contact dermatitis (redirected from Dermatitis, allergic contact)

Contact Dermatitis 

Definition

Contact dermatitis is the name for any skin inflammation that occurs when the skin's surface comes in contact with a substance originating outside the body. There are two kinds of contact dermatitis, irritant and allergic.

Description

Thousands of natural and man made substances can cause contact dermatitis, which is the most common skin condition requiring medical attention and the foremost source of work-related disease. Florists, domestic workers, hairdressers, food preparers, and employees in industry, construction, and health care are the people most at risk of contracting work-related contact dermatitis. Americans spend roughly $300 million a year in their quest for relief from contact dermatitis, not counting the considerable sums devoted by governments and businesses to regulating and policing the use of skin-threatening chemicals in the workplace. But exactly how many people suffer from contact dermatitis remains unclear; a 1997 article in the Journal of the American Medical Association notes that figures ranging from 1% to 15% have been put forward for Western industrial nations.

Causes and symptoms

Irritant contact dermatitis (ICD) is the more commonly reported of the two kinds of contact dermatitis, anf is seen in about 80% of cases. It can be caused by soaps, detergents, solvents, adhesives, fiberglass, and other substances that are able to directly injure the skin. Most attacks are slight and confined to the hands and forearms, but can affect any part of the body that comes in contact with an irritating substance. The symptoms can take many forms: redness, itching, crusting, swelling, blistering, oozing, dryness, scaliness, thickening of the skin, and a feeling of warmth at the site of contact. In extreme cases, severe blistering can occur and open sores can form. Jobs that require frequent skin exposure to water, such as hairdressing and food preparation, can make the skin more susceptible to ICD.

Allergic contact dermatitis (ACD) results when repeated exposure to an allergen (an allergy-causing substance) triggers an immune response that inflames the skin. Tens of thousands of drugs, pesticides, cosmetics, food additives, commercial chemicals, and other substances have been identified as potential allergens. Fewer than 30, however, are responsible the majority of ACD cases. Common culprits include poison ivy, poison oak, and poison sumac; fragrances and preservatives in cosmetics and personal care products; latex items such as gloves and condoms; and formaldehyde. Many people find that they are allergic to the nickel in inexpensive jewelry. ACD is usually confined to the area of skin that comes in contact with the allergen, typically the hands or face. Symptoms range from mild to severe and resemble those of ICD; a patch test may be needed to determine which kind of contact dermatitis a person is suffering from.

Diagnosis

Diagnosis begins with a physical examination and asking the patient questions about his or her health and daily activities. When contact dermatitis is suspected, the doctor attempts to learn as much as possible about the patient's hobbies, workplace duties, use of medications and cosmetics, etc.-anything that might shed light on the source of the disease. In some cases, an examination of the home or workplace is undertaken. If the dermatitis is mild, responds well to treatment, and does not recur, ordinarily the investigation is at an end. More difficult cases require patch testing to identify the allergen.

Two methods of patch testing are currently used. The most widely used method, the Finn chamber method, employs a multiwell, aluminum patch. Each well is filled with a small amount of the allergen being tested and the patch is taped to normal skin on the patient's upper back. After 48 hours, the patch is removed and an initial reading is taken. A second reading is made a few days later. The second method of patch testing involves applying a small amount of the test substance to directly to normal skin and covering it with a dressing that keeps air out and keeps the test substance in (occlusive dressing). After 48 hours, the dressing is taken off to see if a reaction has occurred. Identifying the allergen may require repeated testing, can take weeks or months, and is not always successful. Moreover, patch testing works only with ACD, though it is considered an essential step in ruling out ICD.

Treatment

The best treatment for contact dermatitis is to identify the allergen or irritating substance and avoid further contact with it. If the culprit is, for instance, a cosmetic, avoidance is a simple matter, but in some situations, such as an allergy to an essential workplace chemical for which no substitute can be found, avoidance may be impossible or force the sufferer to find new work or make other drastic changes in his or her life. Barrier creams and protective clothing such as gloves, masks, and long-sleeved shirts are ways of coping with contact dermatitis when avoidance is impossible, though they are not always effective.

