Contact Dermatitis
Basics
Description
Description
- Irritant:
- Immediate eczematous eruption (superficial inflammatory process primarily in epidermis)
- Most common type of dermatitis
- Trigger substance directly damages the skin resulting in nonimmunologic inflammatory reaction with erythema, dryness, cracking, or fissuring
- Usually due to repeated exposure to mild irritant (e.g., water, soaps, heat, friction, metals)
- Lesions itch or burn
- Usually gradual onset with indistinct borders
- Most often seen on hands
- May see vesicles or fissures
- Dry, red, and rough skin
- Common irritants include:
- Cement
- Hair dyes
- Wet diapers
- Rubber gloves
- Shampoos
- Frequent hand washing
- Allergic:
- Delayed (type IV) hypersensitivity reaction (requires prior sensitization)
- Allergen-induced immune response
- Local edema, vesicles, erythema, pruritus, or burning
- Usually corresponds to exact distribution of contact (e.g., watchband)
- Onset usually within 12–48 hr with prior sensitization; may take 14–21 d for primary exposure
- Common sources:
- Nickel
- Gold
- Neomycin
- Bacitracin
- Preservatives
- Fragrances
- Dyes
- Poison ivy
- Photocontact:
- Interaction between an otherwise harmless substance on the skin and UV light
- Common sources:
- Shaving lotions
- Sunscreens
- Sulfa ointments
- Perfumes
Pediatric Considerations
- Allergic contact dermatitis is less frequent in children, especially infants
- Major sources of pediatric contact allergy:
- Metals, shoes, preservatives, or fragrances in cosmetics, topical medications, and plants
- Diaper dermatitis: Prototype for irritant contact dermatitis in children
- Circumoral dermatitis: Seen in infants and small children; may result from certain foods (irritant or allergic reaction)
Etiology
Etiology
- Irritant (80% of contact dermatitis), e.g.:
- Soaps, solvents
- Chemicals (aerosolized pesticides)
- Certain foods
- Urine, feces
- Diapers
- Continuous or repeated exposure to moisture (hand washing)
- Coarse paper, glass, and wool fibers
- Shoe dermatitis: Common; identify by lesions limited to distal dorsal surface of foot usually sparing the interdigital spaces
- Cement (prolonged exposure may result in severe alkali burn)
- Solvents, epoxy
- Chemicals in rubber (e.g., elastic waistbands) or leather
- Allergic:
- Plants, poison ivy, oak, sumac (Rhus dermatitis):
- Most common form of allergic contact dermatitis in North America
- Direct: Reaction to oleoresin urushiol from plant
- Indirect: Contact with pet or clothes with oleoresin on surface or fur or in smoke from burning leaves
- Lesions may appear up to 3 d after exposure with prior sensitization (12–21 d after primary exposure) and may persist up to 3 wk
- Fluid from vesicles is not contagious and does not produce new lesions
- Oleoresin on pets or clothes remains contagious until removed
- Ragweed pollen
- Metals (especially nickel, gold)
- Lotions, cosmetics
- Topical medications (e.g., neomycin, hydrocortisone, benzocaine, paraben)
- Some foods
- Ability to respond to certain antigens is probably genetically determined
- Plants, poison ivy, oak, sumac (Rhus dermatitis):
- Photodermatitis:
- Inflammatory reaction from exposure to irritant (frequently plant sap) and sunlight
- Typically no response in absence of sunlight
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Citation
Schaider, Jeffrey J., et al., editors. "Contact Dermatitis." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307159/all/Contact_Dermatitis.
Contact Dermatitis. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307159/all/Contact_Dermatitis. Accessed December 10, 2024.
Contact Dermatitis. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307159/all/Contact_Dermatitis
Contact Dermatitis [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307159/all/Contact_Dermatitis.
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