Contact dermatitis

Background

• Type IV hypersensitivity reaction
• Three Types
  • Allergic contact dermatitis: nickel, gold, chromium, poison ivy, poison oak, and poison sumac
  • Irritant contact dermatitis: solvents, neat oils, kerosene, surfactants in cosmetics, latex, drain cleaners
  • Photocontact dermatitis: interaction with UV light (lime juice and sunlight)

Clinical Features

• Inflammation of the epidermis and dermis
  • Erythema may take 1-3 days to show up
  • May also have blisters and wheels
  • Form in linear or shaped-pattern depending on exposure
  • Itchy, burning, and sometimes painful
  • Can take weeks to heal

Contact dermatitis

Differential Diagnosis

Vesiculobullous rashes

Febrile

• Diffuse distribution
  • Varicella
  • Smallpox
  • Disseminated gonococcal disease
  • DIC
  • Purpural fulminans
• Localized distribution
  • Necrotizing fasciitis
  • Hand-foot-and-mouth disease

Afebrile

• Diffuse distribution
  • Bullous pemphigoid
  • Drug-Induced bullous disorders
  • Pemphigus vulgaris
  • Phytophotodermatitis
  • Erythema multiforme major
• Localized distribution
  • Contact dermatitis
  • Herpes zoster
  • Dyshidrotic eczema
  • Burn
  • Dermatitis herpetiformis
  • Erythema multiforme minor
  • Poison Oak, Ivy, Sumac dermatitis
  • Bullosis diabeticorum

Evaluation

• Clinical diagnosis
• Allergist or dermatologist may use patch test to determine exact cause

Management

• Supportive care
  • Remove irritant
  • Barrier protection
  • Emollients
  • Topical steroids show marginal benefit.

Disposition

• Discharge

See Also

• Generalized rashes

References

Authors

Daniel Eggeman, Ross Donaldson, Amr Badawy, Michael Holtz, Neil Young, Daniel Ostermayer