Contact Dermatitis

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritant or allergen. This common skin condition is marked by itching, inflammation, redness and blistering, sometimes resembling a burn. Contact dermatitis itself is not dangerous, and it is not contagious.

Contact dermatitis is one of many forms of dermatitis including eczema, infantile eczema, and seborrheic dermatitis.

Irritant dermatitis is the most common type of contact dermatitis and occurs when skin comes in direct contact with an irritating substance, such as soaps, detergents, and other chemicals. This skin reaction looks more like a burn. Allergic contact dermatitis is caused by coming in direct contact with substances to which you are allergic, such as poison ivy, some medications, fragrances, dyes, and preservatives.

The appearance, severity and triggers of contact dermatitis vary between individuals. With accurate diagnosis of the underlying allergy or sensitivity, contact dermatitis is treatable and curable by avoiding exposure to the substance that triggers the rash and using topical medications and other therapies.

Contact dermatitis is generally not a serious condition, but there is a potential for complications, such as a secondary bacterial or fungal infection of the rash. Seek prompt medical care if you have symptoms of contact dermatitis. Early diagnosis and treatment can help reduce the risk for complications of contact dermatitis.

Symptoms of contact dermatitis differ in severity, frequency and duration among individuals. Symptoms may develop quickly after contact with the allergen or substance that triggers contact dermatitis, or it may take days to weeks for symptoms to appear.

Hallmark symptoms of contact dermatitis include:

• Itching skin

• Rash or patch of dry, inflamed skin

• Scales and blisters that ooze fluid and crust over

Scratching the affected area generally does not relieve the itching. It can spread the allergen and the contact dermatitis rash to other areas of the body, such as contact dermatitis related to poison ivy or poison oak. Scratching can also lead to increased inflammation, more intense itching, and harder scratching.

In some cases, scratching can lead to potentially serious complications, such as a secondary bacterial or fungal infection and cellulitis. Seek prompt medical care if you have any of these symptoms:

• High fever (higher than 101 degrees Fahrenheit)

• Increase or change in the type of drainage from the blisters

• Open sores or lesions

• Redness, swelling and warmth of the skin surrounding the rash

Contact dermatitis, also called allergic contact dermatitis and irritant contact dermatitis, is often associated with allergies and is caused by direct contact of the skin with a substance to which an individual is allergic or sensitive. These substances are called allergens and irritants. Allergens and irritants that cause contact dermatitis vary between individuals. Common irritants and allergens include:

• Chemicals, such as acids, solvents and dyes

• Food preservatives

• Fragrances and perfumes

• Latex and rubber

• Nickel, a metal often used in the manufacture of jewelry, accessories  and clothing

• Poison ivy, poison oak, or poison sumac

• Soaps and detergents

• Some medications

A number of factors increase the risk of developing contact dermatitis. Risk factors include:

• Existing skin conditions, such as eczema and psoriasis

• Exposing the hands to wet conditions for long periods of time

• Getting a lot of sun exposure while taking certain medications that cause skin sensitivity to the sun, such as tetracycline and doxycycline

• History of allergies

• Repeated exposure to common irritants, such as nickel

• Working with the hands in hot conditions for long periods of time

Not all people who are at risk for contact dermatitis will develop the condition. In many cases, it is possible to prevent contact dermatitis. You can lower your risk of developing contact dermatitis by :

• Avoiding exposure to the specific allergen or irritant that triggers a skin reaction

• Avoiding situations in which your skin will be exposed to wet or hot conditions for long periods of time

• Seeking regular medical care and following your treatment plan for allergies and other skin conditions

• Staying out of the sun when taking certain medications, such as tetracycline and doxycycline

In many cases, contact dermatitis can be cured. With a well-integrated, individualized treatment plan, outbreaks of contact dermatitis can be avoided, and symptoms can be effectively controlled or eliminated. A good treatment plan is individualized to your medical history, the severity of your contact dermatitis, the specific cause, and other factors. 

Goals of treatment include identification and avoidance of the offending allergen, alternatives to offending products, treatment of skin inflammation, restoration of a healthy skin barrier, and ongoing skin protection.

Lifestyle changes and considerations for treating contact dermatitis include:

• Avoiding alcohol and caffeine

• Avoiding hot tubs, steam baths, saunas, and chlorinated swimming pools

• Avoiding scratchy clothes

• Drinking plenty of fluids

• Getting skin patch testing, in which small amounts of common allergens are applied methodically to the skin to determine what substances are triggering the allergic response that leads to the contact dermatitis

• Minimizing skin dryness by using lotion specifically designed for sensitive skin

• Preventing flare-ups by avoiding exposure to the specific allergen or allergens that induce the condition

• Using a cool mist vaporizer or home humidifier

• Using a perfume-free moisturizer

• Using an oatmeal-based soap, such as Aveeno, to help relieve itching and inflammation

• Using ice bags or cool wet compresses to help relieve itching and inflammation

• Using mild soaps and not over washing or harshly scrubbing skin

In moderate to severe cases of contact dermatitis, medications may be prescribed. Medications may include:

• Antibiotics or antifungal drugs, which treat secondary bacterial or fungal infections

• Antihistamines, which reduce itching

• Corticosteroid cream, which reduces inflammation

These medications can all have side effects, so they should only be used under the direction of a licensed health care clinician.

When left untreated, contact dermatitis can develop into an escalating cycle of itching, scratching and inflammation. In some cases, the excessive scratching can introduce bacteria or fungus into layers of the skin, resulting in infections that can be serious in some people. Complications include:

• Bacterial or fungal infection

• Cellulitis (an infection of the skin and surrounding tissues caused by a growing bacterial or fungal infection)

• Open sores and lesions

• Permanent change in skin texture or scarring

• Permanent skin discoloration