— Dermatitis is defined as an inflammation of the skin resulting in redness, itching, and/or scale. Contact dermatitis refers to dermatitis that is caused by contact between the skin and a substance. The substance can be an allergen (a substance that provokes an allergic reaction) or an irritant (a substance that damages the skin). Irritants are responsible for about 80 percent of cases of contact dermatitis.
In most cases, self-care measures and drug therapy can control the symptoms and prevent complications of contact dermatitis.
IRRITANT CONTACT DERMATITIS
— Irritant contact dermatitis occurs when the skin comes in direct contact with a substance that physically, mechanically, or chemically irritates the skin, causing the normal skin barrier to be disrupted.
The most common causes of irritant dermatitis are products used on a daily basis, including soap, cleansers, and rubbing alcohol. People with other skin conditions, dry skin, and light-colored or “fair” skin are at greatest risk, although anyone can develop irritant dermatitis.
— Mild irritants cause redness, dryness, fissures (small cracks), and itching. Strong irritants may cause swelling, oozing, tenderness, or blisters. The hands are commonly affected, often between the fingers. Irritant dermatitis can also affect the face, especially the thin skin of the eyelids.
— The diagnosis of irritant contact dermatitis is usually based upon a person’s history and physical examination. In some cases, a patch test (applying a small amount of a substance to the skin) may be recommended to determine if the dermatitis is allergic or irritant-type. Patch testing should be done by a dermatologist or allergist who is trained in this procedure.
— The goal of treatment of irritant contact dermatitis is to restore the normal skin barrier and protect the skin from future injury. Reducing or avoiding altogether exposure to known irritants is essential. In some cases, simply reducing the use of soap and using an emollient cream or ointment completely alleviates symptoms. Wearing gloves when working with irritants may help as well.
In more severe cases, topical corticosteroids (steroids) may be recommended. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available in the United States without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription.
Steroid treatments for contact dermatitis are most effective when applied and covered with a barrier, such as plastic wrap, a dressing (eg, Telfa), cotton gloves, or petroleum jelly. Oral steroids (eg, prednisone) may be used briefly to treat severe dermatitis, but are not recommended for long-term treatment of irritant contact dermatitis.
ALLERGIC CONTACT DERMATITIS
— Allergic contact dermatitis occurs when the skin comes in direct contact with an allergen. This activates the body’s immune system, which triggers inflammation. Allergic contact dermatitis can occur after being exposed to a new product or after using a product for months or years. Weak allergens require exposure of weeks to months before they cause dermatitis. The patient can help find the cause of allergic contact dermatitis by providing a history of exposures. As an example, if the patient presents with sudden-onset allergic contact dermatitis with blisters, plant exposure history is most helpful. In contrast, with chronic allergic contact dermatitis with skin redness and thickening, exposure to everyday items, such as clothing, shoes, cosmetics, and metals, should be mentioned.
— Poison ivy, poison oak, and poison sumac contain an oil called urushiol, which is the most common cause of allergic contact dermatitis. Ginkgo fruit and the skin of mangos also contain urushiol and can cause allergic contact dermatitis.
Other common allergens include nickel in jewelry, perfumes and cosmetics, components of rubber, nail polish, and chemicals in shoes (both leather and synthetic.
Allergic contact dermatitis can also be triggered by certain medications, including hydrocortisone cream, antibiotic creams (sample brand names: Neosporin, Bacitracin), benzocaine, and thimerosal. Laundry detergents are an uncommon cause of allergic contact dermatitis.
— Symptoms include intense itching and a red raised rash. The rash may blister in severe cases. The rash is usually limited to areas that were in direct contact with the allergen, but a rash can appear in other areas of the body, if the allergen was transferred to those areas on a person’s hands. Washing the allergen away with soap and water can usually prevent this spread.
The rash typically appears within 12 to 48 hours of exposure to the allergen, although in some cases it may not appear for up to two weeks. Less commonly, the rash persists for months or years, which makes it difficult to identify the cause of the reaction.
— The diagnosis of allergic contact dermatitis is based upon a person’s history and physical examination. If symptoms improve after the allergen is eliminated, this supports the diagnosis. Patch testing may be recommended in some cases and is usually performed by a dermatologist or allergist.
