Allergic Contact Dermatitis – Types, Causes & Treatments

Contact Dermatitis Overview

Contact dermatitis is a condition that makes skin red or inflamed after contact with an allergen or an irritant. Its a common skin problem occurring in 15% to 20% of people. It can have a consequential financial freight with direct and indirect costs from lost time off work and school. Contact Dermatitis may be allergic (ACD) or irritant (ICD).

Irritant Contact Dermatits (ICD) is more common (80%) and can occur in anyone, especially after repeated exposure. Symptoms Contact Dermatits are a burning or stinging sensation with redness, swelling or peeling. Soaps, detergents, acids, bases, solvents, saliva, urine and stool are the most common triggers for ICD.

Allergic Contact Dermatits, on the other hand, is seen in genetically predisposed and previously sensitized individuals who react to even low concentrations of the agent. Cosmetics, medicines, clothes dyes, as well as foods, rubber and poison ivy are common causes of ACD.

Any topical cream or ointment may contain chemicals that irritate the skin. It is important to bring your personal products with you when you see your doctor so they can be examined as a potential cause of the dermatitis.

Also Read: Types Of Eczema & Their Symptoms

What are Contact Allergens?

Contact allergens are the causative agents behind the occurrence of Allergic Contact Dermatitis or Contact Allergy. This common form of eczema is characterized by an allergic reaction prompted by the skin when it comes in contact with an allergen. Allergens are classified as any specific substance or material to which the skin is sensitive.

However, allergens are individual-specific and are harmless to those that are not allergic to it. Contact allergies can also trigger eczema flare-ups. There have been various studies on what causes eczema flare-ups.

Symptoms of Contact Dermatitis

Contact dermatitis appears few hours after an individual comes in contact with the allergen. The common symptoms of contact dermatitis includes red, itchy, swollen and blistered or dry skin. The symptoms may subside over the next few days, if the affected person doesn’t come in contact with the responsible allergen again.

In most of the cases, contact allergy is restricted to the site that comes in contact with the allergen. However, in case of severe reactions, the infection may spread from the affected skin area to other body parts. E.g. from the fingers, the infection may be transmitted the eyelids and genitals.

Take into consideration that if the part of skin that came in contact with a specific allergen is unaffected and exhibits no allergic response, then eczema is not likely to be due to that allergen.

Some typical examples of allergic contact dermatitis include:

A few people are sensitive to jewellery items and coming in contact with them initiates eczema. This is linked with allergy from nickel.

• A few people are allergic to the fragrances in perfumes and household items
• Dermatitis resulting from adhesive plaster, which is related to allergy arising from rosin.
• Permanent hair dye contains paraphenylene diamine that may cause allergic reaction in the form of swelling or blistering of face and neck.
• Manufacturing of rubber gloves makes use of rubber accelerator chemicals that causes hand dermatitis in few people.
• Methylisothiazolinone, a preservative used in wash-off hair products and baby wipes, may cause allergies in a few people and result in red, itchy face.
• Acrylates used in hair extensions and nail cosmetics may result in dermatitis on the fingertips.
• A few individuals may develop allergic reactions to metallic implants due to methyl methacrylate, benzoyl peroxide or gentamicin in bone cement.
• Acrylates used in dental implants may cause skin reactions.
• Localised blistering at the site of topical medications such as antibiotics

There is a long list of allergens/irritants that may result in Allergic Contact Dermatitis. The allergens causing skin reactions vary from an individual to individual.

How is Allergic Contact Dermatitis Diagnosed?

In most of the cases, it is easy to acknowledge the symptoms of contact allergy without the need to carry out any specific tests. However, in a few cases, tests are recommended by the dermatologist to diagnose the cause of allergic contact dermatitis.

Open application test is one of the diagnostic measures suggested to confirm if the allergy is as a result of cosmetic product like moisturizer. During the test, the individual is asked to apply the suspected product several times in a day to a small patch of sensitive skin. The treated skin is then tested for any reactions. In case, the reaction is severe, recurrent or chronic, the doctor performs patch tests to identify the allergen causing the reaction. E.g. Dimethylgloxime test is available to ‘spot test’ if a product contains nickel.

