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Contact dermatitis

Definition

Contact dermatitis is a condition in which the skin becomes red, sore, or inflamed after direct contact with a substance. There are two kinds of contact dermatitis: irritant or allergic.

See also: Poison ivy - oak - sumac

Alternative Names

Dermatitis - contact; Allergic dermatitis; Dermatitis - allergic

Causes

Irritant dermatitis is the most common type. It's caused by contact with acids, alkaline materials such as soaps and detergents, fabric softeners, solvents, or other chemicals. The reaction usually looks like a burn.

Other irritants may include:

Allergic contact dermatitis is caused by exposure to a substance or material to which you have become extra sensitive or allergic.

Common allergens include:

Although you may not have a reaction to a substance when you are first exposed to it, regular use can eventually cause sensitivity and a reaction to the product.

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, and oil from the skin of a lime. A few airborne allergens, such as ragweed or insecticide spray, can 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 only after months of being exposed to a substance.

The hands are a common site for contact dermatitis. Hair products, cosmetics, and perfumes often lead to skin reactions on the face, head, and neck. Jewelry can also cause skin problems in the area under it.

Itching of the skin in exposed areas is a common symptom. In the case of an allergic dermatitis, itching can be severe. Dermatitis caused by an irritant may also cause burning or pain.

Allergic dermatitis often causes a red, streaky, or patchy rash where the substance touched the skin. The allergic reaction is often delayed, with the rash appearing 24 - 48 hours after exposure. The rash may:

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

The diagnosis is mostly based on the skin appearance and a history of exposure to an irritant or an allergen.

Allergy testing with skin patches (called patch testing) may determine which allergen is causing the reaction. Patch testing is used for certain patients who have long-term, repeated contact dermatitis. It requires three office visits and must be done by a health care provider with the experience and skill to interpret the results correctly.

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

Treatment

Treatment includes washing with lots of water to remove any traces of the irritant that may remain on the skin. You should avoid further exposure to known irritants or allergens.

In some cases, the best treatment is to do nothing to the area.

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.

Corticosteroid skin creams or ointments may reduce inflammation. Carefully follow the instructions when using these creams. Overuse, even of low-strength over-the-counter products, may cause a skin condition.

Along with, or instead of corticosteroids, your health care provider may prescribe drugs called tacrolimus ointment or pimecrolimus cream to use on the skin.

In severe cases, corticosteroid pills may be needed. You will start them on a high dose, which is tapered gradually over about 12 days. You may also receive a corticosteroid shot.

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

Outlook (Prognosis)

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

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

Possible Complications

Bacterial skin infections may occur.

When to Contact a Medical Professional

Call your health care provider if:

References

Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010; 82:249-255.

Gober MD, DeCapite TJ, Gaspari AA. Contact dermatitis. In: Adkinson NF Jr, ed. Middleton’s Allergy: Principles and Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 63.

Habif TP. Contact dermatitis and patch testing. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 4.



Review Date: 11/21/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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