Contact Dermatitis

Allergic contact dermatitis

Some people have an allergic skin reaction. You have had this type of contact dermatitis if you had a rash caused by:

• Poison ivy
• Nickel
• Makeup you applied once or few times
• Jewelry you wore for a long time without a reaction, such as a wedding ring
• Jewelry you wore for only a few hours or days
• Latex gloves

Irritant contact dermatitis

This type is more common. It develops when something irritates the skin. With enough contact, most things will irritate our skin. A person diagnosed with any of the following has irritant contact dermatitis:

• Diaper rash
• Acid burn
• Dry, cracked hands due to lots of contact with water
• Irritated skin around the mouth due to lip licking

When a toxic substance touches our skin, the skin is quickly irritated. You’ve had irritant contact dermatitis if your skin reacted to a toxic substance like:

• Battery acid
• Bleach
• Pepper spray

You can also develop irritant contact dermatitis when you have lots of contact with less irritating substances like:

• Water
• Foods
• Soap

People often develop irritant contact dermatitis at work. Beauticians, nurses, bartenders, and others who spend lots of time with wet hands get this. It often starts with dry, cracked hands. In time, the skin on their hands may begin to sting and burn. The skin becomes very tender. Sometimes, the skin itches and bleeds.

When a rash does not clear within a few weeks, you should see one of our Gardens Dermatology board certified providers. When contact dermatitis develops, treatment is important. It can prevent the contact dermatitis from worsening and help your skin heal.

When to seek immediate medical care

A few people develop a severe allergic reaction known as anaphylaxis (an-uh-fuh-lax-sis). Symptoms occur within seconds or minutes. A person may have:

• Difficulty breathing due to swelling in the throat
• Swollen face and/or eyes
• Confusion

In short, the entire body reacts. If you have any of these symptoms, you need immediate medical care.

Allergic contact dermatitis

This skin condition occurs when you have an allergic reaction to something that comes in contact with your skin.

Signs and symptoms rarely appear on contact. It may take a few hours for your skin to react. If this is your first time that your skin has an allergic reaction to that substance, weeks may pass before you notice anything.

When signs and symptoms appear, you may have:

• Itchy skin (often intense)
• Rash (skin red, swollen, and hot)
• Excessively dry skin
• Burning
• Stinging
• Hives (round welts on the skin that itch intensely)
• Fluid-filled blisters
• Oozing blisters that leave crusts and scales

If exposure to the allergen continues, your skin may:

• Flake and crack
• Become scaly
• Darken, thicken, and feel leathery

Irritant contact dermatitis

Many substances can irritate our skin. Soap, shampoo, food, and water are mild irritants. With lots of exposure, these can cause irritant contact dermatitis. Getting a strong irritant like battery acid or fiberglass on your skin just once also can cause irritant contact dermatitis.

The signs and symptoms differ for mild and strong irritants.

Mild irritant : The signs and symptoms develop over time. You’ll gradually notice:

• Dry, chapped skin.
• With repeat exposure, patches of itchy, red, swollen, and scaly skin develop. By this time, each time something that can irritate the skin touches the affected skin, you may feel stinging and burning right away.
• If exposure continues, the skin may crack, get scaly, and become excessive dry.
• Sores and blisters may develop and erupt, causing crusts and scales.

Strong irritant : On contact or within a few hours, the skin can:

• Burn, sting, and/or itch
• Become inflamed (red and swollen)
• Develop fluid-filled blisters

When you have irritant contact dermatitis, many things can irritate your skin. You may feel pain on contact. With repeat exposure, the condition worsens.

Reduced quality of life

This skin condition often affects a person’s quality of life. The rash can make many daily activities painful, especially when the rash forms on the hands. The rash can cause:

• Missed work days
• Inability to enjoy leisure activities

Loss of sleep

How is Contact Dermatitis diagnosed?

To diagnose this common skin condition, your Gardens Dermatology provider will:

• Examine your skin, paying close attention to the rash.
• Ask about current and past health issues.
• Ask questions to help them determine what is causing the rash.

