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Updated: Dec 16 2021

Contact Dermatitis

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  • Snapshot
    • A 17-year-old girl presents to her primary care physician with symmetric swollen eyes. On further questioning, she reveals that she recently changed her brand of eye shadow. On exam, only her upper eyelids are erythematous with vesicles. She is instructed to stop the eyeshadow immediately. Given the sensitive nature of eyelids, she is given petroleum jelly to soothe the contact dermatitis. She is reassured that this will resolve.
  • Introduction
    • Clinical definition
      • erythematous and pruritic rash caused by cutaneous exposure
        • to allergens
          • most common form of contact dermatitis
        • to irritants
          • often involves hands
          • often from occupational exposures
  • Epidemiology
    • Demographics
      • female > male
    • Risk factors
      • exposure to potential allergens or irritants
      • occupations with higher risk of contact dermatitis
        • healthcare
        • food production
        • cosmetics
        • farming
  • Etiology
    • Pathogenesis
      • allergic contact dermatitis
        • immunologic reaction to allergen causing type IV hypersensitivity reaction
        • delayed T-cell mediated reaction
        • activation of Th1 cells
        • memory CD4+ cells are created and dermatitis develops upon re-exposure or cross-reaction
      • irritant contact dermatitis
        • nonimmunologic reaction to substance that causes direct damage to the skin
        • release of inflammatory cytokines activated by non-immune pathways
    • Most common allergens include
      • poison ivy
      • poison oak
      • poison sumac
    • Most common irritants include
      • chemicals
      • alcohol
      • creams
  • Presentation
    • Symptoms
      • presents 12-48 hours after exposure to allergen
      • presents minutes to hours after exposure to irritant
      • pruritic
      • burning or stinging
    • Physical exam
      • linear or geometric rash, corresponding to topical exposure, composed of papules and vesicles
        • can progress to blisters and bullae
        • for example, patients allergic to the adhesive in a bandaid will present with a square or rectangular-shaped rash
      • eczematous rash
        • lichenification
        • fissuring
        • scaling
  • Studies
    • Labs
      • none
    • Patch testing
      • to identify potential allergens
      • to help prevent future exposures
    • Histology
      • spongiosis
  • Differential
    • Atopic dermatitis
  • Treatment
    • Conservative
      • skin moisturizer
        • indication
          • decrease irritation in nonimmunologic contact dermatitis
    • Medical
      • topical corticosteroids
        • indication
          • localized or mild-to-moderate disease
          • first-line therapy
      • topical tacrolimus
        • indication
          • when corticosteroids are contraindicated
      • systemic corticosteroids
        • indications
          • widespread or severe disease
          • disease that involves mucosa
  • Comlications
    • Postinflammatory hypo- or hyperpigmentation
    • Secondary bacterial infection
  • Prognosis
    • Typically resolves with treatment
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