First, interpretation of gold reactions in the setting of epicutaneous patch testing may be difficult; in addition to being a common irritant, gold may be associated with significantly delayed and persistent reactions. Second, although gold compounds are commonly positive on patch testing, clinical relevance is relatively low and may be challenging to determine. Third, the complex interplay between gold and the human body is still poorly understood. In this review, we provide an overview of the literature concerning gold patch test positivity and present recommendations for epicutaneous patch testing with gold.

Although a significant number of nickel dermatitis cases are seen clinically, most cases are neither patch-tested nor captured in the literature, allowing for a prospering hidden nickel epidemic. We present a qualitative review utilizing the public medical library of peer-reviewed US adult nickel dermatitis cases with the goal of identifying regional variations and trends. Between 1962 and 2015, 18,251 adult patients were reported to be sensitized to nickel. The number of articles has exponentially increased over the past 5.5 decades as 4.3% of total cases were reported between the 1960s and 1990s, 31.3% between 2000 and 2009, and 64.3% were reported between 2010 and 2015. Geographically, 27 US states have had at least 1 reported case of adult nickel dermatitis. Rising rates of US nickel dermatitis noted in our findings further highlight the need for medical professionals, legislators, and manufacturers to advocate for regulation of nickel-containing items.

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Epicutaneous patch testing is the gold standard for obtaining a diagnosis of allergic contact dermatitis. Patients with allergic contact dermatitis who are undergoing patch testing may be taking or using topical, oral, or injectable immunosuppressant medications. Herein, we elucidate guidelines for the use of antihistamines and topical systemic immunosuppressants during the patch test process.