Currently, the most reliable method of identifying contact allergens is patch testing with a standard contact dermatitis series of substances.

Treating Allergic and Irritant Contact Dermatitis

Treating allergic and contact dermatitis is one of the most frequently searched by the individuals affected by this chronic skin condition.  There may be few questions that you might have in your mind:

• How to treat contact dermatitis?
• How long does it take for allergic contact dermatitis to heal?
• How do you stop contact dermatitis?
• How can I treat contact dermatitis at home?
• What is the best treatment for contact dermatitis?

Prolonged medication and unsatisfactory results make a person lose hope. However, the positive aspect is that the ailment can be managed by adopting certain self-care approaches, alterations in the lifestyle and avoiding the triggers.

A basic approach to contact dermatitis treatments and prevent it from recurring, includes:

• Ensuring you are aware of the symptoms and avoid the factors that make them worse
• Seeking medical intervention (if required)
• Using products that are favorable for your condition and help alleviate it

Based on the causative agent, contact dermatitis is broadly classified into two forms, allergic contact dermatitis and irritant contact dermatitis. If the cause of dermatitis is an allergen, the condition is termed as allergic contact dermatitis and if it is due to a strong irritant, it is known as irritant contact dermatitis.

The blog will describe different Contact Dermatitis treatment methods, preventions that you must undertake to manage the type of eczema. The treatment approaches might differ slightly for both the forms of contact dermatitis.

(*For the further supportive evidence for these methods, please consider to check the Medscape, WebMd and Mayoclinic website)

Allergic Contact Dermatitis Treatment?

Topical corticosteroids are mostly recommended to manage allergic contact dermatitis. A few other allergic contact dermatitis treatments may be adviced that may provide short-term relief from itching. However, the definitive course of treatment for allergic contact dermatitis involves the recognition and removal of any potential allergen. Failing to do so will increase the risk of chronic or recurrent eczema.

1. First-line Treatment

• Following an allergic reaction, it is suggested to use topical soaks with cool tap water, Burow solution (1:40 dilution), saline (1 tsp/pint). This will provide a soothing effect to the affected area.
• Wet/cool compresses with saline or aluminum acetate solution can be useful in case of severe dermatitis.
• A few individuals may get benefited from lukewarm oatmeal baths.
• In a few chronic cases, emollients such as white petrolatum, Eucerin, have proved to be helpful.
• Sedating oral antihistamines may help provide relief against itching.

2. Topical Corticosteroids

Topical corticosteroids are considered to be the most effective approach to manage allergic contact dermatitis. E.g. for the allergic contact dermatitis of the face, usually class 6 or class 7 topical corticosteroids are recommended, while class I topical corticosteroids are typically suggested for treating severe allergic contact dermatitis of the hands.

Systemic corticosteroids are often administered for a short duration of 2-weeks for treating the severe conditions. However, long-term usage of this corticosteroid is avoided to prevent morbidity.

Potent topical corticosteroids must not be used for a long-term as they may result in the deterioration of the local skin.

3. Topical Immunomodulators

Topical Immunomodulators (TIMs) are primarily approved for the individuals with atopic dermatitis. TIMs may be prescribed in case of allergic contact dermatitis, as they tend to be safer in comparison to topical corticosteroids.

Topical tacrolimus is one of the most helpful TIM for the people with allergic contact eyelid dermatitis that cannot be managed by short-courses of class l or ll topical corticosteroids and for allergic contact dermatitis of the hands.

4. Phototherapy for Contact Dermatitis

Psoralen plus ultraviolet-A (PUVA) treatments may be an effective alternative for the chronic cases of allergic contact dermatitis that are unable to be control by topical corticosteroids. Psoralen is a photosensitizer that is ingested before exposing the affected area to the light. An individual may also be benefitted by narrow-band UVB phototherapy.

5. Immunosuppressive Agents

Occassionally, immunosuppressive agents may be recommended to treat severe cases of allergic contact dermatitis or hand dermatitis. In such cases, the ailment limits the affected person from carrying out their daily activities or working.

