Contact Dermatitis

1 What is Contact Dermatitis?

Contact dermatitis is a skin condition in which your skin, after direct contact with irritating substances, becomes red, itchy and swollen. The rash doesn’t transmit to other infectious nor claims life, but it can be very unpleasant and troublesome. Soaps, cosmetics products, perfumes, jewelry, and certain plants, such as poison ivy or poison oak can cause contact dermatitis. Some people might develop contact dermatitis due to exposure to irritants at work. Treatment of contact dermatitis includes identification and avoidance of the causes. If contact with the causative substance is discontinued, the rash disappears within four weeks. Use of cool, wet compresses and anti-itch creams can provide you symptomatic relief.

2 Symptoms

The signs and symptoms of contact dermatitis are:

  • Reddish skin changes (rashes)
  • Severe itching
  • Dry, cracked, scaly skin, 

In chronic cases: 

  • Blisters (small vesicle containing fluid), when ruptured forms skin crusts (hard outer layer) 
  • If you body severely reacts to allergens or irritants, inflammation, burning or tenderness 

The severity of rash depends on:

  • Length of exposure to the substance
  • Strength of the substance eliciting reaction 
  • Environmental factors such as, temperature, airflow and sweating 
  • Genetic factor that affect the way you respond to the substances 

Contact dermatitis develops on the part of skin that comes in contact with the causative substance. For instance, if calf is brushed against poison ivy, contact dermatitis develops on the calf. Your skin, after being exposed to irritants or allergens, can develop dermatitis within minutes to hours. The rash persists for two to four weeks. 

When to see a doctor? 

Make an appointment with doctor if the rash:

  • Interferes with your sleep or daily activities
  • Is painful or has spread all over the body
  • Doesn’t disappear within few weeks
  • Develops on your face or genitals

See your doctor immediately if you think:

  • Skin infection, fever and pus from the blisters, has occurred
  • The rash has injured the mucosal lining of your mouth and digestive tract
  • Your lungs, nasal passage or eyes are painful or it's difficult for you to breathe

3 Causes

Contact dermatitis is simply caused by an irritation to the skin.

You may develop contact dermatitis if you are exposed to allergens (substance that elicit allergic reaction) or irritants (substance that irritates your skin). There are only a few substances that can cause both irritant contact dermatitis and allergic contact dermatitis. Irritant contact dermatitis, most common type, is non-allergic inflammatory reaction which develops due to damage of skin's outermost layer. Either single exposure to strong irritants or repeated exposure to mild or severe irritants can develop irritant contact dermatitis. Some people can develop resistance against the substance over time. Some irritants are:

  • Solvents 
  • Rubbing alcohol 
  • Bleaching agents 
  • Soaps, body sprays and cosmetics 
  • Sawdust or wool dust 
  • Burdock, a plant used in alternative medicine therapies 

Allergic contact dermatitis develops as your body launches immune reactions against the allergens. It develops in the area where allergens come in contact with skin. Systemic contact dermatitis occurs when allergens enter your body through foods, flavorings, medicine, or medical or dental procedures. Single exposure to strong allergens, such as poison ivy, can provoke allergic reactions while for weak allergens, repetitive exposure for many years is required to elicit allergic reaction. Some allergens are:

  • Nickel widely used in jewelry, buckles 
  • Medications, such as antibiotic creams and oral antihistamines 
  • Balsam of Peru, found in perfumes, cosmetics, mouth rinses and flavourings 
  • Formaldehyde, found in adhesives, solvents 
  • Personal care products, such as body sprays, shower gel, hair dyes, cosmetics, nail polish, and herbal preparations containing eucalyptus, camphor or rosemary 
  • Skin tattooing and black henna 
  • Plants such as poison ivy and mango
  • Airborne substances from aromatherapy and spray insecticides 

Some sunscreens and oral medications can cause photoallergic contact dermatitis (allergic reaction to sun). Children can develop allergic contact dermatitis from the usual allergens as well as from exposure to car seats, plastic in toilet seats and infant clothing snaps. 

Occupational contact dermatitis develops from exposure to allergens or irritants while working. Health care workers, those working in pharmaceutical industry, metalworkers, construction workers, hairdressers and cosmetologists, waiters, cleaners, gardeners and agricultural workers, scuba divers or swimmers and chefs are at heightened risk of occupational contact dermatitis.

4 Making A Diagnosis

Your primary care doctor might refer you to dermatologist (skin specialist) to receive a diagnosis of contact dermatitis.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms. 

