Contact Dermatitis

The two major types of contact dermatitis are allergic contact dermatitis and irritant contact dermatitis. It occurs when something touches the skin and causes a rash. Some rashes happen immediately, however some take time to appear (up to 1 week or more)

When signs and symptoms appear, you may have:
◦ Itchy skin (often intense).
◦ Inflammation, redness, scaling .
◦ Dry and scaly skin.
◦ Burning.
◦ Stinging.
◦ Fluid-filled blisters.
◦ Oozing blisters that leave crusts and scales.

If exposure to the allergen continues, your skin may:
◦ Flake and crack.
◦ Become scaly.
◦ Darken, thicken, and feel leathery.

Allergic contact dermatitis (ACD)
This occurs when you are allergic to a specific chemical, and that chemical comes in contact with your skin. Over the next 3-10 days you develop a scaly or blistered inflamed itchy rash in the area of contact. Common causes of allergic contact dermatitis include poison ivy, nickel (in cell phones, jewelry, zippers etc), make-up, jewelry, latex gloves, nail polish, fragrances. There are more than 3600 other possible causes of ACD, and it can develop from a chemical that you’ve been using for many years. Your doctor can narrow down possible causes based on getting a detailed history and thorough examination. Sometimes your doctor may recommend doing patch allergy testing. This helps to figure out which chemical is causing the rash, and helps you select skin products without this chemical.

What happens during patch testing?
◦ Stickers containing small amounts of substances to which you may be allergic are applied to the skin, usually on the back.
◦ You keep the substances on your skin for a specific amount of time, usually 2 days.
◦ You return to your doctor’s office so that the doctor can check your skin for reactions and remove the stickers.
◦ You return 1-4 days later for another evaluation of the area to check for any delayed reactions.

Irritant contact dermatitis (ICD)
This is the more common type of contact dermatitis. It develops when something contacts the skin and irritates it, but you are not allergic to it. With enough contact, most things will irritate our skin. Common causes of irritant contact dermatitis include diaper dermatitis (urine or feces irritates the skin), dry cracked hands due to excessive hand wetting (irritation due to moisture), redness and itching under the breasts (irritated by rubbing and moisture), or irritation around the mouth due to constant lip licking (irritation due to moisture). Soap, shampoo, and food are other mild irritants.

Anyone can develop contact dermatitis. People working in certain professions have a higher risk. In fact, this is so common that your doctor may tell you that you have occupational dermatitis (can be irritant or allergic).
People who are more likely to get occupational dermatitis include:
◦ Nurses (and other health care workers).
◦ Beauticians.
◦ Bartenders.
◦ Chefs (and others who work with food).
◦ Florists (and others who work with plants).
◦ Construction workers.
◦ Janitors.
◦ Mechanics.
◦ Plumbers.

Treatment
◦ Treatment for ACD and ICD is the same.
◦ Avoid what is causing the rash (may take 1-3 weeks to improve).
◦ Antihistamine pills.
◦ Moisturizers help to seal the skin and protect them from chemicals that contact the skin.
◦ Topical corticosteroids (over-the-counter or prescription).
◦ Oatmeal baths can relieve discomfort and itching.
◦ If you have an infection (i.e. from scratching) your dermatologist may prescribe a topical or oral antibiotic).
◦ Phototherapy (UV light treatments 2x per week) can help with these rashes.
◦ Clearing may take longer if poison ivy, poison oak, or poison sumac caused your rash. These rashes may linger for 6 weeks.
◦ After your dermatologist identifies the offending agent, your doctor may be able to help you create a list of things you need to avoid.