For the symptoms themselves, treatments in mild cases include cool compresses and nonprescription lotions and ointments. When the symptoms are severe, corticosteroids applied to the skin or taken orally are used. Contact dermatitis that leads to a bacterial skin infection is treated with antibiotics.

Alternative treatment

Herbal remedies have been used for centuries to treat skin disorders including contact dermatitis. An experienced herbalist can recommend the remedies that will be most effective for an individual's condition. Among the herbs often recommended are:

• burdock (Arctium lappa) minimizes inflammation and boosts the immune system. It is taken internally as a tea or tincture (a concentrated herbal extract prepared with alcohol).
• calendula (Calendula officinalis) is a natural antiseptic and anti-inflammatory agent. It is applied topically in a lotion, ointment, or oil to the affected area.
• aloe (Aloe barbadensis) soothes skin irritations. The gel is applied topically to the affected area.

A homeopath treating a patient with contact dermatitis will do a thorough investigation of the individual's history and exposures before prescribing a remedy. One homeopathic remedy commonly prescribed to relieve the itching associated with contact dermatitis is Rhus toxicodendron taken internally three to four times daily.

Poison ivy, poison oak, and poison sumac are common culprits in cases of allergic contact dermatitis. Following exposure to these plants, rash development may be prevented by washing the area with soap and water within 15 minutes of exposure. The leaves of jewelweed (Impatiens spp.), which often grows near poison ivy, may neutralize the poison-ivy allergen if rubbed on the skin right after contact. Several topical remedies may help relieve the itching associated with allergic contact dermatitis, including the juice of plantain leaves (Plantago major); a paste made of equal parts of green clay and goldenseal root (Hydrastis canadensis); a paste made of salt, water, clay, and peppermint (Mentha piperita) oil; and calamine lotion.

Key terms

Antibiotics — Substances used against microorganisms that cause infection.

Corticosteroids — A group of anti-inflammatory substances often used to treat skin conditions.

Immune response — The protective reaction by the immune system against foreign antigens (substances that the body perceives as potentially dangerous). The immune system combats disease by neutralizing or destroying antigens.

Prognosis

If the offending substance is promptly identified and avoided, the chances of a quick and complete recovery are excellent. Otherwise, symptom management-not cure-is the best doctors can offer. For some people, contact dermatitis becomes a chronic and disabling condition that can have a profound effect on employability and quality of life.

Prevention

Avoidance of known or suspected allergens or irritating substances is the best prevention. If avoidance is difficult, barrier creams and protective clothing can be tried. Skin that comes in contact with an offending substance should be thoroughly washed as soon as possible.

Resources

Periodicals

Beltrani, Vincent S., and Vincent P. Beltrani. "Contact Dermatitis." Annals of Allergy, Asthma, and Immunology 78 (February 1997): 160-75.

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dermatitis /der·ma·ti·tis/ (der″mah-ti´tis) pl. dermati´tides   inflammation of the skin.

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actinic dermatitis  dermatitis due to exposure to actinic radiation, such as that from the sun, ultraviolet waves, or x- or gamma radiation.

allergic dermatitis 

1. atopic d.

2. allergic contact d.

allergic contact dermatitis  contact dermatitis due to allergic sensitization.

ammonia dermatitis  diaper dermatitis attributed to skin irritation, due to the ammonia decomposition products of urine.

atopic dermatitis  a chronic inflammatory, pruritic, eczematous skin disorder in individuals with a hereditary predisposition to cutaneous pruritus; often accompanied by allergic rhinitis, hay fever, and asthma.

berlock dermatitis , berloque dermatitis dermatitis of the neck, face, or chest, with patches or streaks, caused by exposure to perfume or other toilet articles containing bergamot oil and then to sunlight.

cercarial dermatitis  swimmers' itch.

contact dermatitis  acute or chronic dermatitis caused by substances contacting the skin; it may involve allergic or nonallergic mechanisms.

diaper dermatitis  diaper rash.

