Allergies

All About Contact Dermatitis

Contact Dermatitis

Contact dermatitis is just one of the rashes that are among the most common reasons why people visit doctors' offices every day. It often scares parents and annoys patients by causing a number of different irritating symptoms.

Contact dermatitis is an inflammation of the skin that is the result of exposure to a simple irritant or a true allergic condition:

  • In irritant contact dermatitis, the offending substance comes into direct contact with the skin and then physically, mechanically, or chemically irritates the skin and leads to the symptoms you experience.
     
  • In allergic contact dermatitis, an allergen activates your body’s immune system, resulting in inflammation. These reactions can occur after using a product or being exposed to a substance (such as metal) for the first time for, or you may develop symptoms after many exposures.

More than eight out of 10 cases of contact dermatitis result from irritants rather than allergens. Contact dermatitis can be difficult to treat if you (or your doctor) are not able to identify the cause.

 

What Are the Most Common Causes of Irritant Contact Dermatitis?

The most common causes of irritant dermatitis are things that you use every day. This can include:

  • Soaps/cleansers
  • Lotions
  • Perfumes

While anyone can develop irritant contact dermatitis, those with fair, dry, or sensitive skin appear to be at greater risk.

What Are the Most Common Causes of Allergic Contact Dermatitis?

Poison ivy, poison oak, and poison sumac are the most common causes of allergic contact dermatitis. Other common causes seen in clinical practice include:

  • Nickel allergy (commonly seen in jewelry wearers)
  • Cosmetics
  • Antibiotic creams
  • Rubber
  • Chemicals

Surprisingly, laundry detergents are not a common cause of allergic contact dermatitis.

Common Signs and Symptoms of Contact Dermatitis

In irritant contact dermatitis, the symptoms experienced will depend on how irritating the offending agent is. With mild irritants, you may only see small amounts of redness, dry skin, small skin cracks, and/or itching. With stronger irritants, you’re likely to see or swelling, pain, blistering, and oozing of the affected area.

Symptoms of allergic contact dermatitis are very similar. Typically, there is a raised rash that is often intensely itchy. The affected area is usually where the substance came into contact with the skin, but can spread to other parts of the body on your hands. This is why it is very important to wash your hands thoroughly if you know that you've come in contact with a substance that causes allergic contact dermatitis for you.

How Is Contact Dermatitis Diagnosed?

Both types of contact dermatitis are usually diagnosed based on your history and a physical exam.

Sometimes your doctor may want to do patch testing (a test where small amounts of the suspected offending substance are applied to the skin). In other cases, your doctor may choose to just eliminate the suspected allergen. If symptoms improve after elimination, this supports the diagnosis of the substance causing your symptoms.

The location of the rash can sometimes help you/your doctor make a diagnosis:

  • Face/eyelids: The thinner the skin, the more likely a substance could be irritating. Think about things you might place on your face such as cosmetics, but other substances or products that also come into contact with the face, such as sunblock or children’s toys.
  • Scalp: The scalp is not commonly impacted, but hair dyes are one of the most commonly identified agents. However, if you think you have contact dermatitis on the scalp, anything you put on your head could be the cause.
  • Hands: Food workers, professional cleaners/custodians/housekeepers, health professionals, and anyone else who uses their hands a lot can be impacted. You are more likely to develop symptoms on the palm where you have thinner skin. Anything that touches your hand, from gloves to chemicals, can be the culprit.
  • Neck: Jewelry, perfumes, lotions, or anything you may put on this are of the body may be to blame.
  • Underarms: Not only are things like deodorants and shaving products a common cause, but chemicals that come off of clothes as a result of sweating and lead to irritation can also cause contact dermatitis.
  • Legs: The causes here are similar to other areas of the body—topical medications, creams, and dyes. Stockings can also contribute to this problem.
  • Genital/rectal area: Many of the previous causes (soaps, for example) can impact this area. Though this skin may not come directly into contact with some irritants, anything that your hands touch could also affect it when you clean yourself.

How Is Contact Dermatitis Treated?

Treatment for both types of dermatitis is the same.

The first, and perhaps most obvious suggestion, is to avoid the irritant. While there are a number of different ways to do this, you need to consider avoiding places where the irritant is or wearing protective gear to prevent the irritant from coming into contact with the body.

If certain lotions, soaps, or agents lead to contact dermatitis symptoms, they need to be eliminated. When you do this, the rash will often go away on its own.

Mild Reactions: If your irritant contact dermatitis rash requires further treatment, over-the-counter medications may be recommended. Antihistamine pills can be used to control itching, while non-irritating moisturizer creams and corticosteroids can be applied to the rash to relieve symptoms. You can apply the moisturizer twice a day for one week, and then daily for another week. If antihistamines do not relieve itching, oatmeal baths or calamine lotion can be soothing.

More Severe or Widespread Reactions: If the rash covers large portions of your body or you have severe symptoms, you may need a prescription-strength cream or a systemic steroid, such as prednisone. It is very important to take this medication exactly as your doctor prescribes it and, in the case of a steroid, take all of the pills that are given to you. If you have severely irritated skin with oozing or crusting lesions, your doctor may also prescribe wet dressings that will help with the more severe symptoms.

Other treatments may include:

  • Antibiotics: If your doctor feels that the rash or skin is infected, an antibiotic may be prescribed. It is important that you take this medication as directed and complete your entire course.
  • PhototherapyIf contact dermatitis does not respond to steroid creams or systemic steroids, your doctor may try phototherapy.
  • Immunosuppressant agents: In the uncommon event that you do not respond to any of the aforementioned treatments, your doctor may try drugs that suppress the immune response.

Learn more about contact dermatitis treatment.

Everyday Life With Contact Dermatitis

Sometimes living with contact dermatitis can be a mystery. You can have a red, itching, and oozing rash and you are not sure why. This can be really frustrating when you are doing everything your doctor recommends, but your symptoms are not going away and are bothersome. Ask yourself if anything at work or at home has changed? You may need to become a bit of a sleuth to figure out the cause. Sharing any information with your doctor, no matter how insignificant you think it may be, is helpful.

A Word From Verywell

It may seem like a difficult task to avoid the triggers causing your symptoms, especially if the cause is occupational or you are not exactly sure of the cause entirely. Then, of course, you might also need to manage a complicated treatment regimen that includes both over-the-counter and prescription treatments. You need to make sure that you are developing an open, trusting, and communicative relationship with your doctors and healthcare team. This will help you develop a treatment regimen that is manageable and also lessen the impact contact dermatitis has on your life.

Sources:

Beltrani VS, Bernstein IL, Cohen DE, Fonacier L. Contact Dermatitis: A Practice Parameter. Ann Allergy Asthma Immunol. 2006;97:S1–38.

Katta R, Schlichte M. Diet and dermatitis: Food triggers. J Clin Aesthet Dermatol. March 2014;30–36.

Nguyen JC, Chesnut G, et al. Allergic contact dermatitis caused by lanolin (wool) alcohol contained in an emollient in three postsurgical patients. J Am Acad Dermatol. 2010;62:1064–5.

Saary J, Qureshi R. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol. 2005;53:845–55.

Wentworth AB, Yiannias JA, et at. Trends in patch testing, J Am Acad Dermatol. 2014;70:269–75.

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