Synonyms

• Delayed Hypersensitivity
• Dermatitis Medicamentosa
• Dermatitis Venenata
• Drug Hypersensitivity

Disorder Subdivisions

• Irritant Contact Dermatitis
• Allergic Contact Dermatitis
• Photoallergic Contact Dermatitis
• Phototoxic Contact Dermatitis

Related Disorders List

Information on the following diseases can be found in the Related Disorders section of this report:

• Atopic Dermatitis
• Dyshidrosis
• Psoriasis

General Discussion

Contact dermatitis is an acute or chronic skin inflammation triggered by substances that come in contact with the skin. Affected individuals may have abnormal redness of the skin (erythema) and/or itching (pruritis). Symptoms and physical findings associated with contact dermatitis vary greatly depending upon the cause of the disorder. Causes of contact dermatitis include an allergic reaction or response to a substance or a direct toxic effect of a substance (e.g., chemical irritants, medications, certain plants).

Symptoms

Contact dermatitis is a common disorder characterized by skin inflammation (dermatitis) and possibly blisters when the disorder is acute. Redness, swelling (edema), oozing, crusting, scaling, burning pain and usually itching may also occur. Scratching or rubbing may lead to thickening of the skin with changed markings (lichenification).



Irritant contact dermatitis, when it is due to strong chemical irritants, usually appears immediately after contact with the skin. When it is caused by a milder irritant, the skin inflammation may take longer to become apparent.



Allergic contact dermatitis represents a delayed allergic reaction; e.g., to poison ivy or certain medications such as aspirin or antibiotics. The period between the time of exposure and appearance of symptoms may range from a few hours to days or weeks. Affected individuals may unexpectedly become hypersensitive (allergic) to some of the dermatologic medications or cosmetics that they may have used for years.



Photoallergic and phototoxic contact dermatitis require exposure to light following the application of certain chemicals. Reactions appear to be an exaggerated response to sunlight. Chemicals that are commonly responsible for photoallergic contact dermatitis include aftershave lotions, perfumes, and locally applied sulfonamides. Certain substances used in perfumes or drugs (psoralens), coal tar, and cutting oils may also cause photoallergic contact dermatitis. Hypersensitivity to sunlight caused by certain types of drugs are NOT a form of photoallergic contact dermatitis. Rather, abnormal reactions to sunlight are a side effect of these drugs (usually antibiotics.)

Causes

The list of agents that can cause contact dermatitis is endless since new chemicals are manufactured constantly, and each person may be sensitive or allergic to different substances. The disorder may be caused either by irritants or by allergic sensitizers (allergens). Some of the more common causative agents are:



1. Chemical irritants: rhus oleoresin (found in poison ivy and poison oak); acids; alkalis; formaldehyde used in permanent press clothing; tanning agents used in the manufacture of shoes; solvents; oils; plastics; resins; phenol acrylates; chrome compounds (Chromates); mercury compounds; nickel compounds; cosmetics such as hair removers (depilatories), nail polish and nail polish remover (acetone), or deodorants; dyes such as Phenyldiamine and others; rubber chemicals and antioxidants in gloves, shoes, elastic underwear, and other apparel; petroleum products not used as solvents; glass; dust; and fiberglass.



2. Dermatologic medications: local anesthetics such as benzocaine; antibiotics such as neomycin, penicillin, sulfonamides; antihistamines such as diphenhydramine, promethazine; antiseptics such as thimerosal, hexachlorophene; preservatives such as parabens; or stabilizers such as ethylene diamine and substances derived from ethylene diamine.



3. Plant and wood substances: burning nettle; citrus fruit; poison ivy, oak, or sumac; pink rot celery; primrose; or ragweed.



4. Physical agents: Ionizing and nonionizing radiation; wind; sunlight; temperature extremes; or humidity.



5. Biological agents: bacteria; viruses; fungi; ectoparasites such as mites, ticks, fleas, etc.; or sweat or saliva (particularly the saliva of house pets).



6. Mechanical factors: pressure; friction; or vibrations.

Affected Populations

Contact dermatitis affects males and females of all ages in equal numbers. Hypersensitivity usually increases with each subsequent exposure. Of all occupational skin disorders in the United States, 90 percent are forms of contact dermatitis. Persons who have allergies, asthma and hay fever should stay away from jobs that put them in touch with water, dirt or chemicals. Thirty percent of Contact Dermatitis are caused by irritants, 70 percent by allergies.



In July 1991, the Centers for Disease Control (CDC) in Atlanta, GA, reported cases of extreme life-threatening allergic reactions (anaphylactic shock) to latex occuring in children with spina bifida who have undergone surgery for spina bifida. Latex is commonly used in many medical products such as gloves, endotracheal tubes, and urinary catheters. It has been suggested that any elective surgery be postponed until the reason for the increased risk of anaphalaxis in children with spina bifida can be determined. If a surgical procedure cannot be postponed, then caution should be taken to avoid or minimize any contact with latex.

