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Contact dermatitis

Dermatitis - contact; Allergic dermatitis; Dermatitis - allergic; Irritant contact dermatitis; Skin rash - contact dermatitis

 

Contact dermatitis is a condition in which the skin becomes red, sore, or inflamed after direct contact with a substance.

Causes

 

There are 2 types of contact dermatitis.

Irritant dermatitis: This is the most common type. It can be by contact with acids, alkaline materials such as soaps and detergents, fabric softeners, solvents, or other chemicals. The reaction most often looks like a burn. It is not caused by an allergy, but rather the skin's reaction to a very irritating substance.

Other materials that may irritate your skin include:

  • Cement
  • Hair dyes
  • Long-term exposure to wet diapers
  • Pesticides or weed killers
  • Rubber gloves
  • Shampoos

Allergic contact dermatitis: This form of the condition occurs when your skin comes in contact with a substance that causes you to have an allergic reaction.

Common allergens include:

  • Adhesives, including those used for false eyelashes or toupees
  • Antibiotics, such as neomycin rubbed on the surface of the skin
  • Balsam of Peru (used in many personal products and cosmetics, as well as in many foods and drinks)
  • Fabrics and clothing
  • Fragrances in perfumes, cosmetics, soaps, and moisturizers
  • Nail polish, hair dyes, and permanent wave solutions
  • Nickel or other metals (found in jewelry, watch straps, metal zips, bra hooks, buttons, pocketknives, lipstick holders, and powder compacts)
  • Poison ivy, poison oak, poison sumac, and other plants
  • Rubber or latex gloves or shoes

You will not have a reaction to a substance when you are first exposed to the substance. However, you will form a reaction after future exposures. You may become more sensitive and develop a reaction if you use it regularly. The reaction most often occurs 24 to 48 hours after the exposure.

Some products cause a reaction only when the skin is also exposed to sunlight (photosensitivity). These include:

  • Shaving lotions
  • Sunscreens
  • Sulfa ointments
  • Some perfumes
  • Coal tar products
  • Oil from the skin of a lime

A few airborne allergens, such as ragweed or insecticide spray, can also cause contact dermatitis.

 

Symptoms

 

Symptoms vary depending on the cause and whether the dermatitis is due to an allergic reaction or an irritant. The same person may also have different symptoms over time.

Allergic reactions may occur suddenly, or develop after months of exposure.

Contact dermatitis often occurs on the hands. Hair products, cosmetics, and perfumes can lead to skin reactions on the face, head, and neck. Jewelry can also cause skin problems in the area under it.

Itching is a common symptom. In the case of an allergic dermatitis, itching can be severe.

You may have red, streaky, or patchy rash where the substance touched the skin. The allergic reaction is often delayed so that the rash may not appear until 24 to 48 hours after exposure.

The rash may:

  • Have red bumps that may form moist, weeping blisters
  • Feel warm and tender
  • Ooze, drain, or crust
  • Become scaly, raw, or thickened

Dermatitis caused by an irritant may also cause burning or pain as well as itching. Irritant dermatitis often shows as dry, red, and rough skin. Cuts (fissures) may form on the hands. Skin may become inflamed with long-term exposure.

 

Exams and Tests

 

Your health care provider will make the diagnosis based on how the skin looks and by asking questions about substances you may have come in contact with.

Allergy testing with skin patches (called patch testing) may determine what is causing the reaction. Patch testing is used for certain people who have long-term or repeated contact dermatitis. It requires 3 office visits and must be done by a provider with the skill to interpret the results correctly.

  • On the first visit, small patches of possible allergens are applied to the skin. These patches are removed 48 hours later to see if a reaction has occurred.
  • A third visit, about 2 days later, is done to look for any delayed reaction.
  • If you have already tested a material on a small area of your skin and noticed a reaction, you should bring the material with you.

Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion.

 

Treatment

 

Your doctor will recommend treatment based on what is causing the problem. In some cases, the best treatment is to do nothing to the area.

Often, treatment includes washing the area with a lot of water to get rid of any traces of the irritant that are still on the skin. You should avoid further exposure to the substance.

Emollients or moisturizers help keep the skin moist, and also help skin repair itself. They protect the skin from becoming inflamed again. They are a key part of preventing and treating contact dermatitis.

Topical corticosteroids are medicines used to treat eczema.

  • Topical means you place it on the skin. You will be prescribed a cream or ointment. Topical corticosteroids may also be called topical steroids or topical cortisones.
  • DO NOT use more medicine or use it more often than your doctor advises you to use it.