Treatment — Allergic contact dermatitis usually resolves within two to four weeks after the allergen is eliminated, although it can take more time in some cases. Several measures can minimize symptoms during this time and help to control symptoms in people who have chronic allergic contact dermatitis.
●Whenever possible, identify and stop all exposure to the allergen.
●Oatmeal baths or soothing lotions such as calamine lotion can provide relief in mild cases.
●Topical corticosteroids (steroids) may be recommended for people with mild to moderate symptoms. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available in the United States without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription.
●For people with more bothersome symptoms, wet or damp dressings are recommended, especially when the affected area is oozing fluid and crusting. Such dressings are soothing and relieve itching, reduce redness, gently remove crusts, and prevent additional injury from scratching.
A damp cotton garment (the garment is soaked with water and then wrung out) is worn over the affected area and covered with a dry garment. As an example, for an adult with allergic contact dermatitis of the legs, wet long underwear can be covered with larger dry long underwear. Adults may prefer to apply wet dressings at night. When used during the day, wet dressings should be changed every eight hours. Infants and toddlers with extensive skin involvement can wear wet pajamas covered by a dry pair of pajamas or a sleep sack.
●In people with severe dermatitis, a short course of steroid pills (eg, prednisone) may be recommended to get symptoms under control.
The use of topical antihistamines (sample brand name: Benadryl) should be avoided because it can cause contact dermatitis.
— Latex is a fluid produced by rubber trees that is processed into a variety of products, including gloves, balloons, and condoms. In some individuals, exposure to these products and others can cause a contact dermatitis that is either an irritant or allergic reaction. Less commonly, a person can develop a potentially life-threatening allergic reaction to latex.
— Irritant dermatitis usually occurs on the hands of people who wear latex or other rubber gloves, but the problem is not the latex. These gloves—whether or not they contain latex—often contain chemical additives that irritate the skin. Also, the gloves trap moisture against the skin, making it softer and more vulnerable to irritants. The combination of these factors can lead to dermatitis.
The symptoms of irritant rubber or latex dermatitis include redness and itching on the skin. There may also be dryness and cracking.
People with irritant dermatitis often believe they have a latex allergy and then discover that their dermatitis occurs even when they use latex-free gloves. For them, treatment involves avoiding products that contain the irritants and using an emollient cream or ointment.
— A true latex allergy causes a different response than that seen with irritant dermatitis. A latex allergy can cause hives (raised, red, itchy welts on the skin), nasal and eye irritation or congestion, asthma, and even a life-threatening reaction called anaphylaxis. Also, people who have a latex allergy often also have allergic responses to fruits or vegetables that contain proteins similar to those found in latex. These foods include banana, kiwi, avocado, chestnut, papaya, potato, and tomato.
Diagnosis — To diagnose a latex allergy, healthcare providers learn as much as possible about a person’s responses when they have been exposed to latex and related allergens in the past. If the pattern suggests a latex allergy, they usually confirm the allergy using blood or skin tests. In the United States, the preferred way to diagnose a latex allergy is through a blood test. In other parts of the world, diagnosis can be done with skin tests using latex derivatives, but such testing products are not easily available in the United States. Diagnosis of a latex allergy is usually done by an allergist
— The primary treatment for latex allergy is to avoid all latex-containing products. Non-latex examination gloves are widely available, and use of glove liners may also be an effective approach.
Natural membrane (sometimes called sheep skin) condoms may be used in place of latex condoms, and are effective for preventing pregnancy. However, natural membrane condoms do not protect against sexually transmitted diseases such as HIV, gonorrhea, and chlamydia.
People with a serious latex allergy should wear a bracelet, necklace, or similar alert tag at all times. If a reaction occurs and the person is too ill to explain their condition, this will help responders provide the proper care as quickly as possible. This measure is especially important in children. The alert tag should include a list of known allergies, as well as the name and phone number of an emergency contact.
People with a latex allergy should inform their doctors, dentists, and other healthcare providers about their allergy. Some patients are advised to carry an anaphylaxis kit (containing epinephrine that can be injected under the skin) as a precautionary measure.
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