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Contact dermatitis
Contact dermatitis
is a type of inflammation of the skin. 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]

Contents

1 Signs and symptoms 2 Causes

2.1 Irritant contact dermatitis 2.2 Allergic contact dermatitis 2.3 Photocontact dermatitis

3 Diagnosis 4 Prevention 5 Treatment

5.1 Self-care 5.2 Medical care

6 See also 7 References 8 External links

Signs and symptoms[edit] Contact dermatitis
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
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
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
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[edit] Common causes of allergic contact dermatitis include: nickel allergy, 14K or 18K gold, Balsam of Peru
Balsam of Peru
(Myroxylon pereirae), and chromium. In the Americas
Americas
they include the oily coating from plants of the Toxicodendron
Toxicodendron
genus: poison ivy, poison oak, and poison sumac. Millions of cases occur each year in North America alone.[4] The alkyl resorcinols in Grevillea banksii
Grevillea banksii
and Grevillea 'Robyn Gordon'
Grevillea 'Robyn Gordon'
are responsible for contact dermatitis.[5] Bilobol, another alkyl resorcinol found in Ginkgo biloba
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
Photocontact dermatitis
is divided into two categories: phototoxic and photoallergic. Irritant contact dermatitis[edit] Main article: Irritant contact dermatitis 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[edit] Main article: Allergic contact dermatitis

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

Allergic contact dermatitis
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
Balsam of Peru
(Myroxylon pereirae), chromium, and the oily coating from plants of the Toxicodendron
Toxicodendron
genus, such as poison ivy, poison oak, and poison sumac. Photocontact dermatitis[edit] Main article: Phytophotodermatitis 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
Psoralens
are in fact used therapeutically for the treatment of psoriasis, eczema, and vitiligo. Photocontact dermatitis
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[edit]

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[edit] 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[edit] Self-care[edit]

If blistering develops, cold moist compresses[19] applied for 30 minutes, 3 times a day can offer relief. Calamine lotion
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[edit] 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[edit]

Urushiol-induced contact dermatitis Nickel
Nickel
allergy Eczema

References[edit]

^ 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.  ^ European Society of Contact Dermatitis. "What is contact dermatitis".  ^ "DermNet NZ: Contact Dermatitis". Retrieved 2006-08-14.  ^ Gladman A. C. (2006). " Toxicodendron
Toxicodendron
dermatitis: poison ivy, oak, and sumac". Wilderness & Environmental Medicine. 17 (2): 120–8. doi:10.1580/pr31-05.1. PMID 16805148.  ^ 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.  ^ 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.  ^ a b " Balsam of Peru
Balsam of Peru
contact allergy". DermNet NZ. 2013-12-28. Retrieved 2014-04-17.  ^ "Contact Dermatitis
Dermatitis
and Related Conditions". Clevelandclinicmeded.com. Retrieved 2014-04-17.  ^ Irritant Contact Dermatitis. DermNetNZ.org ^ Morris-Jones R, Robertson SJ, Ross JS, White IR, McFadden JP, Rycroft RJ (2002). " Dermatitis
Dermatitis
caused by physical irritants". Br. J. Dermatol. 147 (2): 270–5. doi:10.1046/j.1365-2133.2002.04852.x. PMID 12174098.  ^ 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.  ^ 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.  ^ "Photocontact Dermatitis". www.skinchannel.com. Retrieved 31 March 2011.  ^ Hristakieva E, Gancheva D, Gancheva T; Trakia University. "Contact dermatitis in patient with chronic venous insufficiency". Research Gate (2014). ^ 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
Dermatitis
Group 2005–2006. Dermatitis. 2009 May–Jun;20(3):149-60. ^ DermNet dermatitis/contact-allergy ^ a b Rietschel RL (1997). "Mechanisms in irritant contact dermatitis". Clin. Dermatol. 15 (4): 557–9. doi:10.1016/S0738-081X(97)00058-8. PMID 9255462.  ^ a b American Academy of Dermatology
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. 

^ a b c d " Contact dermatitis
Contact dermatitis
Lifestyle and home remedies – Diseases and Conditions". Mayo Clinic. 2011-07-30. Retrieved 2014-04-18. 