Your provider may also prescribe other creams or ointments, such as tacrolimus or pimecrolimus, to use on the skin.

In severe cases, you may need to take corticosteroid pills. Your provider will start you on a high dose and your dose will be slowly reduced over about 12 days. You may also receive a corticosteroid shot.

Wet dressings and soothing anti-itch (antipruritic) lotions may be recommended to reduce other symptoms.

 

Outlook (Prognosis)

 

Contact dermatitis clears up without complications in 2 or 3 weeks in most cases. However, it may return if the substance that caused it cannot be found or avoided.

You may need to change your job or job habits if the disorder is caused by exposure at work.

Sometimes, the allergen causing the reaction is never identified.

 

Possible Complications

 

Bacterial skin infections may occur.

 

When to Contact a Medical Professional

 

Call your provider if:

  • You have symptoms of contact dermatitis.
  • The skin reaction is severe.
  • You do not get better after treatment.
  • Signs of infection such as tenderness, redness, warmth, or fever.

 

 

References

Habif TP. Contact dermatitis and patch testing. In: Habif TP, ed. Clinical Dermatology. 6th ed. St. Louis, MO: Elsevier Saunders; 2016:chap 4.

Nixon RL, Diepgen T. Contact dermatitis. In: Adkinson NF, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 35.

Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010; 82:249-55. PMID: 20672788 www.ncbi.nlm.nih.gov/pubmed/20672788.

 
  • Poison oak rash on the arm

    Poison oak rash on the arm - illustration

    Poison oak rash on the arm. Several plants produce toxins that cause skin reaction. This is the appearance of poison oak dermatitis. Note the typical linear streaks produced either by scratching or brushing against the plant. (Image courtesy of the Centers for Disease Control and Prevention.)

    Poison oak rash on the arm

    illustration

  • Poison plants

    Poison plants - illustration

    The term "dermatitis" describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. An example of contact dermatitis is the reaction of a sensitive person's skin to poison ivy, oak or sumac. Contact with these plants, which contain a chemical called urushiol, produces an itchy rash, redness, blisters and scaling. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.

    Poison plants

    illustration

  • Dermatitis, nickel on the sole

    Dermatitis, nickel on the sole - illustration

    The metal, nickel, can cause inflammation (erythema), rash, and itching. Nickel dermatitis is relatively common, and can be seen on the wrist from the stainless backs of watches, on the earlobes from nickel plated earrings, or elsewhere on the body from snaps. This person was in contact with something made of nickel or containing nickel salts.

    Dermatitis, nickel on the sole

    illustration

  • Dermatitis, contact

    Dermatitis, contact - illustration

    This picture shows a skin inflammation (dermatitis) caused by contact with a material that causes an allergic reaction in this person. Contact dermatitis is a relatively common condition, and can be caused by many substances.

    Dermatitis, contact

    illustration

  • Dermatitis, close-up of allergic contact

    Dermatitis, close-up of allergic contact - illustration

    This is an example of an allergic skin reaction (allergic dermatitis) caused by hair dye. The skin on the neck is red (erythematous), thickened (lichenified), scaly, and crusted.

    Dermatitis, close-up of allergic contact

    illustration

  • Dermatitis, contact on the cheek

    Dermatitis, contact on the cheek - illustration

    This picture shows a person with a skin inflammation (dermatitis) on the cheek caused by contact with a substance that produced an allergic reaction (allergen). Contact dermatitis causes redness, itching, and small blisters (vesicles).

    Dermatitis, contact on the cheek

    illustration

  • Dermatitis, pustular contact

    Dermatitis, pustular contact - illustration

    This is a close-up of a dermatitis reaction. It consists of a large, red (erythematous) lesion (plaque) with numerous small pus-filled areas (pustules).

    Dermatitis, pustular contact

    illustration

  • Poison ivy on the knee

    Poison ivy on the knee - illustration

    This is a typical early appearance of a poison ivy rash, located on the knee. These early lesions consist of multiple small blisters (vesicles), often in a line where the skin has brushed against the poison ivy plant.

    Poison ivy on the knee

    illustration

  • Poison ivy on the leg

    Poison ivy on the leg - illustration

    This is a typical early appearance of a poison ivy rash, located on the leg. These early lesions consist of multiple small blisters, often in a line where the skin has brushed against the poison ivy plant. The rash is caused by skin contact with the oily sap (resin) of these plants. The oily resin usually enters the skin rapidly, and is seldom transferred from person to person. The rash is not caused by the fluid from the blisters. Thus, once the person has washed the oil off the skin, the rash is usually not contagious.

