A precision medicine approach to allergic contact dermatitis: current evidence and future opportunities

Allergic contact dermatitis (ACD) is a common inflammatory skin disease arising from interactions between environmental exposures and individual susceptibility. While patch testing and allergen avoidance remain cornerstones of management, advances in genetics, barrier biology and digital technologies present opportunities for more precise approaches to prediction, prevention and management. Here, we review evidence for genetic susceptibility and gene–environment interactions in ACD, including variation in epidermal barrier function, immune regulation and xenobiotic metabolism, and consider the role of genetic counselling in interpreting and communicating risk. We further examine emerging applications of artificial intelligence in patch-test interpretation, exposure assessment and predictive modelling. Finally, we propose a future framework for precision approaches to ACD, integrating genomic, phenotypic and exposomic data to characterise individual risk and disease endotypes. These insights could inform more individualised prevention, diagnosis and therapeutic selection, while supporting personalised skincare and safer topical product design. Although substantial challenges remain, convergence of these fields may shift ACD from a predominantly reactive model towards a more predictive, preventive and personalised framework.