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Definition

What is contact dermatitis?

Contact dermatitis is a red, itchy rash caused by a substance that comes into contact with your skin. The rash isn’t contagious or life-threatening, but it can be very uncomfortable.

 

Possible causes include soaps, cosmetics, fragrances, jewelry, and plants, such as poison ivy or poison oak. Some people are exposed to substances at work that may cause contact dermatitis.

 

How common is contact dermatitis?

Contact dermatitis is extremely common. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of contact dermatitis?

The common symptoms of contact dermatitis are:

  • Red rash or bumps
  • Itching, which may be severe
  • Dry, cracked, scaly skin, if your condition is chronic
  • Blisters, draining fluid and crusting, if your reaction is severe
  • Swelling, burning or tenderness

 

The severity of the rash depends on:

  • How long you’re exposed
  • The strength of the substance that caused the rash
  • Environmental factors, such as temperature, airflow and sweating from wearing gloves
  • Your genetic makeup, which can affect how you respond to certain substances

 

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

 

When should I see my doctor?

You should contact your doctor if you have any of the following:

  • The rash is so uncomfortable that you are losing sleep or are distracted from your daily routine
  • The rash is painful, severe or widespread
  • You’re embarrassed by the way your skin looks
  • The rash doesn’t get better within a few weeks
  • The rash affects your face or genitals

 

Seek immediate medical care in the following situations:

  • You think your skin is infected — clues include fever and pus oozing from blisters.
  • Your lungs, eyes or nasal passages are painful and inflamed, perhaps from inhaling an allergen.
  • You think the rash has damaged the mucous lining of your mouth and digestive tract.

Causes

What causes contact dermatitis?

Contact dermatitis is caused by a substance you’re exposed to that irritates your skin or triggers an allergic reaction. The substance could be one of thousands of known allergens and irritants. Some of these substances may cause both irritant contact dermatitis and allergic contact dermatitis.

 

Irritant contact dermatitis is the most common type. This non-allergic inflammatory reaction occurs when a substance damages your skin’s outer protective layer. Some people react to strong irritants after a single exposure. Others may develop signs and symptoms after repeated exposures to even mild irritants. And some people develop a tolerance to the substance over time. Common irritants include:

  • Solvents
  • Rubbing alcohol
  • Bleach
  • Personal care products, such as soaps, deodorants and cosmetics
  • Airborne substances, such as sawdust or wool dust
  • Burdock, a plant used in alternative medicine therapies

 

Allergic contact dermatitis occurs when a substance to which you’re sensitive (allergen) triggers an immune reaction in your skin. It usually affects only the area that came into contact with the allergen. But it may be triggered by something that enters your body through foods, flavorings, medicine, or medical or dental procedures (systemic contact dermatitis).

 

You may become sensitized to a strong allergen such as poison ivy after a single exposure. Weaker allergens may require multiple exposures over several years to trigger an allergy. Once you develop an allergy to a substance, even a small amount of it can cause a reaction. Common allergens include:

  • Nickel, which is used in jewelry, buckles and many other items
  • Medications, such as antibiotic creams and oral antihistamines
  • Balsam of Peru, which is used in many products, such as perfumes, cosmetics, mouth rinses and flavorings
  • Formaldehyde, which is in adhesives, solvents and other things
  • Personal care products, such as deodorants, body washes, hair dyes, cosmetics, nail polish, and herbal preparations for the skin containing eucalyptus, camphor or rosemary
  • Skin tattooing and black henna
  • Plants such as poison ivy and mango, which contain a highly allergenic substance called urushiol
  • Airborne substances, such as from aromatherapy and spray insecticides
  • Products that cause a reaction when you’re in the sun (photoallergic contact dermatitis), such as some sunscreens and oral medications

The rate of allergic contact dermatitis in children is similar to that in adults. Children develop the condition from the usual offenders and also from exposure to car seats, the plastic in toilet seats and infant clothing snaps.

 

Occupational contact dermatitis refers to rashes resulting from exposure to allergens or irritants on the job. Certain occupations and hobbies put you at higher risk of this type of contact dermatitis. Examples include:

  • Health care workers and pharmaceutical industry employees
  • Metalworkers
  • Construction workers
  • Hairdressers and cosmetologists
  • Waiters
  • Scuba divers or swimmers, due to the rubber in face masks or goggles
  • Cleaners
  • Gardeners and agricultural workers
  • Chefs and others who work with food

Risk factors

What increases my risk for contact dermatitis?

Contact dermatitis is caused by the direct application of the inciting substance to unprotected skin. Therefore, the key risk factor is exposure to that substance.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

 

How is contact dermatitis diagnosed?

Doctors rely on these main steps to determine the cause:

  • A thorough medical history and physical exam. Your doctor may be able to diagnose contact dermatitis and identify its cause by talking to you about your signs and symptoms, questioning you to uncover clues about the culprit, and examining your skin to note the pattern and intensity of your reaction.
  • A patch test. Your doctor may recommend a patch test (contact delayed hypersensitivity allergy test) to see if you’re allergic to something. This test can be useful if the cause of your rash isn’t apparent or if your rash recurs often.You may be asked to avoid certain medications and sun tanning your back for a week or two before the test. During a patch test, small amounts of potential allergens are applied to adhesive patches, which are then placed on your skin. The patches remain on your skin for two days, during which time you’ll need to keep your back dry. Your doctor then checks for a skin reaction under the patches and determines whether further testing is needed. Often, people react to more than one substance.

 

How is contact dermatitis treated?

  • Avoiding the irritant or allergen. The key to this is identifying what’s causing your rash and then staying away from it. Your doctor may give you a list of products that typically contain the substance that affects you.
  • Applying prescription steroid creams. If self-care measures haven’t worked, your doctor may prescribe a steroid cream.
  • Applying medications to repair the skin. You can help repair the skin and prevent relapse with creams and ointments containing drugs that affect the immune system, such as calcineurin inhibitors tacrolimus (Protopic) or pimecrolimus (Elidel). This solution is recommended for long-term treatment of contact dermatitis. But the Food and Drug Administration has warned about a possible link between these drugs and lymphoma and skin cancer.
  • Using oral medications. In severe cases, your doctor may prescribe oral corticosteroids to reduce inflammation, antihistamines to relieve itching or antibiotics to fight a bacterial infection.

Review Date: June 16, 2017 | Last Modified: June 16, 2017

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