title: Clinical course of occupational irritant contact dermatitis of the hands in relation to filaggrin genotype status and atopy.
abstract: 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.
authors.affiliation: Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany. llandeck@uos.de
authors.forename: L
authors.initials: L
authors.lastname: Landeck
authors.forename: M
authors.initials: M
authors.lastname: Visser
authors.forename: C
authors.initials: C
authors.lastname: Skudlik
authors.forename: R
authors.initials: R
authors.lastname: Brans
authors.forename: S
authors.initials: S
authors.lastname: Kezic
authors.forename: S M
authors.initials: SM
authors.lastname: John
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017453:Dermatitis, Irritant / Q000235:genetics*; D009783:Dermatitis, Occupational / Q000235:genetics*; D005260:Female; D000091344:Filaggrin Proteins; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006225:Hand; D006801:Humans; D007381:Intermediate Filament Proteins / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011110:Polymorphism, Genetic; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D044465:White People; D055815:Young Adult
chemical_list: C000717249:FLG protein, human; D000091344:Filaggrin Proteins; D007381:Intermediate Filament Proteins