Contact Dermatitis

Contact dermatitis is a red, itchy rash that occurs when a chemical comes into contact with the skin. It is estimated that 3% of the US population has contact dermatitis. It is a frequently seen in patients who have a history of eczema and is the most commonly reported occupationally caused disease.

What is Contact Dermatitis?

It is a disease caused by the skin’s reactions to a substance one comes in contact with. This reaction can be acute or chronic, but typically there is a delay between the exposure and the skin reaction. Patients with a history of allergic diseases or a family history of contact dermatitis are at higher risk. The list of potential causes for contact dermatitis includes: foods, metals, dyes, preservatives, cosmetics, adhesives, plants, fragrances, herbal remedies, and occupational chemicals. However, any chemical can cause contact dermatitis.

When should I consider if I have Contact Dermatitis?

Rashes on isolated parts of your body are characteristic of contact dermatitis. Hands, ears, neck, eyelids, and feet are common areas for contact dermatitis, but it can occur anywhere on the body and can be widespread. If you have an occupation that places you in contact with chemicals on a regular basis and you have rashes, contact dermatitis may be a cause. If you have other skin conditions and they do not appear to be improving with treatment, then contact dermatitis can be a reason for this. If you use certain products and your rash occurs or worsens, then it may be due to contact dermatitis.

What are symptoms of contact dermatitis?

Signs and symptoms of contact dermatitis include itching, which can be severe, red rash or bumps, dry, cracked, scaly, thickened skin. If the condition becomes chronic, swollen skin can become painful and in severe cases, blisters can form with draining bumps and crusty skin. The severity of this skin rash depends on the location on the body, frequency of contact with the offending chemical or allergen, strength of the contact trigger, how sensitive a person is to the trigger and the patients genetic makeup.

When should I see a doctor for contact dermatitis?

If you have a rash that does not go away after 4 weeks, it should be evaluated. If your skin condition interferes with daily activities, work and/or sleep, a visit to the doctor can help. If self-treatment does not work, then an evaluation is warranted. If your rash causes embarrassment and affects your quality of life, further treatment is warranted. Rashes that cause blisters, are painful, or widespread should be seen by a physician. Rashes that occur on face, hands, or genital areas should be evaluated.

How is contact dermatitis evaluated?

In order to evaluate contact dermatitis, a thorough history and physical is needed. A history of chemicals that a patient comes into contact with at home, school or work is very important. A diary of when the symptoms occur, when an exacerbation occurs, and what caused the exacerbation of the symptoms can be helpful to determine the causative agent.

Patch testing is the gold standard for determining the cause of contact dermatitis. This process requires three separate office visits.  Initially a series of patches is placed on the back and kept in place for two days; during this time the patches cannot be removed and should be kept dry. During the second visit, the patches are removed and the results are recorded.  Another reading is necessary 72-96 hours later at the third visit for accurate results. We have a standard battery of tests of common irritants, but can include additional items for a custom patch test.

How is contact dermatitis treated?

Once a diagnosis has been established, the first step is to avoid the offending agent. This is very important to resolve this skin disease as continued exposure will make the skin worse. Skin care is helpful. Allergy medications can reduce itching. Topical anti-inflammatory creams can help to relieve acute symptoms. Occasionally oral corticosteroids are necessary to relieve severe attacks.