6. Diet For Eczema OR (Eczema Diet Plan)

An individual may be allergic to some chemicals, minerals and their presence in the diet can cause eczema flare-ups. A diet low in such minerals and chemicals is considered as one of the way to treat allergic contact dermatitis. E.g. An affected person may be put through a low-nickel diet or one that is low in chromate, cobalt, or balsam of Peru to mange the condition. you would like to know about the Foods for eczema, Eczema Elimination Diet, Seasonal Diet for Eczema-Care and much more.

Medical Intervention

You must immediately visit your dermatologist,  if the rash is painful or none of the treatment helps to make it better within a couple of days. Your doctor will examine the affected area and might inquire to know more about your condition. Depending upon the severity of the ailment, you may be prescribed steroid pills or ointments, and antihistamines. The specialist may conduct skin tests to identify the allergen.

How to Treat Irritant Contact Dermatitis?

The most direct approach to treat irritant contact dermatitis (ICD) aims at identifying and removing the potential agent that provokes an inflammatory reaction in the individual. The first-line treatment for irritant contact dermatitis is similar to that provided to individuals with allergic contact dermatitis.

Affected individuals are commonly suggested to use ceramide creams or mild emollients to moisturize the skin after cleansing them with soap. In most of the cases, bland cleansers are recommended instead of soaps to avoid irritation of the affected area. Also, people are adviced to avoid usage of solvents or abrasives that come in direct contact of the skin and agitate it.

7. Barrier Creams for Contact Dermatitis

Barrier cream is a general term used for the specific creams that are composed of ceramides. These creams can help restore the epidermal barrier of the dermis in individuals with ICD and atopic dermatitis. Creams containing dimethicone can work well for those with a wet work–related ICD.

8. Cleansers

Most of the soaps, detergents are alkaline in nature and increase the pH of the skin. As a result,  the protective layer is greatly affected and the moisture level alleviates because of the decrease in fat cells. These products make the skin dry and sensitive. Winter months are more problematic for the affected people.

Irritant contact dermatitis is a common skin condition amongst those serving in the healthcare department due to frequent hand washing. It is preferable to make use of alcohol-based hand cleansers that contain various emollients. These cleansers can help provide relief against skin damage, dryness, and irritation in the individuals. In addition to these alcohol-based hand rubs, non-antimicrobial soaps and preparations containing low concentrations of chlorhexidine gluconate, significantly reduce the occurrence of ICD.

9. Steroids and Immunomodulators for CD

Topical corticosteroids and Immunomodulators have been found ineffective in treating irritant contact dermatitis (ICD). Corticosteroids were found unsuccessful in individuals with surfactant-induced irritant dermatitis.

Topical corticosteroids when applied near the eye may cause cutaneous atrophy, glaucoma, or cataracts. Additionally, the application is not suitable for a long-term basis.

Topical tacrolimus can be used instead of topical corticosteroids but it may result in further stinging and irritation.

How to Prevent Contact Dermatitis

In addition to the self-care approach adopted to treat the condition, it is important you follow certain precautionary measures how to prevent contact dermatitis symptoms from aggravating.

• Avoid irritants and allergens: It is essential you recognize and avoid substance, chemicals or factors that may agitate the skin and cause an allergic reaction.
• Rinse the affected skin: Washing the affected area can help remove most of the irritants/allergens that are causing the rash. However, ensure to rinse the skin immediately after coming in contact with a specific substance and make use of a mild, fragrance-free soap. Additionally, wash any clothing that may have come in contact with the substance.
• Prefer wearing protective items or clothing: Protective items such as gloves, face masks can help guard your skin against rash-causing substances like detergents, cleansers.
• Use moisturizer: This can help hydrate your skin and keep it supple.
• Take extra care with pets: Pets may easily carry allergens from the plants such as poison ivy and spread to people. This can trigger allergic reactions.

Further Reading:

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Weeping Eczema  |  Eczema on Lips  |  Dyshidrotic Eczema  |  Eczema on Hands  |  Follicular Eczema  |  Eczema on Ear  |  Eczema on Eyes  |  Nummular Eczema  |  Eczema on Face  |  Perioral Dermatitis

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