contact dermatitis (exogenous eczema)
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Classification
- allergic contact dermatitis
- irritant contact dermatitis
Etiology
- plants
- poison oak (allergic contact dermatitis)
- poison ivy
- poison sumac
- daffodil, pineapple, rhubarb, & century plants contain calcium oxalate[10]
- stinging nettle plant (Urtica dioica) are covered in tiny trichome hairs containing histamine
- phytophotodermatitis
- Furocoumarins are the most common causative agents, found in limes (rhine), grapefruit, garden rue...
- coral dermatitis
- nickel (allergic contact dermatitis)[12]
- inexpensive pierced earrings
- belt buckles
- iPad[4]
- inexpensive jewlery
- rubber
- sterile gloves
- shoes
- soaps, fragrances, personal care products (allergic)
- cleansers (irritant)
- topical pharmaceutical agents
- cream & lotion preservatives: methylparaben
- lanolin
- topical antihistamines
- topical antimicrobials, especially neomycin, polymixin B, bacitracin
- topical local anesthetics
- transdermal patches
- other
- paraphenylenediamine, a common ingredient in hair dyes, temporary black henna tattoos
- chromates, contained in cement
- solvents, surfactants
- acidic substances, alkaline substances (irritant)
- greases, tar, asphalt
- rubber
Pathology
- allergic contact dermatitis
- type-4 hypersensitivity reaction
- prior exposure & immunologic sensitization to the causative agent must have occurred
- irritant contact dermatitis
- caustic or irritant effect of a chemical
Clinical manifestations
- develops hours to days after contact with the offending agent
- lasts for days to weeks.[13]
- symptoms
- signs
- acute lesions:
- subacute lesions:
- scaling, erythematous lesions without clear borders
- chronic lesions:
- thick plaques with accentuated skin lines
- distribution of rash may provide diagnostic clues
- rash in distribution of where jewelry is worn (wrist, neck) suggests hypersensitivity to nickel[5]
- lesions may be coin-shaped (coin-shaped jewlery containing nickel)
- irritant contact dermatitis
- inorganic acids & strongly alkaline substances may cause ulcerations
- greases, tar, or asphalt may cause folliculitis
- contact with crustaceans may cause eczema[10]
Diagnostic procedures
- standard patch testing (gold standard)[10]
- controlled application of suspected offending agent
- cellulitis may complicate contact dermatitis
Complications
- erythema multiforme from allergic contact dermatitis[10]
- chronic allergic contact dermatitis can lead to hyperpigmented, lichenified plaques with painful fissures
Differential diagnosis
- atopic dermatitis
- lichen simplex chronicus
- nummular eczema
- lower legs (older men)
- fingers (younger female)
- psoriasis
- seborrheic dermatitis
- photosensitivity reaction
- chronic urticaria (occurs immediately & resolves quickly)
Management
- glucocorticoids
- topical glucocorticoid (local reaction)
- use low potency (hydrocortisone, desonide) on face & neck[17]
- systemic:
- systemic reaction or widespread skin involvement
- prednisone 40-60 mg PO QD for 5-14 days, followed by cautious taper
- topical glucocorticoid (local reaction)
- antihistamines
- avoidance
- cool, wet compresses
Follow-up:
- lesions should be monitored for signs of secondary infection
- counseling regarding avoidance of offending agent
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 924
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010 Aug 1;82(3):249-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20672788
- ↑ 4.0 4.1 Jacob SE and Admani S Case Report iPad - Increasing Nickel Exposure in Children. Pediatrics peds.2013-2871; July 14, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25022741 <Internet> http://pediatrics.aappublications.org/content/early/2014/07/09/peds.2013-2871.abstract
- ↑ 5.0 5.1 Leung DY et al. New insights into atopic dermatitis. J Clin Invest 2004 Mar 3; 113:651 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14991059
- ↑ Sasseville D Neomycin Dermatitis. 2010 Jan-Feb;21(1):3-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20137735
- ↑ 7.0 7.1 Contact dermatitis (image) American Academy of Dermatology https://www.aad.org/public/diseases/eczema/contact-dermatitis
Mayo Clinic: Contact dermatitis (image) http://www.mayoclinic.org/diseases-conditions/contact-dermatitis/basics/definition/con-20032048 - ↑ 8.0 8.1 Hogan DJ, James WD (image) Medscape: Allergic Contact Dermatitis http://emedicine.medscape.com/article/1049216-overview
- ↑ DermNet NZ. Contact dermatitis (no images) http://www.dermnetnz.org/dermatitis/contact-dermatitis.html
- ↑ 10.0 10.1 10.2 10.3 10.4 Mattessich S, Finch J (images) Contact Dermatitis: An Overview Medscape. September 12, 2016 http://reference.medscape.com/features/slideshow/contact-dermatitis
- ↑ Spring S, Pratt M, Chaplin A. Contact dermatitis to topical medicaments: a retrospective chart review from the Ottawa Hospital Patch Test Clinic. Dermatitis. 2012 Sep-Oct;23(5):210-3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23010827
- ↑ 12.0 12.1 12.2 12.3 12.4 Contact Dermatitis: An Overview https://reference.medscape.com/slideshow/contact-dermatitis-6013071
- ↑ 13.0 13.1 James W Fast Five Quiz: Urticaria (Hives) Medscape. December 12, 2022 https://reference.medscape.com/viewarticle/984987
- ↑ 14.0 14.1 Finch J Contact Dermatitis: A Summary Medscape. Feb 6, 2023 https://reference.medscape.com/slideshow/contact-dermatitis-6013071
- ↑ 15.0 15.1 NEJM Knowledge+ Dermatology
Nguyen HL, Yiannias JA. Contact Dermatitis to Medications and Skin Products. Clin Rev Allergy Immunol. 2019 Feb;56(1):41-59. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30145645 Review - ↑ NEJM Knowledge+ Allergy/Immunology
- ↑ 17.0 17.1 Fonacier L, Bernstein DI, Pacheco K, et al; American Academy of Allergy, Asthma & Immunology. Contact dermatitis: a practice parameter-update 2015. J Allergy Clin Immunol Pract. 2015;3:S1-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25965350