    Poison ivy on the leg

    illustration

  • Phytophotodermatitis on the hand

    Phytophotodermatitis on the hand - illustration

    This person is sensitive to chemicals used in perfumes, and now develops a rash when the area is exposed to light (Phytophotodermatitis). These perfumes include Oil of Bergamot, an oil also found in some citrus fruits and wild plants. It results in streaky redness (erythema) and pigmentary changes.

    Phytophotodermatitis on the hand

    illustration

    • Poison oak rash on the arm

      Poison oak rash on the arm - illustration

      Poison oak rash on the arm. Several plants produce toxins that cause skin reaction. This is the appearance of poison oak dermatitis. Note the typical linear streaks produced either by scratching or brushing against the plant. (Image courtesy of the Centers for Disease Control and Prevention.)

      Poison oak rash on the arm

      illustration

    • Poison plants

      Poison plants - illustration

      The term "dermatitis" describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. An example of contact dermatitis is the reaction of a sensitive person's skin to poison ivy, oak or sumac. Contact with these plants, which contain a chemical called urushiol, produces an itchy rash, redness, blisters and scaling. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.

      Poison plants

      illustration

    • Dermatitis, nickel on the sole

      Dermatitis, nickel on the sole - illustration

      The metal, nickel, can cause inflammation (erythema), rash, and itching. Nickel dermatitis is relatively common, and can be seen on the wrist from the stainless backs of watches, on the earlobes from nickel plated earrings, or elsewhere on the body from snaps. This person was in contact with something made of nickel or containing nickel salts.

      Dermatitis, nickel on the sole

      illustration

    • Dermatitis, contact

      Dermatitis, contact - illustration

      This picture shows a skin inflammation (dermatitis) caused by contact with a material that causes an allergic reaction in this person. Contact dermatitis is a relatively common condition, and can be caused by many substances.

      Dermatitis, contact

      illustration

    • Dermatitis, close-up of allergic contact

      Dermatitis, close-up of allergic contact - illustration

      This is an example of an allergic skin reaction (allergic dermatitis) caused by hair dye. The skin on the neck is red (erythematous), thickened (lichenified), scaly, and crusted.

      Dermatitis, close-up of allergic contact

      illustration

    • Dermatitis, contact on the cheek

      Dermatitis, contact on the cheek - illustration

      This picture shows a person with a skin inflammation (dermatitis) on the cheek caused by contact with a substance that produced an allergic reaction (allergen). Contact dermatitis causes redness, itching, and small blisters (vesicles).

      Dermatitis, contact on the cheek

      illustration

    • Dermatitis, pustular contact

      Dermatitis, pustular contact - illustration

      This is a close-up of a dermatitis reaction. It consists of a large, red (erythematous) lesion (plaque) with numerous small pus-filled areas (pustules).

      Dermatitis, pustular contact

      illustration

    • Poison ivy on the knee

      Poison ivy on the knee - illustration

      This is a typical early appearance of a poison ivy rash, located on the knee. These early lesions consist of multiple small blisters (vesicles), often in a line where the skin has brushed against the poison ivy plant.

      Poison ivy on the knee

      illustration

    • Poison ivy on the leg

      Poison ivy on the leg - illustration

      This is a typical early appearance of a poison ivy rash, located on the leg. These early lesions consist of multiple small blisters, often in a line where the skin has brushed against the poison ivy plant. The rash is caused by skin contact with the oily sap (resin) of these plants. The oily resin usually enters the skin rapidly, and is seldom transferred from person to person. The rash is not caused by the fluid from the blisters. Thus, once the person has washed the oil off the skin, the rash is usually not contagious.

      Poison ivy on the leg

      illustration

    • Phytophotodermatitis on the hand

      Phytophotodermatitis on the hand - illustration

      This person is sensitive to chemicals used in perfumes, and now develops a rash when the area is exposed to light (Phytophotodermatitis). These perfumes include Oil of Bergamot, an oil also found in some citrus fruits and wild plants. It results in streaky redness (erythema) and pigmentary changes.

      Phytophotodermatitis on the hand

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

        Tests for Contact dermatitis

         

           

          Review Date: 7/23/2015

          Reviewed By: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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