dermatitis exfoliati´va neonato´rum  staphylococcal scalded skin syndrome.

exfoliative dermatitis  virtually universal erythema, desquamation, scaling, and itching of the skin, with loss of hair.

dermatitis herpetifor´mis  pruritic chronic dermatitis with successive groups of symmetrical, erythematous, papular, vesicular, eczematous, or bullous lesions, usually associated with asymptomatic gluten-sensitive enteropathy.

infectious eczematous dermatitis  a pustular eczematoid eruption arising from a primary lesion that is the source of an infectious exudate.

insect dermatitis  a transient skin eruption caused by the toxin-containing irritant hairs of insects such as certain moths and their caterpillars.

irritant dermatitis  a nonallergic type of contact dermatitis due to exposure to a substance that damages the skin.

livedoid dermatitis  local pain, swelling, livedoid changes, and increased temperature; due to temporary or prolonged local ischemia from vasculitis or from accidental arterial obliteration during intragluteal administration of medications.

meadow dermatitis , meadow-grass dermatitis phytophotodermatitis with eruption of vesicles and bullae in streaks or other configurations, caused by exposure to sunlight after contact with meadow grass.

photoallergic contact dermatitis , photocontact dermatitis allergic contact dermatitis caused by the action of sunlight on skin sensitized by contact with substances such as halogenated salicylanilides, sandalwood oil, or hexachlorophene.

phototoxic dermatitis  erythema followed by hyperpigmentation of sun-exposed areas of the skin, due to exposure to agents containing photosensitizing substances, such as coal tar and psoralen-containing perfumes, drugs, or plants, and then to sunlight.

poison ivy dermatitis , poison oak dermatitis, poison sumac dermatitis allergic contact dermatitis due to exposure to plants of the genus Rhus, which contain urushiol, a skin-sensitizing agent.

radiation dermatitis  radiodermatitis.

rat mite dermatitis  that due to a bite of the rat-mite, Ornithonyssus bacoti.

dermatitis re´pens  acrodermatitis continua.

rhus dermatitis  poison ivy, poison oak, or poison sumac d.

schistosome dermatitis  swimmer's itch.

seborrheic dermatitis , dermatitis seborrhe´ica chronic pruritic dermatitis with erythema, scaling, and yellow crust on areas such as the scalp, with exfoliation of excessive dandruff.

stasis dermatitis  chronic eczematous dermatitis due to venous insufficiency, initially on the inner aspect of the lower leg above the internal malleolus, sometimes spreading over the lower leg, marked by edema, pigmentation, and often ulceration.

swimmers' dermatitis  see under itch.

uncinarial dermatitis  ground itch.

x-ray dermatitis  radiodermatitis.

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contact dermatitis

n.

An acute or chronic skin inflammation resulting from contact with an irritating substance or allergen.

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contact dermatitis,

a skin rash resulting from exposure to a primary irritant or to a sensitizing antigen. In the first, or nonallergic, type, a primary irritant, such as an alkaline detergent or an acid, causes a lesion similar to a thermal burn. Emergency treatment is to drench liberally and immediately with water. In the second, or allergic, type, sensitizing antigens cause an immunologic change in certain lymphocytes. Subsequent exposure to the antigen causes the lymphocytes to release irritating chemicals, leading to inflammation, edema, and vesiculation. Poison ivy and nickel dermatitis are common examples of this type of delayed hypersensitivity reaction. The diagnosis can be aided by patch testing with suspected antigens. Treatment includes avoidance of the irritant or sensitizer, administration of topical corticosteroid preparations, and use of soothing or drying lotions. In severe cases, systemic corticosteroids may be used. Also called dermatitis venenata. Compare atopic dermatitis. See also hypersensitivity reaction.

observations Contact dermatitis is caused by contact with irritants and manifests as skin irritation at the site of contact. This irritation can vary from transient redness to bulla formation. Itching is common, and weeping and crusting may be present. Diagnosis is made through clinical evaluation, detailed history to locate possible source of contact rash, and patch testing to isolate allergens.

interventions Removal of irritant from the skin with soap and water is the first line of treatment. Treatment then focuses on alleviating the itching and rash. Cool, wet cloths are effective for treating blistering. Oral antihistamines and colloidal oatmeal baths are used to control itching. Erythema may be treated with topical steroids. Oral corticosteroids are reserved for severe or widespread dermatitis.

nursing considerations Instruction is needed about avoidance of contact with known irritants.