Finding the cause can require a bit of detective work. Your provider may ask you questions about your work, free time, pets, and skin care products. Be sure to tell your provider about all cosmetics you use. If you or a close family member uses a skin lightener, be sure to mention this, too.

If your Gardens Dermatology provider suspects that you have an allergy, patch testing may be recommended. This offers patients a safe and effective way to find out if your skin has developed an allergic reaction to anything.

What happens during patch testing?

If patch testing is recommended, the following will happen:

• Patches containing small amounts of substances to which you may be allergic will be applied to your skin, usually on your back.
• You keep the substances on your skin for a specific amount of time, usually 2 days.
• You return to Gardens Dermatology so that your provider can check your skin for reactions.
• You may need to keep some patches on your skin for a longer time and see your provider again in a few days.

To find out if the allergen is causing your rash, you will need to avoid that substance. For example, if the test shows that you have a nickel allergy, you may need to:

• Stop wearing jewelry and clothing (zippers, fasteners) that contains nickel.
• Cover your cell phone with a case to avoid touching the metal.
• Get a pair of eyeglasses made without nickel.

If your skin clears when you avoid the allergen, it is likely the cause of your rash.

How is contact dermatitis treated?

Treatment is the same for both types of contact dermatitis.

Avoid what is causing your rash . If avoiding the cause will be difficult, ask your dermatologist for help.

For example, if you are allergic to latex but must wear exam gloves, your dermatologist can recommend another type of glove that you can wear. If you must work outdoors where poison ivy grows, your dermatologist can recommend a protective barrier cream and clothing that can help.

Treat the rash . Once you can avoid the cause, your rash should clear. To relieve your symptoms, your provider may recommend the following:

• Mild reaction : Antihistamine pills, moisturizer, and a corticosteroid that you can apply to your skin. Most patients apply the medicine twice a day for 1 week and once a day for 1 to 2 weeks.
• Oatmeal baths can relieve discomfort.
• Severe reaction : If you have a lot of swelling, your face swells, or the rash covers much of your body, you may need a strong medication. Your provider may prescribe prednisone. It is important to take this medication exactly as directed to avoid another flare.
• Wet dressings can help soothe skin that has lots of oozing and crusting. If your provider recommends wet dressings, you’ll receive instructions to help you make these at home.
• If you have an infection, your provider may prescribe an antibiotic.

Some patients need light therapy to calm their immune system. Your provider may refer to this as phototherapy.

If you avoid what caused the rash, your skin will clear. Most people see clear skin within 1 to 3 weeks.

Clearing may take longer if poison ivy, poison oak, or poison sumac caused your rash. The first time you have an allergic reaction to one of these plants, the rash may linger for 6 weeks. If you get another rash, your skin should clear within 10 to 21 days.

Once your skin clears, you must continue to avoid what caused your rash.

If your rash does not clear, you should tell your dermatologist. You may need extra help.

Systemic contact dermatitis

Some people develop a rash even when they avoid touching the allergen. A rash can appear when the substance to which you have an allergy gets inside your body. The medical term for this condition is systemic contact dermatitis .

The allergen can get inside your body in different ways. You could:

• Eat food that contains the allergen
• Inhale or inject a medicine that contains the allergen
• Use birth control (IUD or spermicide) that contains the allergen

While rare, some people develop a rash because the fillings in their mouth contain mercury. They could only get rid of the rash when a dentist replaced their fillings with fillings that did not contain mercury.

Trying to find everything that contains the allergen can be a challenge. Your provider may be able to help you create a list of things you need to avoid. The list often varies from region to region.

Outcome for patients with contact dermatitis

By avoiding what caused the rash, most people can avoid flare-ups.

If you work with substances that caused the rash, you can still avoid a rash. Your provider can recommend ways to work and products to use. More than 80% of people diagnosed with occupational dermatitis successfully manage the condition and recover without any problems.

Below are some tips for managing your Contact Dermatitis:

Sometimes you can get rid of a rash yourself. These dermatologists’ tips can help you find the cause.

