Contact Dermatitis

Definition

Contact dermatitis is inflammation of the outer layers of the skin caused by contact with a particular substance. It usually presents as a rash that is confined to the specific area of the body where the contact occurred.
Contact Dermatitis
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Causes

Contact dermatitis is usually caused by either an irritant or an allergen. An irritant is a substance that irritates the skin. An allergen is a substance that causes an allergic reaction. People may be exposed to certain substances for years and never have a problem, and then suddenly develop contact dermatitis.Some common causes of contact dermatitis include:
  • Acids
  • Alkalis
  • Solvents
  • Acetone
  • Soaps
  • Detergents
  • Metals, such as nickel—common in jewelry allergy
  • Rubber
  • Latex
  • Cosmetics and toiletries
  • Deodorants
  • Sunlight or artificial light
  • Preservatives
  • Plants, such as poison ivy
  • Medications

Risk Factors

Factors that may increase your risk of contact dermatitis include:
  • Contact with an irritant or allergen
  • Allergies to certain substances, such as plants, chemicals, or medications

Symptoms

The symptoms of contact dermatitis may vary from person to person. Scratching and rubbing can cause or worsen some symptoms. The rash is usually confined to the area where the contact with the substance occurred, but occasionally may spread. If contact with the substance occurred all over the body, such as with a body lotion, the rash may be large.Symptoms include:
  • Itching
  • Redness
  • Swelling
  • Blisters
  • Crusting, oozing, and scaling
  • Temporary thickening of the skin

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a doctor who specializes in skin disorders (dermatologist) or allergies (allergist).

Treatment

The primary goal of treatment is to identify the substance causing the reaction and remove or avoid it. This could take several days or weeks of avoiding certain substances.If you cannot identify the cause of your skin reaction, you may need to have a skin patch test. In a skin patch test, a small amount of the suspected substance is applied to the skin and covered with tape. Another patch without the substance on it is also attached to the skin. Both patches are removed after a period of time. If your skin is red and swollen under the suspected substance patch, and not under the other patch, you are probably allergic to that substance.Treatment also focuses on caring for skin and relieving symptoms. Methods include:

Skin Care

Skin care guidelines may include:
  • Wash the area with water and mild soap or cleanser and gently pat dry.
  • Apply a barrier ointment such as petrolatum or petroleum jelly.
  • Do not poke at or cut open blisters. They can become infected.
  • Cover blisters with dry bandages.

Medications

Do not use any of these medications until after you have discussed them with your doctor.
  • Over-the-counter or prescription creams and ointments containing cortisone
  • Prescription medications containing corticosteroids, such as prednisone—for severe cases
  • Prescription or over-the-counter antihistamines—may relieve itching in some cases, but not always useful for contact dermatitis
  • Phototherapy or immunosuppressants in the most severe, resistant, and chronic cases

Prevention

To prevent contact dermatitis:
  • Identify the allergens and irritants that cause the condition and try to avoid them.
  • If you have to come into contact with these substances, wear gloves and protective clothing.
  • Use protective skin cream and take care of your skin.

RESOURCES

American Academy of Allergy, Asthma, and Immunology
http://www.aaaai.org

American Academy of Dermatology
http://www.aad.org

CANADIAN RESOURCES

Canadian Dermatology Association
http://www.dermatology.ca

Health Canada
http://www.hc-sc.gc.ca

References

Bourke J, Coulson I, English J. Guidelines for care of contact dermatitis. Br J Dermatol. 2001;145:877-885.

11/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kütting B, Baumeister T, et al. Effectiveness of skin protection measures in prevention of occupational hand eczema: results of a prospective randomized controlled trial over a follow-up period of 1 year. Br J Dermatol. 2009 Sep 1. [Epub ahead of print]

2/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Dawe R, Ferguson J. Diagnosis and treatment of chronic actinic dermatitis. Dermatol Ther. 2003;16(1):45-51.

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