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Contact Dermatitis

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 23, 2021.

Key Points

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. Redness, swelling, itching and scaling can occur.

This condition will usually clear up once exposure to the irritant or allergen is avoided. In some cases, treatment with a topical corticosteroid or short-term use of an oral corticosteroid medicine like prednisone may be needed.

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 irritant dermatitis include things you might use on a daily basis, such as:

  • soaps
  • household cleansers (bleach, Clorox)
  • detergents
  • solvents like paint thinner
  • rubbing (isopropyl) alcohol
  • other chemicals

Reactions to irritants can be mild to severe in intensity. The hands (especially between the fingers), face or eyelids are often involved in contact dermatitis reactions as they may come into contact with these agents through rubbing or itching. 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 include:

  • urushiol, found in 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)
  • perfumes, cosmetics, nail polish
  • preservatives often found in contact lens solutions
  • substances found in the skin of mango fruit.

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 washed away or avoided, it usually clears up 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, and the reaction is not necessarily due to the latex.

More rarely, someone may develop a true allergy to latex that can be life-threatening (anaphylaxis). This can occur within minutes of exposure. 

  • 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.
  • Anaphylaxis may involve a rapid drop in blood pressure, a fast heart beat, trouble breathing, and swelling of the mouth or throat. Rapid medical treatment is needed.

Latex allergy can be confirmed with blood testing if needed. Avoid all latex products if you have a severe 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 allergy increases the risk for this condition. Allergic and contact dermatitis can occur at the same time.

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

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, laptops, coins, jewelry, eyeglass frames, zippers, vaping devices, 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

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: hair stylists (hair dyes), bartenders, florists, jewelers, 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 (Atopic Dermatitis): 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 a photosensitivity reaction). 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 
  • skin redness, inflammation or tenderness 
  • 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
  • can 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 family physician, allergist, or dermatologist can diagnose and treat contact dermatitis.

  • Your doctor may ask about your exposure to home or workplace chemicals, recent outdoor activity, pets, skin care products, latex or nickel contact, and personal history of allergies.
  • 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 as 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 allergic and irritant contact dermatitis. For most patients, avoiding the irritant or allergen will clear up their symptoms.

In some cases, the best treatment is to do little to the area other than washing the area with a mild soap and water. This will help to prevent spreading of the irritant or allergen. Further exposure to known irritants or allergens should be avoided. Cool compresses are an easy way to help relieve itching. Constant itching can worsen the reaction and may lead to an infection.

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. Some petroleum-based products (for example, Vaseline) can be linked with allergies, too.

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.

Drying lotions such as calamine may be helpful for oozing or weeping lesions.

For patients with nickel allergy, avoid the metal, which is often found in cell phones, jewelry and components of clothing like snaps or buttons. Choose hypoallergenic, nickel-free jewelry. Once you develop a nickel allergy you'll always be sensitive and need to avoid contact. Consider using a nickel test kit for items to determine if they contain nickel. The application of a clear barrier (such as Nickel Guard) may help prove helpful for metal items on clothes or other items such as watch, earrings, or a belt buckle.

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.

  • Strengths of a prescription topical corticosteroids will be selected based on the area of the reaction. Higher potency corticosteroids, such as clobetasol propionate (brand examples: Temovate, Impeklo, Clobex-E, Olux) can be used in areas that do not involve the face or where the skin does not touch regularly.
  • Lower-to-medium strength products (for example, betamethasone) can be used on the face or areas where skin touches.
  • Topical corticosteroids are usually applied once or twice daily for two to four weeks, or until your symptoms resolve. Follow your doctor's order exactly.

See the full list of topical steroids: Common OTC and Prescription Topical Corticosteroids

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

  • Commonly prescribed oral corticosteroids include prednisone and methylprednisolone (Medrol Dosepak).
  • These are usually tapered gradually over one or two weeks 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 used 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 or tongue, face, or throat, fainting, sudden confusion, or other life-threatening symptoms, call emergency 911 or get other emergency help immediately.

See Also

Sources

Further information

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