Source: Law RM, Law DTS.
Dermatologic Drug Reactions and Common Skin Conditions. In: DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=7998475.
Accessed May 27, 2012.
- Inflammation of skin following contact by irritants or
- Skin contact with irritant or allergenic substance.
- In allergic contact dermatitis (ACD), antigenic substance
triggers immunologic response, sometimes several days later.
- In irritant contact dermatitis (ICD), organic substance causes
reaction within a few hours of exposure.
- Accounts for 5.7 million physician visits each year in
the United States.
- Affects all age groups.
- Prevalence of ACD similar in children and adults.
- Prevention by avoiding skin exposure to known irritants
or sensitizing agents.
- Acute phase: Small vesicles and weeping, crusted lesions
- Resolving or chronic phase: Scaling, erythema, and perhaps
thickened skin; itching, burning, and stinging may be severe.
- Lesions on exposed areas include erythematous macules, papules,
- Affected area may be warm and swollen, with exudates and crusting.
- Lesion location may suggest cause.
Means of Confirmation
- Patient history, signs, and symptoms
- Gram stain and culture of lesions can exclude impetigo
or secondary infection.
- Relieve symptoms and decrease skin lesions.
- Remove precipitating factors.
- Prevent recurrences.
- Avoid adverse treatment effects.
- Improve quality of life.
- First intervention: identify, remove, and avoid the offending
- Cold compresses soothe and cleanse skin; apply to wet
or oozing lesions, remove, remoisten, and reapply every few minutes
for 20–30 minutes.
- If affected areas are dry or hardened, use wet dressings as
soaks without removal for up to 20–30 minutes to soften
and hydrate skin; avoid soaks on exudating lesions.
- Topical corticosteroids are primary treatment. Use higher-potency
products initially, switching to medium or lower potency as condition
improves (see Dermatitis, Atopic for topical corticosteroid
- Oatmeal baths or oral first-generation antihistamines may
provide relief for excessive itching.
- Calamine lotion or Burow solution (aluminum acetate) may also
- May use moisturizers to prevent dryness and skin fissuring.
- Educate patients on causative factors, avoidance of triggers,
and benefits and limitations of various therapies.
- Evaluate patients periodically to assess disease control,
efficacy of therapy, and presence of possible adverse effects.
- Usually resolves without complication
in 2–3 weeks.
- May return with reexposure to irritant substance.
Beltrani VS, Bernstein IL, Cohen DE, Fonacier
L. Contact dermatitis: A practice parameter. Ann Allergy Asthma
Immunol 2006;97(3 Suppl 2)Suppl:S1–S38.