Dermatitis, Contact

Dermatitis, Contact is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A cutaneous reaction to contact with an external substance
  • Different mechanisms result in similar skin manifestation (1)
  • Primary irritant dermatitis (ID) results from direct damage to the stratum corneum by chemicals or physical agents occurring faster than the skin is able to repair itself, leading to an inflammatory nonimmunologic cutaneous reaction. Prior sensitization is not required (2).
  • Allergic contact dermatitis (ACD) affects only individuals previously sensitized to a substance. It represents a delayed hypersensitivity reaction, requiring several hours for the cascade of cellular immunity to be completed to manifest itself (2).
  • System(s) affected: skin/exocrine
  • Synonym(s): dermatitis venenata

Epidemiology

Common

Incidence
Occupational contact dermatitis: 20.5/100,000 workers/year in one Australian study

Prevalence
  • Contact dermatitis represents >90% of all occupational skin disorders.
  • Predominant sex: male = female
    • Variations due to differences in exposure to offending agents, as well as normal cutaneous variations between males and females (eccrine and sebaceous gland function and hair distribution)

Geriatric Considerations
Increased incidence of ID secondary to skin dryness

Pediatric Considerations
Increased incidence of positive patch testing due to better delayed hypersensitivity reactions (3)

Etiology and Pathophysiology

Hypersensitivity reaction to a substance generating cellular immunity response (4)

  • Plants
    • Urushiol (allergen): poison ivy, poison oak, poison sumac
    • Primary contact: plant (roots/stems/leaves)
    • Secondary contact: clothes/fingernails (not blister fluid)
  • Chemicals
    • Nickel: jewelry, zippers, hooks, and watches (5)
    • Potassium dichromate: tanning agent in leather
    • Paraphenylenediamine: hair dyes, fur dyes, and industrial chemicals
    • Turpentine: cleaning agents, polishes, and waxes
    • Soaps and detergents
  • Topical medicines
    • Neomycin: topical antibiotics
    • Thimerosal (Merthiolate): preservative in topical medications
    • Anesthetics: benzocaine
    • Parabens: preservative in topical medications
    • Formalin: cosmetics, shampoos, and nail enamel

Genetics
Increased frequency of ACD in families with allergies

Risk Factors

  • Occupation
  • Hobbies
  • Travel
  • Cosmetics
  • Jewelry

General Prevention

  • Avoid causative agents.
  • Use of protective gloves (with cotton lining) may be helpful.

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dermatitis, Contact ID - 116173 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116173/all/Dermatitis__Contact PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -