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Contact Dermatitis

Medically reviewed by L. Anderson, PharmD Last updated on Jan 19, 2019.

Contact dermatitis is an inflammation of the skin caused by direct exposure to an irritating or allergenic substance. Contact dermatitis can occur due to poison ivy, contact with nickel metal in jewelry, or the reaction to household cleansers. This condition will usually clear up once exposure to the irritant or allergen is avoided. In some cases, treatment with a topical corticosteroid or use of an oral steroid pills like prednisone may be needed. A family physician, allergist, or dermatologist can diagnose and treat contact dermatitis.

Types of contact dermatitis

Irritant dermatitis

Irritant dermatitis, the most common type of contact dermatitis, involves inflammation resulting from contact with a substance that irritates or damages the skin in some way. This is not due to an allergic-type of reaction.

Common substances that lead to this type of reaction include things you might use on a daily basis, like soaps, household cleansers (bleach), detergents, solvents, rubbing alcohol or other chemicals.

The hands, face or eyelids are often involved as they commonly come into contact with these agents through rubbing or itching. Reactions to irritants can be mild to severe. Skin redness, cracking, and dryness can occur; oozing or blisters may appear in more severe cases. 

Allergic dermatitis

Allergic dermatitis is also a common type of contact dermatitis. It is caused by exposure to a material to which the person has become hypersensitive or allergic. Over 3,500 substances can cause this type of reaction. It may occur upon first exposure or after being exposed to a substance long-term, even if you've touched this substance for years without problems.

Common allergens may be plants such as poison ivy, poison oak, or poison sumac; nickel often found in jewelry; reactions to topical medications such as diphenhydramine (Benadryl) cream or neomycin (found in Neosporin ointment); and preservatives often found in contact lens solutions.

The skin inflammation varies from mild irritation and redness to raised bumps, with intense itching. The reactions typically occur within 12 hours to two days after exposure, and when the allergen is avoided, it usually clears in 2 to 4 weeks.

Latex

Reactions to latex can be an irritant or allergic response. Latex gloves often contain chemicals or powders that may cause irritation; however, more rarely, someone may develop a true allergy to latex that might even be life-threatening (anaphylaxis).

A true latex allergy to the latex protein will involve not just irritation but may result in raised welts (hives), itching, a runny nose, asthma, and the most severe reaction, an anaphylaxis reaction, which is life-threatening. This can occur within minutes of exposure. Anaphylaxis may involve a rapid drop in blood pressure, a fast heart beat, trouble breathing, and swelling of the mouth or throat. Quick treatment is needed.

A true latex allergy can be confirmed with blood testing if needed. Avoid all latex products if you have a true latex allergy. Wear an ID alert tag to identify your latex allergy to emergency personnel.

Learn more: Latex Allergy Health Guide

What causes contact dermatitis and who is at risk?

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy-causing substance (irritant or allergen). These can vary in the same individual over time. A history of any type of allergies increases the risk for this condition. Allergic and contact dermatitis can occur at the same time.

Products commonly associated with allergic contact dermatitis include:

  • poison ivy, poison oak, poison sumac or other plants
  • nickel or other metals (found in cell phones, jewelry, eyeglass frames, zippers, and belt buckles)
  • medications
  • animal dander
  • antibiotics, especially those applied to the skin (topical)
  • topical anesthetics or other medications
  • rubber or latex (found in exam gloves, condoms, balloons)
  • fruits or vegetables with certain proteins (i.e., mangos, papayas)
  • fragrances, perfumes, cosmetics, nail polish or adhesives

Products commonly associated with irritant contact dermatitis include:

  • fabrics and clothing
  • detergents, soaps and cleansers like bleach
  • solvents, fiberglass, turpentine
  • adhesives
  • water (excessive exposure)
  • hair dyes
  • oils and paints

Contact dermatitis may involve a reaction to a substance that the person is exposed to or uses repeatedly. Even excessive exposure to water can lead to contact dermatitis. Although there may be no initial reaction, repeated use (for example, of nail polish remover, preservatives in contact lens solutions, or repeated contact with metals in earring posts and the metal backs of watches) can cause eventual sensitization and reaction to the product.

People at certain occupations who are exposed to irritant or chemicals may be at greater risk; for example, beauticians (hair dyes), bartenders, florists, healthcare workers, construction workers, painters, plumbers, mechanics, restaurant employees, and janitors.

Those with a history of asthma, hay fever, or eczema may be at greater risk of also developing contact dermatitis.

Related: Overview of Eczema: Symptoms, Causes and Treatments

A few airborne allergens, such as ragweed or insecticide spray, can also cause contact dermatitis.

Photosensitivity

Some products cause a reaction only when they contact the skin and are exposed to sunlight (called photosensitivity). These can include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime.

