Contact Dermatitis

What is Contact Dermatitis?

Contact dermatitis is an eczematous skin disease which is caused by direct contact with a noxious agent. Most contact dermatitis reactions are dose related. The severity of the reaction depends on how long, how much and how irritating a particular substance is. Contact dermatitis is categorized into tow categories...irritant and allergic dermatitis.

Irritant contact dermatitis, is more common and occurs immediately after exposure to a specific compound (e.g. solvents or detergents).

Allergic contact dermatitis requires 24 to 48 hours before the skin rash develops. The most common contact allergen is nickel. Costume jewelry, watch faces and gold earrings, all of which contain nickel, can cause this type of reaction to occur.

Fig. 1 Contact Dermatitis- due to nickel (costume jewelry)

How do I recognize a contact dermatitis reaction?

Contact dermatitis usually presents as an itching, red rash which may be associated with blister formation. Skin can be easily rubbed off and oozes when the eruption is severe. In some instances, patients experience hives. Friction, low humidity and temperature changes can influence a contact dermatitis reaction.

 

Fig. 2 Contact Dermatitis-due to an allergy to Polysporin™ ointment.

What are some of the agents which cause contact dermatitis?

Besides nickel, there are a variety of agents which can cause a contact dermatitis reaction. Soaps and detergents are sources for the irritant form of contact dermatitis while materials such as rubber, perfumes, and formaldehyde tend to induce the allergic variety. It is important to note that a contact dermatitis rash can occur in an area different from where skin is exposed. For example, in some instances, it is possible to be allergic to the rubber compounds found in tennis shoe soles and manifest a hand dermatitis, Dr. Harvey and Dr. Hardy can help you sort out the often confusing details of a contact dermatitis rash.

Fig. 3 Contact Dermatitis- due to shoe leather-note the distribution of this rash over the top of the foot. 

How is the diagnosis of contact dermatitis made?

Once the diagnosis of contact dermatitis is suspected, it is important to challenge your skin in a process referred to as patch testing. Patch testing is performed in the office setting. Dr. Harvey and Dr. Hardy will apply various strengths of topical compounds to the skin. He will then assess the tested areas in 48 hours to see if a localized skin rash develops. Once an allergen or irritant has been identified, Dr. Harvey and Dr. Hardy will review with you the sources of these agents. In this way you may practice avoidance techniques to help to minimize your risk of developing new skin reactions.

What are some of the treatments for contact dermatitis?

The main therapy for contact dermatitis reactions is avoidance of the irritating or allergic material. Dr. Harvey and Dr. Hardy can also prescribe topical corticosteroid creams and oral antihistamines to help with any itching or discomfort. The use of protective clothing, e.g. cotton gloves or denim pants, is also helpful. If you suspect that the work place is the cause of your skin rash, it is important to let Dr. Harvey and Dr. Hardy know of your concern. Your employer is responsible to compensate you for any lost wages due to work place related illnesses. A detailed dermatologic investigation can often sort out whether or not your work environment is the source of your skin rash. Please call our office at 285-SKIN (7546) if you have further questions.

Fig. 4 Contact Dermatitis- on nails due to acrylates found in nail adhesives.

Dr. Harvey and Dr. Hardy may recommend:

• Patch testing to standard, cosmetic, rubber, glue trays.

• Avoidance of those allergens identified.

• Avoidance of irritant sources such as soaps, detergents or solvents.

• That personal protective clothing be worn These include items such as cotton gloves. denim shirts, pants, and a filtered mask.

• Eucerin™ cream twice daily after gently wetting the skin. Please remember to minimize hot water exposure as dry skin can often exacerbate your tendency to develop contact dermatitis.

• Potent topical corticosteroids as directed:

• Avoid bleaching your underwear.

• Apply nail polish or felt to underside of your watch if you are nickel allergic.

• Preparation H will help fissures on hands to heal.

• Avoid candies that contain cinnamon if cinnamic aldehyde is the source of your allergy.

• Avoidance of the Sun or other light source (e.g. tanning parlors) until your skin rash improves. (If Dr. Harvey and Dr. Hardy suspects a photoallergic or phototoxic reaction this won ld necessitate that you avoid excessive sun exposure.)

• Burrow's Solution (Aluminum Acetate soaks). Soak cotton gauze with Burrow's solution and leave on the affected area for 5 to 10 minutes. Repeat this procedure 3 to 4 times a day.

• Contact your employer for any relevant Material and Safety Data Sheets (MSD sheets). Dr. Harvey and Dr. Hardy can assess and test the sources in your work environment to see if they are causing your skin reaction.

Prescription creams -Use as directed:

• Temovate™ Ointment, 0.05% twice daily to the affected area for 2 weeks.

• Diprolene™ Ointment, 0.1% twice daily to the affected area as directed.

• Lidex™ Cream 0.05% twice daily to the affected area as directed.

• Hydrocortisone Cream, I% twice daily to the affected area as directed.

• Triamcinolone 0.1% 1:1 with Sarna lotion. Apply twice daily to the affected areas. 

• Cutivate™ Ointement twice daily to the affected area

• Protopic™ Ointment 0.1% Apply twice daily until rash clears and then for one week after. Use as directed.

 If you have any questions, or wish to schedule a consultation, please call Ponte Vedra Dermatology  & Aesthetic Surgery at (904) 285-7546 or email consultation@pvderm.com.