Our results indicate that both FLG mutations and AD increase the risk of ICD. Individuals with concurrent FLG mutations and AD are at the highest risk of developing ICD.

Chromium compounds and adhesives were the most common causes of allergic contact dermatitis among our foot patients. Psoriasis should be considered, particularly when the hands are concomitantly affected.

Chromium compounds and adhesives were the most common causes of allergic contact dermatitis among our foot patients. Psoriasis should be considered, particularly when the hands are concomitantly affected.

Allergic contact dermatitis is a leading cause of periorbital dermatitis. Patch testing should be considered in all patients with periorbital dermatitis when contact allergy is suspected, in order to identify and avoid offending allergens.

SummaryBackground Filaggrin loss-of-function mutations and atopy may alter the clinical course of irritant contact dermatitis (ICD). Objective To investigate the clinical course of patients with occupational ICD according to loss-of-function mutations in the filaggrin gene (FLG) and atopy. Methods In a prospective cohort study, the clinical course, use of topical corticosteroids, sick leave, recovery rate and job continuation were investigated in 459 inpatients treated for occupational ICD of the hands. Patients were genotyped for four FLG mutations, examined for atopy and followed for up to 3 years after discharge. Results Our study included 327 (71AE2%) atopic individuals and 132 nonatopic individuals. Overall, 68 patients showed a mutation in the FLG alleles R501X, R2447X, S3247X and 2282del4 (60 atopic and eight nonatopic). Nonatopic patients with ICD responded well to therapeutic approaches, while atopy status made subjects more resistant to therapy, resulting in lower rates of recovery and job continuation and higher use of topical corticosteroids. Carriage of FLG lossof-function mutations in combination with atopy worsened the course. The risk of abandoning one's profession in this group was significantly increased when compared with 'pure' ICD (odds ratio 3AE1) after 3 years. Conclusions Patients with atopy are a special risk population for ICD. In the presence of atopy, FLG mutations seem to be a modifier of the severity of the clinical course in ICD. Early-stage identification of this subgroup may result in additional emphasis to these patients regarding the importance of adherence to specific therapeutic interventions.