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contact dermatitis,

n skin rash or inflammation following exposure to a primary irritant.

Contact dermatitis.

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dermatitis (durmtī´tis),

n an inflammation of the skin.

dermatitis, allergic contact,

n the reaction of the skin to direct contact with a specific antigen. Poison ivy rash is a common example of an allergic contact dermatitis.

dermatitis, atopic

(ātō´pik),
n an atopic eczema characterized by the distinctive phenomenon of atopy, a familial related allergic response associated with IgE antibody.

dermatitis, contact,

n a delayed type of induced sensitivity (allergy) of the skin with varying degrees of erythema, edema, and vesiculation, resulting from cutaneous contact with a specific allergen. It is an occupational hazard in dentistry.

dermatitis herpetiformis

n dermatitis characterized by grouped, erythematous, papular, vesicular, pustular, or bullous lesions occurring in various combinations, often accompanied by vesicobullous and ulcerative lesions of the oral mucosa.

dermatitis infectiosa eczematoides (Engman's disease),

n a pustular eczematous eruption that frequently follows or occurs coincidentally with some pyogenic process.

dermatitis, occupational,

n a contact dermatitis associated with allergens found in the workplace.

dermatitis, radiation,

n an inflammation of the skin resulting from a high dose of radiation. The reaction varies with the quality and quantity of radiation used and is usually transitory.

dermatitis, seborrheic

n a chronic inflammatory skin disease that can affect the scalp, face, ears, armpits, breasts, and groin. Its symptoms include moist, greasy, or dry scaling and patches of yellowish crust. Although the cause is unknown, it can be treated with selenium sulfide shampoos, topical antibiotics, and topical and oral corticosteroids.

Dermatitis.

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contact

1. a mutual touching of two bodies or animals.

2. an animal known to have been sufficiently near an infected animal to have been exposed to the transfer of infectious material.

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contact activation

the initiation of the intrinsic pathway of coagulation that occurs when whole blood contacts glass or similar surfaces; involves the conversion of factor XII into its active form, factor XIIa. This subsequently converts factor XI to XIa and so the coagulation cascade begins.

contact allergy

see contact dermatitis (below).

bone contact repair

repair of a fracture by contact apposition of the two fracture surfaces.

contact dermatitis

is caused by direct contact between the skin and a substance which is irritating or to which the animal is allergic or sensitive. The reaction usually occurs only on that area of the body that has come into contact with the substance. See also allergic contact dermatitis.

direct contact, immediate contact

the contact, by sharing the same accommodation or pasture or group, of a healthy animal with an animal having a communicable disease, the disease being transmitted as a result. See also contact transmission.

contact healing

a form of primary bone healing at a fracture site where there is cortical bone in contact.

contact hypersensitivity

see allergic contact dermatitis.

indirect contact

that achieved through some intervening medium, as propagation of a communicable disease through the air or by means of fomites or another animal, e.g. an infection may be passed to animal A from animal B via animal C; animal C is an indirect contact.

contact irritant dermatitis

skin disease produced by contact with an irritating substance; in contrast with allergic contact dermatitis, an immune reaction is not involved.

mediate contact

indirect contact.

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contact dermatitis

Dermatology A dermatitis evoked by a substance in regular direct contact with the skin Types Irritant CD–accounts for 80% of occupational dermatitides and damages skin by nonimmune mechanisms–eg detergents, solvents, adhesives, ointments, etc; allergic CD is due to an immune skin response, and is more common in a nonoccupational setting and caused by allergy to various substances–eg, jewelry, rubber, latex, poison ivy, neomycin, etc. See Allergic contract dermatitis, Irritant contact dermatitis, Latex allergy.