Once you know what’s causing your rash, avoiding it often clears the rash.

To help you find the cause, follow these steps:

• Ask yourself the questions on this page (below) that are relevant.
• If you answered yes to a question, stop using/wearing what you think caused the rash.
• If the rash begins to clear, you may have found the culprit. If the rash worsens or remains for 2 weeks, make an appointment to see your board certified provider. You’ll need help to get rid of the rash.

Rash beneath jewelry, shoes, or clothing

If a rash develops where jewelry, shoes, gloves or other clothing, a zipper, a buckle, or a fastener touches your skin:

• Stop wearing the item for a few days.

If the rash begins to clear when you stop wearing the item, you may have an allergy to a metal, dye, or fabric finisher.

Some people develop an allergy to jewelry that they’ve worn for years. The cause is often nickel, a metal found in many pieces of jewelry. A wedding ring can cause this problem. In fact, this rash is so common that it has a name, wedding-ring dermatitis .

If this happens, ask your Gardens Dermatology provider for tips to prevent getting a rash from your wedding ring.

Rash on face

It can be a challenge to find the cause of this rash, but you can start by answering the following questions:

• Have you recently tried a new makeup, eye cream, or fragrance?
• Some people are allergic to ingredients in these products.
• Do you use an eyelash curler or tweezers?
• These items often contain nickel, which is a common cause of allergic contact dermatitis. Brief direct contact with an eyelash curler or tweezers can cause an allergic skin reaction.
• Do you rub your eyes?
• If you find yourself rubbing your eyes, try to stop. Indirect contact with an allergen can cause a rash on your face. Even nickel used in a doorknob or keys can end up on your face when you rub your eyes.
• Do you wear nail polish or artificial nails?
• These products can cause a rash when you touch your face. Even when you don’t develop a rash on your hands, the skin on your face can react.
• Has a fragrance touched your skin?
• Directly applying a fragrance can cause a rash. You can also get a rash from indirect contact. Touching a a towel or pillow that has a fragrance on it could cause a rash.

Rash on side of face, neck, hairline, or chest

You can often find the cause of a rash in one of these areas by asking yourself these questions:

• Do you hold your cell phone against your face?
• A rash that appears on one side of the face may indicate that you have an allergy to nickel or chromium. Some cell phones contain one of these metals. You also could have an allergy to something in the case you use for your cell phone.
• Have you recently switched shampoo or conditioner?
• If you are allergic to an ingredient in a shampoo or conditioner, a rash can appear where the product runs down your body when you rinse.
• Have you recently used a hair dye or perm solution?
• These can cause a rash.

Rash after hiking or being in a wooded area

• If you were in a wooded area, you may have touched poison ivy, poison oak, or poison sumac without knowing it. Poison ivy is one of the most common causes of allergic contact dermatitis.

Rash from musical instrument

Metals in musical instruments, such as nickel, cobalt, palladium, silver, and gold, can cause a rash. So too can cane reeds and exotic woods. Stains, glues, and varnishes also cause contact dermatitis.

Dermatologists recommend the following to people who get a rash from playing a musical instrument:

• Stop playing the instrument while your skin heals.
• See a dermatologist. You may need medication to treat the rash. Patch testing also can be very helpful. This medical test helps to find allergens. It is important to know if you have an allergy to something in the instrument that you play.
• Once the cause is found, your dermatologist can help you make some changes so that you can play again.

When to see a dermatologist

You’ll want to make an appointment If you have a rash that:

• Is severe (raw skin, blisters, oozing, or intense itch).
• Does not clear in a few weeks.
• Comes and goes.
• Is caused by something in your workplace.

Sometimes we can find one cause but miss others. For example, many people develop an allergy to nickel. This metal is so common that it may be in your wedding ring and dozens of products that you regularly use.

A dermatologist can help you find out if you have any allergies. If you have an allergy, your dermatologist can create a plan to help you avoid things that cause your rash.

Many dermatologists use databases that can tell them what products you should avoid if you have an allergy and what products you can use. This alone could save you lots of time and money.