CONTACT DERMATITIS SYMPTOMS & DIAGNOSIS

CONTACT DERMATITIS OVERVIEW

Contact dermatitis (CD) is a common skin problem occurring in 15% to 20% of people. It can have a significant financial burden with direct and indirect costs from lost time off work and school. CD may be allergic (ACD) or irritant (ICD). ICD is more common (80%) and can occur in anyone, especially after repeated exposure. Symptoms are a burning or stinging sensation with redness, swelling, or peeling. Soaps, detergents, acids, bases, solvents, saliva, urine and stool are the most common triggers for ICD. Allergic CD, on the other hand, is seen in genetically predisposed and previously sensitized individuals who react to even low concentrations of the agent. Cosmetics, medicines, clothes dyes, as well as foods, rubber, and poison ivy are common causes of ACD. Any topical cream or ointment may contain chemicals that irritate the skin. It is important to bring your personal products with you when you see your doctor so they can be examined as a potential cause of dermatitis.

CONTACT DERMATITIS SYMPTOMS & DIAGNOSIS

ACD presents with rash and itch. Acute reactions from poison ivy, sumac or oak are different from chronic lesions. Acute CD may look red and swollen with small fluid-filled bumps (vesicles). Symptoms occur within a few hours of exposure. With chronic exposure, the rash appears like “eczema” and the skin may thicken, scale or crack from scratching. The location of the rash depends on the allergen exposure. For instance, the rash associated with nickel allergy is located in areas of contact (underneath the belly button, ear lobes from earrings, around the neck from necklace). The rash from cosmetics is located on the face and particularly the eyelids. Patients with allergies to rubber gloves will present with hand dermatitis. Your allergist/immunologist can help differentiate ACD from other types of dermatitis including atopic dermatitis, psoriasis, seborrheic dermatitis, and pityriasis rosea.

The diagnosis is made from history (what your doctor learns from talking to you including your hobbies, your work exposures, cosmetic/fragrance/hair dye/nail polish exposures, exposure to jewelry and other metals), physical exam, and testing.

The patch test is used for the diagnosis of contact dermatitis. A small number of diluted test allergens are applied to the skin under a patch of paper tape. The patches are placed on the back and are removed after 48 hours. Skin reactions are looked at and scored at a 48-hour visit and then again after 72 to 96 hours. Testing allows the identification of chemicals you are allergic to so that they can be avoided in the future.

CONTACT DERMATITIS TREATMENT & MANAGEMENT

Identifying the trigger is essential for correct advice to be given. Avoidance is key to treating the rash. If avoidance is not possible, the rash may become chronic, disabling, and lead to major impairment in quality of life. Advice might include:
•    For acute symptoms, cold compresses can help with the itch.
•    For patients with oozing lesions, Burrow’s solution (aluminum triacetate), calamine, and/or oatmeal baths can also be utilized.
•    In hand dermatitis, avoiding excessive hand washing and using non-irritating moisturizers is recommended. Choose mild soaps, moisturizers, and detergents without dyes or perfumes. Wear gloves to protect your hands and other body parts from exposure if contact with these chemicals is unavoidable, however, be aware that you can become allergic to chemicals in the gloves as well.
•    In foot dermatitis, the use of barrier socks may be helpful.
•    Wash skin immediately after contact with an allergen to limit the spread and severity of the reaction such as after known contact with a plant allergen (poison ivy).
•    Apply covers over metal fasteners in clothing to avoid contact with nickel.

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