Write down your key medical information. 

Write down the names of all your medications, vitamins, supplements or cosmetics. 

Ask a friend or a family member to accompany you during the visit.

Make a list of the questions to ask your doctor. Some typical questions can be: 

  • What could be possible causes of my signs and symptoms? 
  • Do I need some tests? 
  • What are my treatment options? 
  • How long will this condition last?
  • Can scratching spread the rash? 
  • How can I improve my condition through skin care routines? 
  • How can I prevent this in the future? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

  • When did the symptoms start appearing? 
  • How often do you have symptoms? 
  • Do you symptoms occur continuously or occasionally? 
  • Does anything improve or worsen your symptoms? 
  • Have you recently changed your cosmetic? 
  • Do you work or play in an environment that might cause these symptoms?

 The causes can be identified by following tests:

  • Medical history review and physical exam: Your doctor may examine your skin and ask about your signs and symptoms. 
  • A patch test: A patch test is a test for your allergens which involves applying a small amount of probable allergens into your skin through adhesive patches. After two days, the patches are removed and checked if any allergic reaction has occurred. Your skin may again be examined after two days to check for delayed allergic reactions. This test is performed if the cause of your allergy can't be determined or if you have recurrent rash. You may be asked to avoid certain medication for a week or so prior to the test. 

5 Treatment

There are several treatment methods for contact dermatitis.

Avoiding exposure to irritant or allergen, if known, is the key. Your doctor may provide you a list of products that usually contain irritants or allergens. Your doctor may prescribe:

  • Steroid creams: Steroids creams are applied on your affected site.
  • Immune suppressing medications: Creams or ointments of immune suppressing medication, such as tacrolimus or pimecrolimus not only repair skin but also prevent the incidence of recurrence. These are recommended for long-term treatment of contact dermatitis but USFDA has warned that these drugs may be associated with lymphoma and skin cancer.
  • Oral medications: In chronic cases, your doctor may recommend oral corticosteroids for reducing swelling, antihistamines for itching or antibiotics for a bacterial infection. 

6 Prevention

Following tips can help you prevent contact dermatitis:

  • Avoid being exposed to irritants and allergens. Identify substances that are likely to cause irritation of your skin or trigger allergic reaction. 
  • Wash your skin with enough water to remove any traces of irritants or allergens. Use a mild, fragrance-free soap and wash completely. Wash any clothing or other items that may have come into contact irritants or allergens. 
  • Protect your skin from irritants by wearing face masks, goggles, gloves and other protectives. 
  • Use a barrier cream or gel to form a protective layer on your skin. For example, an over-the-counter skin cream containing bentoquatam may prevent or reduce your skin's reactivity to poison ivy. 
  • Use moisturizer in generous amount to keep your skin hydrated and protected from irritants or allergens. 
  • Exercise caution while playing with your pets.

7 Alternative And Homeopathic Remedies

Different alternative remedies have contact dermatitis as their side effects. Examples include burdock (a plant mostly used in traditional Chinese medicine), aromatherapy, herbal creams or lotions that contain eucalyptus, camphor, calendula and rosemary.

8 Lifestyle And Coping

Lifestyle modifications are necessary in order to relieve the symptoms of contact dermatitis.

To relieve your symptoms, you may try following measures:

  • Avoid contact with allergen: If a piece of jewelry is likely to cause allergy, you may apply barrier cream to your skin before wearing it. 
  • Apply an anti-itch cream or calamine lotion to the affected area.
  • A nonprescription cream containing at least 1 percent hydrocortisone can be used to relieve itch.
  • A nonprescription oral antihistamine, such as diphenhydramine, may be used if you have severe itching.
  • Keep soft and wet washcloths over the rash to soothe your skin.
  • Don’t scratch: If you need to, scratch on the bandage placed over the rash. 
  • Immerse in a comfortably cool bath.
  • Wear cotton clothing. 
  • Choose mild soaps
  • Wash rashes completely, dry your skin and apply generous amount of moisturizer. 
  • Use gloves to protect your hands. 

9 Risks And Complications

There are few complications associated with contact dermatitis.

Complications include:

  • Neurodermatitis, also known as lichen simplex chronicus, causes chronic itching. Itching can be so intense that your skin becomes thick and leathery.  
  • Infection: Continued itching can cause drainage of fluid making the skin wet, an ideal place for bacterial and fungal growth. 

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