Funding sources None.
Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy
Article first published online: 26 NOV 2012
© 2012 The Authors. BJD © 2012 British Association of Dermatologists 2012
British Journal of Dermatology
Volume 167, Issue 6, pages 1302–1309, December 2012
How to Cite
Landeck, L., Visser, M., Skudlik, C., Brans, R., Kezic, S. and John, S.M. (2012), Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy. British Journal of Dermatology, 167: 1302–1309. doi: 10.1111/bjd.12035
Conflicts of interest None to declare.
S.K. and S.M.J. contributed equally to this manuscript.
- Issue published online: 26 NOV 2012
- Article first published online: 26 NOV 2012
- Accepted manuscript online: 10 SEP 2012 10:40AM EST
- Accepted for publication 24 August 2012
Background 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 (71·2%) 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 loss-of-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 3·1) 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.