Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy

Abstract

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.

Garment industry in Lithuania: a study of self-reported dermatological problems

“…Individuals with atopy are a special risk population for occupational irritant contact dermatitis (20). It is known that irritant contact dermatitis is slightly more frequent than allergic contact dermatitis in textile industry (12)(13)16).…”

Occupational and Non-Occupational Allergic Contact Dermatitis: A Follow-Up Study

“…According to the literature, it could be suggested that sex (female), atopy, and wet work should be considered as markers of poor prognosis primarily for ICD. Wet work is known as a highly important occupational and non-occupational skin irritant and is performed mainly by female workers [3], while atopy in the form of childhood or adult atopic eczema or some other atopic disease is undoubtedly the most important independent risk factor in the development of ICD [4,10,30]. It could be stated that predictors of ACD prognosis have not yet been clearly defined, but there is agreement about the influence and interactions of genetic and environmental factors on the development and course of ACD [1,22], with a thus far more clearly presented influence of environmental factors [3,31].…”

“…However, the influence of these gene polymorphisms has not yet been clearly established, and the impact of FLG mutations has been shown for the development of nickel ACD [7,8]. Atopy, defined as a genetically defined tendency toward the development of IgE-mediated immune reactions to common environmental allergens with allergic rhinitis, allergic asthma or atopic dermatitis as related clinical phenotypes [9], is clearly presented as the most important risk factor in the development of irritant contact dermatitis (ICD) [4,10]. However, the impact of atopy on the development and course of CS and ACD is still controversial.…”

Clinical and demographic characteristics of patients with occupational contact dermatitis: A 3-year single center experience

“…Eldiven kullanımı ile egzamaların yerleşim yerleri, duyarlanılan alerjenler ve atopi öyküsü arasında ilişki bulunamadı. Eldiven kullanan hastaların yaş ortalaması (34), kullanmayanlardan (41) daha düşüktü (p<0,05), yiyecek sektörü çalışanlarının eldiven kullanma oranı diğer gruplardan yüksekti (p=0,03). Eldiven kullanım oranları Grafik 1' de özetlendi.…”

“…Sorgulanan hasta sayısı az olmakla beraber çalışmamızda 19 irritan MKD'li hastanın 7'sinde atopi öyküsü saptanmıştır. Atopi varlığının irritan MKD'li hastalarda tedaviye dirence neden olduğu, daha fazla kortikosteroid kullanımı ve işgücü kaybıyla ilişkili olduğu gösterilmiştir 34 . Tedavi sırasında atopi sorgulanması ve bu hasta grubuna özel ilgi gösterilmesi tedavi başarısı yüzdesini arttıracaktır.…”