Related Disorders

Symptoms of the following disorders may be similar to those of contact dermatitis. Comparisons can be useful for a differential diagnosis:



Atopic dermatitis (Besnier Prurigo; Atopic Eczema; Constitutional Eczema; Disseminated Neurodermatitis) is a chronic, inherited form of eczema. The disorder is characterized by red, oozing and weeping skin inflammation with itching. Atopic dermatitis can occur in three forms: infantile, childhood, and adult eczema. Usually, the first two forms clear up during childhood. The adult form may become either widespread over the body surface, or may be limited to a small area; e.g. on the hands or scalp only.



Dyshidrosis (Difficult Sweating; Hand Eczema; Cheiropompholyx; Pompholyx) is a disorder of unknown cause, characterized initially by deep-seated itchy blisters or elevated spots usually on the sides of the fingers. Later, the skin of the hands may become dry, scaly, hardened, and fissured. The feet may also be affected.



Psoriasis is a common chronic and recurrent skin disorder characterized by dry, well-circumscribed silvery gray scaling spots (papules) or plaques which usually appear on the scalp, elbows, knees, back, or buttocks. In a few cases, the entire body may be affected. (For more information, choose "Psoriasis" as your search term in the Rare Disease Database.)

Standard Therapies

Contact dermatitis can almost always be prevented by a combination of environmental, personal, and medical measures. Diagnosis of the disorder can be made by blood tests for the immunoglobulin levels in the blood and skin tests for delayed-hypersensitivity against specific agents causing the reaction.



Treatment for contact dermatitis consists in removing the agent that causes the skin inflammation whenever possible. For treatment of mild contact dermatitis, over-the-counter hydrocortisone creams may b applied to the affected areas. For acute severe cases, prednisone may be prescribed. Antihistamines can be used to decrease itching, and antibiotics to treat possible secondary bacterial infections. Local cortisone preparations can be prescribed for chronic forms of contact dermatitis. Local treatment for acute weeping dermatitis includes the use of wet compresses (water or aluminum subacetate) and cortisone lotions.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOK OF DERMATOLOGY, 5th Ed.: R.H. Champion, J.L. Burton, and F.J.G. Ebling, Editors; Blackwell Scientific Publications, 1992. Pp. 611-715.



ALLERGIC CONTACT DERMATITIS IN CHILDREN: W.L. Weston, et al.; Am Journal Dis Child (October 1984: issue 138(10)). Pp. 932-936.



HOUSEHOLD TREATMENT FOR "CHILE BURNS" OF THE HANDS: L.A. Jones, et al.; Journal Toxicol Clin Toxicol (1987: issue 25(6)). Pp. 483-491.



LOCAL AND SYSTEMIC DESENSITIZATION INDUCED BY REPEATED EPICUTANEOUS HAPTEN APPLICATION: G.H. Boerrigter, et al.; Journal Invest Dermatol (January 1987: issue 88(1)). Pp. 3-7.



INTERNAL MEDICINE, 2nd ed.: Jay H. Stein, et al., eds; Little, Brown, 1987. Pp. 1377-1378, 2268-2269.



TEXTBOOKS

Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:.



Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:.



Kasper, DL, Fauci AS, Longo DL, et al. Eds. Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill Companies. New York, NY; 2005:.





James WD, Berger T, Elston DM. Eds. Andrew's Diseases of the Skin: Clinical Dermatology. 10th ed. Saunders Elsevier. Philadelphia, PA. 2006:.



REVIEW ARTICLES

Kockentiet B, Adams BB. Contact dermatitis in athletes. J Am Acad Dermatol. 2007;56:1048-55.



Gates T. Atopic dermatitis: diagnosis, treatment, and aeromedical implications. Aviat Space Environ Med. 2007;78:29-37.



Osimitz TG, Franzosa JA, Maciver DR, Maibach HI. Pyrethrum allergic contact dermatitis in humans--real?, common?, or not documented? An evidence-based approach. Cutan Ocul Toxicol. 2006;25:287-308.



Jacob SE, Steele T. Allergic contact dermatitis: early recognition and diagnosis of important allergens. Dermatol Nurs. 2006;18:433-9, 446.



FROM THE INTERNET

Lehrer MS. Contact dermatitis. Medical Encyclopedia. MedlinePlus. Update date: 5/3/2006.

http://www.nlm.nih.gov/medlineplus/ency/article/000869.htm

Accessed: 6/21/2007



Allergic contact dermatitis. DermNet NZ. Last updated 24 Feb 2007

http://dermnetnz.org/dermatitis/contact-allergy.html

Accessed: 6/21/2007



Mayo Clinic Staff. Dermatitis/Eczema. MayoClinic.com. Dec. 8, 2005.

http://www.mayoclinic.com/health/dermatitis-eczema/DS00339/DSECTION=3

Accessed: 6/21/2007



Contact Dermatitis. Asthma and Allergy Foundation of America (AAFA). Most recent update: 2005.

http://www.aafa.org/display.cfm?id=9&sub=23&cont=329

Accessed: 6/21/2007

Resources

National Eczema Association

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