Contact dermatitis

Contact dermatitis is a type of

inflammation of the skin.
 Contact dermatitis

Rash resulting from skin reactions.

Specialty Dermatology

It results from either exposure to allergens

(allergic contact dermatitis) or irritants
(irritant contact dermatitis). Phototoxic
dermatitis occurs when the allergen or
irritant is activated by sunlight. Diagnosis
of allergic contact dermatitis can often be
supported by patch testing.[1]

Signs and symptoms

Contact dermatitis is a localized rash or
irritation of the skin caused by contact
with a foreign substance. Only the
superficial regions of the skin are affected
in contact dermatitis. Inflammation of the
affected tissue is present in the epidermis
(the outermost layer of skin) and the outer
dermis (the layer beneath the
epidermis).[2]

Contact dermatitis results in large,

burning, and itchy rashes. These can take
anywhere from several days to weeks to
heal. This differentiates it from contact
urticaria (hives), in which a rash appears
within minutes of exposure and then fades
away within minutes to hours. Even after
days, contact dermatitis fades only if the
skin no longer comes in contact with the
allergen or irritant.[3] Chronic contact
dermatitis can develop when the removal
of the offending agent no longer provides
expected relief.

Irritant dermatitis is usually confined to the

area where the trigger actually touched the
skin, whereas allergic dermatitis may be
more widespread on the skin. Symptoms
of both forms include the following:

Red rash. This is the usual reaction. The

rash appears immediately in irritant
contact dermatitis; in allergic contact
dermatitis, the rash sometimes does not
appear until 24–72 hours after exposure
to the allergen.
Blisters or wheals. Blisters, wheals
(welts), and urticaria (hives) often form
in a pattern where skin was directly
exposed to the allergen or irritant.
Itchy, burning skin. Irritant contact
dermatitis tends to be more painful than
 itchy, while allergic contact dermatitis
often itches.

While either form of contact dermatitis

can affect any part of the body, irritant
contact dermatitis often affects the hands,
which have been exposed by resting in or
dipping into a container (sink, pail, tub,
swimming pools with high chlorine)
containing the irritant.

Causes
Common causes of allergic contact
dermatitis include: nickel allergy, 14K or
18K gold, Balsam of Peru (Myroxylon
pereirae), and chromium. In the Americas
they include the oily coating from plants of
the genus Toxicodendron: poison ivy,
poison oak, and poison sumac. Millions of
cases occur each year in North America
alone.[4] The alkyl resorcinols in Grevillea
banksii and Grevillea 'Robyn Gordon' are
responsible for contact dermatitis.[5]
Bilobol, another alkyl resorcinol found in
Ginkgo biloba fruits, is also a strong skin
irritant.[6]

Common causes of irritant contact

dermatitis include solvents, metalworking
fluids, latex, kerosene, ethylene oxide,
paper, especially papers coated with
chemicals and printing inks, certain foods
and drink,[7] food flavorings and spices,[8]
perfume,[7] surfactants in topical
medications and cosmetics, alkalis, low
humidity from air conditioning, and many
plants. Other common causes of irritant
contact dermatitis are harsh, alkaline
soaps, detergents, and cleaning
products.[9]

There are three types of contact

dermatitis: irritant contact dermatitis;
allergic contact dermatitis; and
photocontact dermatitis. Photocontact
dermatitis is divided into two categories:
phototoxic and photoallergic.
Irritant contact dermatitis

Irritant contact dermatitis (ICD) can be

divided into forms caused by chemical
irritants, and those caused by physical
irritants. Common chemical irritants
implicated include: solvents (alcohol,
xylene, turpentine, esters, acetone,
ketones, and others); metalworking fluids
(neat oils, water-based metalworking
fluids with surfactants); latex; kerosene;
ethylene oxide; surfactants in topical
medications and cosmetics (sodium lauryl
sulfate); and alkalis (drain cleaners, strong
soap with lye residues).
Physical irritant contact dermatitis may
most commonly be caused by low
humidity from air conditioning.[10] Also,
many plants directly irritate the skin.

Allergic contact dermatitis

3-year-old girl with contact dermatitis, one day after

contact with poison ivy
Allergic contact dermatitis (ACD) is
accepted to be the most prevalent form of
immunotoxicity found in humans, and is a
common occupational and environmental
health problem.[11] By its allergic nature,
this form of contact dermatitis is a
hypersensitive reaction that is atypical
within the population. The mechanisms by
which this reaction occurs are complex,
with many levels of fine control. Their
immunology centres on the interaction of
immunoregulatory cytokines and discrete
subpopulations of T lymphocytes.

