Contact Dermatitis

Contact Dermatitis

Contact dermatitis refers to a skin reaction triggered by exposure to something in your environment, leading to an itchy rash. The term “dermatitis” describes irritation or inflammation of the skin. This condition occurs when your skin comes into contact with an object, organism, substance, or chemical that irritates you.

Types of contact dermatitis

The two main types of contact dermatitis are:

  • Allergic contact dermatitis: This happens when your body reacts to an allergen it doesn’t agree with, like certain metals in jewelry (such as nickel), fragrances, cosmetics, or preservatives. The itchy rash usually shows up a few days after you’ve been exposed.
  • Irritant contact dermatitis: This type of rash shows up quickly after your skin comes into contact with something irritating, like detergents, cleaners, soaps, or acids. It’s more common than allergic contact dermatitis.

Symptoms

Contact dermatitis usually appears as a rash with the following characteristics:

  • Red, purple, or darker than the normal skin color
  • Swollen or raised, sometimes resembling hives
  • Bumpy, often with clusters of small pimples or blisters
  • Leaking fluid or pus
  • Painful, accompanied by a burning or stinging feeling
  • Itchy
  • Flaky or scaly

Scratching the rash can break the skin, leading to wounds that might be infected. Infected areas could appear red and crusty, hurt more, or even ooze pus.

Areas affected by contact dermatitis

Contact dermatitis can occur anywhere your skin touches an allergen or irritant. The most common areas include:

  • Neck, face, and scalp
  • Lips, eyelids, and cheeks
  • Hands, arms, and fingers
  • Genitals (like the penis, vagina, or vulva)
  • Feet and legs
  • Armpits

Causes

Contact dermatitis occurs when your skin physically encounters an irritant or allergen. If the body reacts negatively, the immune system triggers a reaction, causing swelling, inflammation and an itchy rash. Irritant-induced rashes can appear within minutes, while allergen-related rashes may take hours or even days to develop.

Causes of allergic contact dermatitis:

The common allergens that trigger allergic contact dermatitis are:

  • Plants or botanicals such as poison ivy.
  • Scented skin care products.
  • Metals like nickel.
  • Chemicals or preservatives.
  • Drugs, including antibiotics.

Causes of irritant contact dermatitis:

Common irritants that can lead to irritant contact dermatitis are:

  • Cleaning agents
  • Acids
  • Body fluids (e.g., urine, saliva)
  • Hair dyes
  • Plants like poinsettias or peppers
  • Nail polish remover or similar solvents
  • Paints and varnishes
  • Soaps and detergents
  • Plastics, resins and epoxies

Can contact dermatitis spread?

Yes, contact dermatitis can spread to various areas of your body, especially in cases of allergic contact dermatitis. This can happen if you come into direct contact with an allergen and then touch other body parts before realizing you have been exposed. It may also spread if multiple body parts are exposed to the allergen; the reaction develops gradually over time. If the rash spreads, consult a healthcare provider for appropriate treatment.

Risk Factors

The risk of developing contact dermatitis may be higher for individuals in certain professions or those engaging in specific hobbies. These include:

  • Cleaners
  • Agricultural workers
  • Construction workers
  • Hair stylists and cosmetologists
  • Cooks and food handlers
  • Florists
  • Healthcare workers, like dental professionals
  • Mechanics
  • Machinists
  • Scuba divers or swimmers, due to rubber exposure from face masks or goggles

Complications

While the rash is the primary symptom, severe complications can arise, especially in cases of allergic reactions. These include:

  • Hives: Raised, discolored, itchy welts on the skin.
  • Swelling (angioedema): Part of the skin may become enlarged, unlike the previous day. Swelling stems from the deeper layers of the skin.
  • Anaphylaxis: A severe allergic reaction that causes swelling and sometimes closure of the airways.

Anaphylaxis is rare but requires immediate medical attention. If you experience breathing difficulties, call 911 straightaway. An epinephrine injection (such as from an EpiPen®) can help counteract the reaction. Individuals with known severe allergies should always carry with them injectable epinephrine.

Diagnosis and Tests

To diagnose contact dermatitis, your doctor will review your medical history, perform a physical examination, and ask about your symptoms.

No specific test can determine the cause of irritant contact dermatitis. The doctor will ask detailed questions about your environment, potential exposure to irritants, and the characteristics of the rash (size and location). Questions may include:

  • How long has the rash lingered?
  • Did you change your skincare routine?
  • Have you been in direct contact with new plants, chemicals, or materials?
  • Do you regularly encounter irritants or chemicals?

For cases of allergic contact dermatitis, the physician may conduct tests, such as a patch test, in order to confirm the diagnosis. In this test, a sticky patch covered with common allergens is placed on your skin. After a set period, the patch is removed, and the provider checks for a reaction to the allergens.

In rare instances, a skin culture or biopsy may be done, where a sample of the rash tissue is taken and examined under a microscope.

Management and Treatment

Contact dermatitis treatment, whether allergic or irritant, generally includes the following approaches:

  • Avoidance: Identifying and avoiding the substance that triggered the rash is essential.
  • Medications for swelling and itching: Common treatments include non-prescription anti-itch topical creams, corticosteroid creams, oral antihistamines, or prednisone (oral steroid). In rare cases, immunosuppressant medications may be recommended.

Home Remedies

To relieve and soothe your skin from contact dermatitis, consider these at-home remedies:

  • Cleaning your skin using cool water and mild soap immediately after exposure.
  • Identifying and staying away from the allergen or irritant that triggered the reaction.
  • Applying hydrocortisone cream on small affected areas.
  • Applying a cold, moist compress thrice a day for at least 30 minutes to treat blisters.
  • Applying moisturizers frequently to damaged skin to restore its protective barrier.
  • Taking an oral antihistamine to relieve itching.
  • Soaking in a cool bath for about 20 minutes.
  • Keeping nails short to avoid scratching.
  • Drying hands after washing, moisturizing regularly, and wearing gloves when necessary.

Avoid using antihistamine lotions unless recommended by your doctor, as they may cause an allergic reaction or additional skin irritation.

Prevention

To prevent contact dermatitis, consider the following measures:

  • Refraining from known allergens.
  • Opting for products that don’t contain added fragrances.
  • Using soaps and cleansers that do not contain dye or fragrances.
  • Cleaning hands and skin immediately after exposure to a known irritant or allergen.

Living With

When to see a GP

Consider consulting your GP if your skin rash:

  • Develops blisters.
  • Disappears and then reappears.
  • Appears infected (warm, red, swollen).
  • Is painful.
  • Itches continuously.
  • Doesn’t improve within a week after treatment.

When to go to the ER

Seek emergency medical attention or dial 911 immediately if you experience:

  • Difficulty breathing.
  • Swelling of the lips or mouth.

Conclusion

Contact dermatitis occurs when your skin reacts to an environmental trigger, resulting in an itchy rash. A medical practitioner can help identify the specific allergen or irritant responsible for the reaction and guide you on avoiding it. If the trigger is related to your workplace, your doctor can advise you and your employer can assist in creating a safer environment to minimize the risk of skin reactions in the future.

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