Symptoms

  • itching (pruritus) of the skin in exposed areas
  • skin redness or inflammation in the exposed area
  • tenderness of the skin in the exposed area
  • localized swelling of the skin
  • warmth of the exposed area
  • skin lesion or rash at the site of exposure
  • lesions of any type: redness, rash, papules (pimple-like), vesicles, and bullae (blisters)
  • may involve oozing, draining, or crusting
  • may become scaly, raw, or thickened

Diagnosis

The diagnosis is primarily based on the skin appearance and a history of exposure to an irritant or an allergen. A history of your exposure to home or workplace chemicals, recent outdoor activity, pets, skin care products, and personal history of allergies will be documented. Based on questions you answer, a determination can be made of substances leading to your reaction. You can then avoid these products. If your symptoms improve after the irritant or allergen is avoided, most likely this was the cause. 

Patch testing

In some cases, testing with skin patches may be needed to isolate the suspected cause and determine if the reaction is allergic or irritant in nature. Patch testing is used for patients who have chronic, recurring contact dermatitis.

  • A small amount of various suspected substances are applied to the back under an adhesive patch.
  • The patches remain in place for several days and must stay dry.
  • Your doctor then looks for reactions under the patches and may suggest further testing depending upon the results.
  • This procedure should be done by a clinician with experience in patch testing, such an an allergist or dermatologist.

Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion, although this is not typically needed.

Treatment Options

Treatment is often the same for both types of contact dermatitis. For most patients, avoiding the irritant or allergen will clear up their symptoms.

In some cases, the best treatment is to do nothing to the area. Washing the area with a mild soap and water will help to prevent spreading of the irritant or allergen. Further exposure to known irritants or allergens should be avoided.

For some reactions, a soothing oatmeal bath or non-prescription emollient cream or ointment may help with symptoms. Petrolatum-based emollients can help provide a barrier if frequent hand washing leads to dermatitis.

The topical antihistamine (anti-itch) cream diphenhydramine (Benadryl) and topical antibiotic neomycin (Neosporin) have been associated with contact or allergic dermatitis and should be avoided.

Topical corticosteroid medications may reduce inflammation and help relieve itching. Carefully adhere to instructions when using topical steroids because overuse of these medications, even low-strength, over-the-counter topical steroids like hydrocortisone 1% may cause side effects like skin thinning. Drying lotions such as calamine may be helpful for oozing or weeping lesions.

See the List: Common OTC and Prescription Topical Corticosteroids

In severe cases, systemic oral corticosteroids may be needed to reduce inflammation.

  • Commonly prescribed oral corticosteroids include prednisone (Rayos, Deltasone) and methylprednisolone (Medrol Dosepak).
  • These are usually tapered gradually over a week or two to prevent recurrence of the rash and the occurrence of other side effects due to adrenal insufficiency if you rapidly stop your steroid treatment. Side effects may include: dizziness, irritability, insomnia, nausea, joint pain, and low blood pressure with rapid discontinuation.

Wet dressings may be recommended for crusted or oozing areas of the skin:

  • Wet dressings can relieve itching, soften crusts, and are protective.
  • To apply a wet dressing, dampen a cloth, gauze or piece of clothing and placed on the affected area, then cover with a dry garment. Wet dressings can be worn over night if preferred. Ask your doctor for specific instructions.
  • Be sure to change wet dressings at least every 8 hours.

If intense itching is interfering with your sleep, ask your doctor if you can use an over-the-counter, oral antihistamine such as diphenhydramine (Benadryl) or prescription hydroxyzine for a short period of time to ease your symptoms. These medications will cause drowsiness; do not drive or use alcohol while taking them, and always have your pharmacist check for drug interactions.

For occupations at high risk of contact with allergens or irritants, the patient should be advised to wear appropriate clothing (i.e., gloves, long-sleeves, long pants) to protect against substances in their work environment.

For allergic contact dermatitis, topical calcineurin inhibitors such as topical tacrolimus (Protopic) or topical pimecrolimus (Elidel) may be an option to topical corticosteroids for recurrent or resistant symptoms, or for sensitive areas where topical steroids should be avoided (face, genital areas, skin folds). Studies have shown effectiveness when used for nickel allergy. These drugs may be use for patients who are actually allergic to topical steroids, as well.

Azathioprine and cyclosporine are immunosuppressive drugs which are used in highly chronic and resistant cases. Phototherapy and retinoids, including alitretinoin (Panretin) may be other options for treatment in resistant cases.

When to Call Your Doctor

Call your health care provider if your symptoms seem to be caused by contact dermatitis and they are severe or if you do not notice any improvement after treatment.

If you or someone close by you is experiencing trouble breathing, swelling in their mouth, face, or throat, fainting, sudden confusion, or other life-threatening symptoms, call emergency 911 immediately.

See Also

Sources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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