Contact Dermatitis

Overview

Contact dermatitis is an itchy rash caused by direct contact with a substance or an allergic reaction to it. The rash isn't contagious, but it can be very uncomfortable. Many substances can cause this reaction, such as cosmetics, fragrances, jewelry, and plants. The rash often shows up within days of exposure, and to treat it successfully, one needs to identify and avoid the cause of the reaction. If the substance causing the reaction is avoided, the rash often clears up in 2 to 4 weeks. Soothing the skin with a cool, wet cloth and other self-care steps can also help alleviate the symptoms.

Understanding the disease

Symptoms

The symptoms of contact dermatitis may include an itchy rash, leathery patches that are darker than usual (hyperpigmented), dry, cracked, scaly skin, bumps and blisters, sometimes with oozing and crusting, and swelling, burning, or tenderness. If the rash is severe or widespread, or if it doesn't improve within three weeks, it's best to see a healthcare provider. Seek immediate medical care if you suspect an infection (e.g., fever and pus oozing from blisters), have trouble breathing after inhaling burning weeds, experience pain in your eyes or nasal passages after inhaling smoke from burning poison ivy, or think an ingested substance has damaged the lining of your mouth or digestive tract.

Risk Factors

Common risk factors for developing contact dermatitis include a history of allergies, atopic dermatitis, or asthma, as well as exposure to certain irritants or allergens in the workplace or environment. Jobs that involve working with metals, solvents, cleaning supplies, or chemicals can increase the risk of contact dermatitis. Having a weakened immune system, other health conditions like Parkinson's disease or HIV/AIDS, and scars or long-lasting wounds on the skin can also contribute to an increased risk.

Development

Contact dermatitis develops when the skin comes into contact with a substance that causes an allergic reaction or irritates the skin. The rash is not contagious, but it can be very uncomfortable. Many substances can cause contact dermatitis, including cosmetics, fragrances, jewelry, and plants. The rash often appears within days of exposure and can last for 2 to 4 weeks. To treat contact dermatitis effectively, it is necessary to identify and avoid the cause of the reaction. If the substance causing the reaction is avoided, the rash often clears up within 2 to 4 weeks. Soothing the skin with a cool, wet cloth and following other self-care steps can also help alleviate symptoms.

Assessment and Diagnosis

Triage

You should see a doctor if contact dermatitis is suspected when:

1. The rash is so itchy that you can't sleep or go about your day.
2. The rash is severe or widespread.
3. You're worried about how your rash looks.
4. The rash doesn't get better within three weeks.
5. The rash involves the eyes, mouth, face, or genitals. In addition, seek immediate medical attention if you have a fever and the rash looks infected or experience difficulty breathing after inhaling burning weeds, or if you think an ingested substance has damaged the lining of your mouth or digestive tract.

Diagnosis

To diagnose contact dermatitis, your health care provider may:

1. Talk to you about your signs and symptoms.
2. Conduct a skin exam.
3. Suggest a patch test to identify potential allergens. In this test, small amounts of potential allergens are applied to sticky patches and placed on your skin for 2 to 3 days. During this time, you'll need to keep your skin dry. Afterward, your health care provider checks for skin reactions under the patches to determine the cause of your rash.

Management and Treatment

Complications

Potential complications of contact dermatitis include repeated scratching that can lead to open sores and cracks, increasing the risk of infection from bacteria and fungi. In rare cases, skin infections can spread and become life-threatening. Other complications may include sleep disturbances due to severe itchiness, as well as emotional distress and self-esteem issues related to the appearance of the rash.

Prevention

Contact dermatitis can be prevented by taking certain precautions to avoid irritants and allergens. Some steps to prevent contact dermatitis include:

1. Identifying and avoiding the cause of the rash.
2. Using hypoallergenic materials for ear and body piercings.
3. Practicing good skin care, such as using mild, non-soap cleansers, drying your skin well, applying moisturizer, and wearing gloves when necessary. By following these measures and being cautious around potential irritants and allergens, you can help reduce the risk of developing contact dermatitis.

Home Remedies

Home remedies for contact dermatitis include:

1. Cool compresses: Apply a cool, damp compress to the affected area to help relieve itching and reduce inflammation. You can use a clean, wet cloth or a bag of ice wrapped in a clean cloth.
2. Over-the-counter creams and ointments: Apply hydrocortisone cream or calamine lotion to the rash to help reduce itching and inflammation. Always follow the instructions on the packaging and consult your doctor if you're unsure about the appropriate usage.
3. Aloe vera: Apply pure aloe vera gel to the rash to soothe and moisturize the affected skin.
4. Oatmeal bath: Add colloidal oatmeal to a warm bath and soak for about 15 minutes to help relieve itching and irritation.
5. Avoid irritants: Remove any known irritants from your environment, such as harsh chemicals or allergens, to prevent further aggravation of the rash.
6. Moisturize: Apply a fragrance-free, hypoallergenic moisturizer to your skin frequently to help prevent dryness and support the healing process. Please note that these remedies may not work for everyone, and it's important to consult a healthcare professional if your symptoms persist or worsen.

Treatment

To treat contact dermatitis successfully, you need to identify and avoid the cause of your reaction. If you avoid the substance causing the reaction, the rash often clears up in 2 to 4 weeks. You can try soothing your skin with a cool, wet cloth and other self-care steps. Treatment options may also include:

1. Topical corticosteroids: Over-the-counter corticosteroid creams or ointments can help reduce itching, redness, and swelling.
2. Antihistamines: These medications can help relieve itching and swelling caused by allergic reactions.
3. Moisturizers: Applying fragrance-free, gentle moisturizers regularly can help soothe and hydrate the affected skin.
4. Antihistamine creams or calamine lotion: These can help relieve itching and redness.
5. Prescription topical immunomodulators: In some cases, your doctor may prescribe stronger topical medications to help calm the skin. Remember to follow your doctor's advice and instructions on using any prescribed medications, and to always avoid the substance causing the reaction.

Preparing for medical consultation

To prepare for an appointment for contact dermatitis, you should:

1. List your symptoms, including when they began and how long they've lasted.
2. Avoid any substances that may have caused the rash.
3. Make notes about any new products you've started using or substances that regularly come in contact with your affected skin areas.
4. Make a list of all medications and supplements you take, including dosages and directions.
5. List questions to ask your healthcare provider, such as:
   • What might be causing my signs and symptoms?
   • Are tests needed to confirm the diagnosis?
   • What treatments are available, and which do you recommend?
   • Is this condition temporary or chronic?
   • Can I wait to see if the condition goes away on its own?
   • Will scratching spread the rash?
   • Will popping the blisters spread the rash?
   • What skin care routines do you recommend to improve my condition?
   • How can I prevent this in the future? Remember to bring this information with you to your appointment and be prepared to discuss it with your healthcare provider.