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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. Accessed May 27, 2012.

  • Inflammation of skin following contact by irritants or allergic sensitizers.

  • 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.

Signs and Symptoms

  • 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, and vesicles.
  • Affected area may be warm and swollen, with exudates and crusting.
  • Lesion location may suggest cause.

Means of Confirmation and Diagnosis

  • Patient history, signs, and symptoms

Laboratory Tests

  • Gram stain and culture of lesions can exclude impetigo or secondary infection.

Differential Diagnosis

  • 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 agent.

  • 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 potencies).
  • Oatmeal baths or oral first-generation antihistamines may provide relief for excessive itching.
  • Calamine lotion or Burow solution (aluminum acetate) may also be soothing.
  • 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.   [PubMed: 17039663]

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