Allergens include nickel, gold, Balsam of

Peru (Myroxylon pereirae), chromium, and
the oily coating from plants of the genus
Toxicodendron, such as poison ivy, poison
oak, and poison sumac.

Photocontact dermatitis

Sometimes termed "photoaggravated",[12]

and divided into two categories,
phototoxic and photoallergic, PCD is the
eczematous condition which is triggered
by an interaction between an otherwise
unharmful or less harmful substance on
the skin and ultraviolet light (320–400 nm
UVA) (ESCD 2006), therefore manifesting
itself only in regions where the sufferer
has been exposed to such rays.
Without the presence of these rays, the
photosensitiser is not harmful. For this
reason, this form of contact dermatitis is
usually associated only with areas of skin
which are left uncovered by clothing, and it
can be soundly defeated by avoiding
exposure to sunlight.[13] The mechanism
of action varies from toxin to toxin, but is
usually due to the production of a
photoproduct. Toxins which are
associated with PCD include the
psoralens. Psoralens are in fact used
therapeutically for the treatment of
psoriasis, eczema, and vitiligo.
Photocontact dermatitis is another
condition in which the distinction between
forms of contact dermatitis is not clear-
cut. Immunological mechanisms can also
play a part, causing a response similar to
ACD.

Diagnosis

Patch test
Since contact dermatitis relies on an
irritant or an allergen to initiate the
reaction, it is important for the patient to
identify the responsible agent and avoid it.
This can be accomplished by having patch
tests, one of various methods commonly
known as allergy testing.[14] The top three
allergens found in patch tests from 2005–
06 were: nickel sulfate (19.0%), Myroxylon
pereirae (Balsam of Peru, 11.9%), and
fragrance mix I (11.5%).[15]

The patient must know where the irritant

or allergen is found to be able to avoid it. It
is important to also note that chemicals
sometimes have several different names,
and do not always appear on labels.[16]

The distinction between the various types

of contact dermatitis is based on a
number of factors. The morphology of the
tissues, the histology, and immunologic
findings are all used in diagnosis of the
form of the condition. However, as
suggested previously, there is some
confusion in the distinction of the different
forms of contact dermatitis.[17] Using
histology on its own is insufficient, as
these findings have been acknowledged
not to distinguish,[17] and even positive
patch testing does not rule out the
existence of an irritant form of dermatitis
as well as an immunological one.

Prevention
In an industrial setting the employer has a
duty of care to its worker to provide the
correct level of safety equipment to
mitigate exposure to harmful irritants. This
can take the form of protective clothing,
gloves, or barrier cream, depending on the
working environment.

Topical antibiotics should not be used to

prevent infection in wounds after
surgery.[18] When they are used, it is
inappropriate, and the person recovering
from surgery is at significantly increased
risk of developing contact dermatitis.[18]

Treatment
Self-care

If blistering develops, cold moist

compresses[19] applied for 30 minutes, 3
times a day can offer relief.
Calamine lotion may relieve itching.[19]
Oral antihistamines such as
diphenhydramine (Benadryl, Ben-
Allergin) can relieve itching.[19]
Avoid scratching.[19]
Immediately after exposure to a known
allergen or irritant, wash with soap and
cool water to remove or inactivate most
of the offending substance.
For mild cases that cover a relatively
small area, hydrocortisone cream in
nonprescription strength may be
sufficient.
Weak acid solutions (lemon juice,
vinegar) can be used to counteract the
effects of dermatitis contracted by
exposure to basic irritants.
A barrier cream, such as those
containing zinc oxide (e.g., Desitin, etc.),
 may help protect the skin and retain
moisture.

Medical care

If the rash does not improve or continues

to spread after 2–3 of days of self-care, or
if the itching and/or pain is severe, the
patient should contact a dermatologist or
other physician. Medical treatment usually
consists of lotions, creams, or oral
medications.

Corticosteroids. A corticosteroid
medication like hydrocortisone may be
prescribed to combat inflammation in a
localized area. It may be applied to the
 skin as a cream or ointment. If the
reaction covers a relatively large portion
of the skin or is severe, a corticosteroid
in pill or injection form may be
prescribed.

In severe cases, a stronger medicine like

halobetasol may be prescribed by a
dermatologist.

Antihistamines. Prescription
antihistamines may be given if non-
prescription strengths are inadequate.