External links[edit]

Classification

V · T · D

ICD-10: L25.9 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

v t e

Diseases of the skin and appendages by morphology

Growths

Epidermal

wart callus seborrheic keratosis acrochordon molluscum contagiosum actinic keratosis squamous-cell carcinoma basal-cell carcinoma Merkel-cell carcinoma nevus sebaceous trichoepithelioma

Pigmented

Freckles lentigo melasma nevus melanoma

Dermal and subcutaneous

epidermal inclusion cyst hemangioma dermatofibroma (benign fibrous histiocytoma) keloid lipoma neurofibroma xanthoma Kaposi's sarcoma infantile digital fibromatosis granular cell tumor leiomyoma lymphangioma circumscriptum myxoid cyst

Rashes

With epidermal involvement

Eczematous

contact dermatitis atopic dermatitis seborrheic dermatitis stasis dermatitis lichen simplex chronicus Darier's disease glucagonoma syndrome langerhans cell histiocytosis lichen sclerosus pemphigus foliaceus Wiskott–Aldrich syndrome Zinc deficiency

Scaling

psoriasis tinea (corporis cruris pedis manuum faciei) pityriasis rosea secondary syphilis mycosis fungoides systemic lupus erythematosus pityriasis rubra pilaris parapsoriasis ichthyosis

Blistering

herpes simplex herpes zoster varicella bullous impetigo acute contact dermatitis pemphigus vulgaris bullous pemphigoid dermatitis herpetiformis porphyria cutanea tarda epidermolysis bullosa simplex

Papular

scabies insect bite reactions lichen planus miliaria keratosis pilaris lichen spinulosus transient acantholytic dermatosis lichen nitidus pityriasis lichenoides et varioliformis acuta

Pustular

acne vulgaris acne rosacea folliculitis impetigo candidiasis gonococcemia dermatophyte coccidioidomycosis subcorneal pustular dermatosis

Hypopigmented

tinea versicolor vitiligo pityriasis alba postinflammatory hyperpigmentation tuberous sclerosis idiopathic guttate hypomelanosis leprosy hypopigmented mycosis fungoides

Without epidermal involvement

Red

Blanchable Erythema

Generalized

drug eruptions viral exanthems toxic erythema systemic lupus erythematosus

Localized

cellulitis abscess boil erythema nodosum carcinoid syndrome fixed drug eruption

Specialized

urticaria erythema (multiforme migrans gyratum repens annulare centrifugum ab igne)

Nonblanchable Purpura

Macular

thrombocytopenic purpura actinic/solar purpura

Papular

disseminated intravascular coagulation vasculitis

Indurated

scleroderma/morphea granuloma annulare lichen sclerosis et atrophicus necrobiosis lipoidica

Miscellaneous disorders

Ulcers

Hair

telogen effluvium androgenic alopecia alopecia areata systemic lupus erythematosus tinea capitis loose anagen syndrome lichen planopilaris folliculitis decalvans acne keloidalis nuchae

Nail

onychomycosis psoriasis paronychia ingrown nail

Mucous membrane

Aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squamous-cell carcinoma

v t e

Dermatitis
Dermatitis
and eczema (L20–L30, 690–693,698)

Atopic dermatitis

Besnier's prurigo

Seborrheic dermatitis

Pityriasis simplex capillitii Cradle cap

Contact dermatitis (allergic, irritant)

plants: Urushiol-induced contact dermatitis African blackwood dermatitis Tulip fingers

other: Abietic acid dermatitis Diaper rash Airbag dermatitis Baboon syndrome Contact stomatitis Protein contact dermatitis

Eczema

Autoimmune estrogen dermatitis Autoimmune progesterone dermatitis

Breast eczema Ear eczema Eyelid dermatitis Topical steroid addiction Hand eczema

Chronic vesiculobullous hand eczema Hyperkeratotic hand dermatitis

Autosensitization dermatitis/Id reaction

Candidid Dermatophytid Molluscum dermatitis

Circumostomy eczema Dyshidrosis Juvenile plantar dermatosis Nummular eczema Nutritional deficiency eczema Sulzberger–Garbe syndrome Xerotic eczema

Pruritus/Itch/ Prurigo

Lichen simplex chronicus/ Prurigo nodularis

by location: Pruritus
Pruritus
ani Pruritus
Pruritus
scroti Pruritus
Pruritus
vulvae Scalp pruritus

Drug-induced pruritus

Hydroxyethyl starch-induced pruritus

Senile pruritus Aquagenic pruritus

Aquadynia

Adult blaschkitis due to liver disease

Biliary pruritus Cholestatic pruritus

Prion pruritus Prurigo pigmentosa Prurigo simplex Puncta pruritica Uremic pruritus

Other

substances taken internally: Bromoderma Fixed drug reaction

Nummular dermatitis Pityriasis alba Papuloery

.