See also
Urushiol-induced contact dermatitis
Nickel allergy
 Eczema

References
1. Mowad, CM (July 2016). "Contact
Dermatitis: Practice Gaps and
Challenges". Dermatologic Clinics. 34
(3): 263–7.
doi:10.1016/j.det.2016.02.010 .
PMID 27363882 .
2. European Society of Contact
Dermatitis. "What is contact
dermatitis" .
3. "DermNet NZ: Contact Dermatitis" .
Retrieved 2006-08-14.
4. Gladman A. C. (2006). "Toxicodendron
dermatitis: poison ivy, oak, and
sumac". Wilderness & Environmental
Medicine. 17 (2): 120–8.
doi:10.1580/pr31-05.1 .
PMID 16805148 .
5. Menz, J.; Rossi, ER; Taylor, WC; Wall, L;
et al. (1986). "Contact dermatitis from
Grevillea 'Robyn Gordon' ". Contact
Dermatitis. 15 (3): 126–31.
doi:10.1111/j.1600-
0536.1986.tb01311.x .
PMID 2946534 .
6. Matsumoto, K.; Fujimoto, Masao; Ito,
Kazuo; Tanaka, Hitoshi; Hirono, Iwao;
et al. (1990). "Comparison of the
effects of bilobol and 12-O-
tetradecanoylphorbol-13-acetate on
skin, and test of tumor promoting
potential of bilobol in CD-1 mice". The
Journal of Toxicological Sciences. 15
(1): 39–46. doi:10.2131/jts.15.39 .
PMID 2110595 .
7. "Balsam of Peru contact allergy" .
DermNet NZ. 2013-12-28. Retrieved
2014-04-17.
 8. "Contact Dermatitis and Related
Conditions" .
Clevelandclinicmeded.com. Retrieved
2014-04-17.
9. Irritant Contact Dermatitis.
DermNetNZ.org
10. Morris-Jones R, Robertson SJ, Ross
JS, White IR, McFadden JP, Rycroft RJ
(2002). "Dermatitis caused by physical
irritants". Br. J. Dermatol. 147 (2):
270–5. doi:10.1046/j.1365-
2133.2002.04852.x .
PMID 12174098 .
11. Kimber I, Basketter DA, Gerberick GF,
Dearman RJ (2002). "Allergic contact
dermatitis" . Int. Immunopharmacol. 2
(2–3): 201–11. doi:10.1016/S1567-
5769(01)00173-4 . PMID 11811925 .
12. Bourke J, Coulson I, English J (2001).
"Guidelines for care of contact
dermatitis". Br. J. Dermatol. 145 (6):
877–85. doi:10.1046/j.1365-
2133.2001.04499.x .
PMID 11899139 .
13. "Photocontact Dermatitis" .
www.skinchannel.com. Retrieved
31 March 2011.
14. Hristakieva E, Gancheva D, Gancheva
T; Trakia University. "Contact
dermatitis in patient with chronic
venous insufficiency". Research Gate
(2014) .
15. Zug KA, Warshaw EM, Fowler JF Jr,
Maibach HI, Belsito DL, Pratt MD,
Sasseville D, Storrs FJ, Taylor JS,
Mathias CG, Deleo VA, Rietschel RL,
Marks J. Patch-test results of the
North American Contact Dermatitis
Group 2005–2006. Dermatitis. 2009
May–Jun;20(3):149-60.
16. DermNet dermatitis/contact-allergy
17. Rietschel RL (1997). "Mechanisms in
irritant contact dermatitis" . Clin.
Dermatol. 15 (4): 557–9.
doi:10.1016/S0738-081X(97)00058-8 .
PMID 9255462 .
18. American Academy of Dermatology
(February 2013), "Five Things
Physicians and Patients Should
Question" , Choosing Wisely: an
initiative of the ABIM Foundation,
American Academy of Dermatology,
retrieved 5 December 2013
Sheth, V. M.; Weitzul, S. (2008).
"Postoperative topical
antimicrobial use". Dermatitis :
Contact, Atopic, Occupational,
Drug. 19 (4): 181–189.
PMID 18674453 .
19. "Contact dermatitis Lifestyle and home
remedies – Diseases and Conditions" .
Mayo Clinic. 2011-07-30. Retrieved
2014-04-18.

External links
Classification ICD-10: L25.9 • D

ICD-9-CM: 692.9 •
MeSH: D003877 •
DiseasesDB: 29585

External resources MedlinePlus: 000869 •

eMedicine: emerg/131
ped/2569 oph/480

Wikimedia Commons has media

related to Contact dermatitis.
 eMedicine Health article on contact
dermatitis

Retrieved from
"https://en.wikipedia.org/w/index.php?
title=Contact_dermatitis&oldid=876751794"

Last edited 5 months ago by Citatio…

Content is available under CC BY-SA 3.0 unless

otherwise noted.