Contact dermatitis

Contact dermatitis is inflammation of the skin due to contact with a particular substance, either an irritating chemical or an allergen (an allergen is something that causes an allergic reaction). Generally, most contact dermatitis is of the irritant type (75 per cent) versus the allergic type (25 per cent).

A seven-year-old girl with contact dermatitis on her neck from using antiseptic bath oil in cool compresses. From Moyle M et al, Characteristic adverse skin reactions to antiseptic bath oils. MJA 2007; 186: 652-653. Copyright 2007 The Medical Journal of Australia. Reproduced with permission. 'Irritant' contact dermatitis is caused by the chemical effect of strong alkali or acidic substances touching the skin. This often develops over time and with continued exposure and it is commonly seen in certain occupations, such as hairdressers, cleaners, health care workers, builders, chefs and mechanics. Water itself is a common known irritant as it weakens the skin's barrier function. Everyone can develop irritant contact dermatitis with enough exposure to strong irritants. Hand dermatitis is commonly caused by contact irritation. Less common 'allergic' contact dermatitis is the result of an allergic reaction in the skin to a certain substance. Allergies can occur at any time after the initial exposure. In some cases, an allergy can occur after years of exposure to a substance. Allergic contact dermatitis is an individual response to the allergen and will not occur in everyone who has been exposed. The skin can become red and swollen and dotted with small, clear, fluid-filled blisters. These break down and weep fluid. The skin is often extremely itchy. It can also lead to thickening of the layers of the skin, often with scaling, fissuring and cracking. Usually a doctor can recognise contact dermatitis just by looking at it. But sometimes it's hard to tell what has caused the reaction, because the rash often doesn't appear until hours or days after exposure. The location of the affected skin offers a clue, because the irritant usually only affects those parts of skin it has contacted directly. So if the rash is on the wrist, for example, it may be from the metal on the underside of a wristwatch. A 'streaking' appearance may indicate the person has brushed past a plant to which they're allergic. To test for allergic dermatitis, a doctor might recommend patch testing. This involves placing small amounts of substances that are commonly known to trigger allergic dermatitis onto patches placed on the skin to see if they trigger a reaction.

Whether it's the irritant or allergic type, most cases of contact dermatitis will gradually fade and disappear once exposure stops, though this can take quite a few weeks to months. In the meantime, there are treatments that can reduce the redness and itching. The most important thing is to protect the skin from further exposure to a known irritant or allergen. Specific treatment for the contact dermatitis is similar to that used for atopic eczema, such as topical steroids and emollients.

Other types of dermatitis

Seborrheic dermatitis is a red, itchy, scaly rash on the scalp, face and other areas of the body like the eyebrows, beard, under the breasts, and in the folds of skin in the genital area. (These are all areas where there are high numbers of oil glands in the skin.) Dandruff on the scalp is a mild form of seborrheic dermatitis. When it occurs in infants it's known as "cradle cap". Seborrheic dermatitis is thought to be triggered by a build up of yeast in the skin that breaks down the oil and inflames the skin. It tends to recur, flaring up with stress and with other illnesses. It can be treated with anti-yeast shampoos or lotions containing selenium, zinc or tar products. In severe cases, steroid creams and ointments are used to reduce the inflammation. Venous dermatitis. This is a blue/brown discolouration of the skin caused by poor circulation of the veins, usually because of varicose veins in the legs. It's most common in the lower legs and ankles, and is also known as stasis dermatitis or varicose eczema. At first, the skin becomes itchy, reddened and mildly scaly. Over several months, the skin turns dark brown (caused by staining from blood that's seeped out of veins) and hardens. The skin may break down and form a painful sore (ulcer), typically near the ankle. It improves with the wearing of compression stockings, exercise and weight loss. Nummular dermatitis. Also known as discoid eczema, this condition usually affects older people. Well-defined, small round or oval red patches with tiny blisters, scabs, and scales can affect any part of the body, especially the lower leg. It is usually intensively itchy. The cause isn't known. It tends to be chronic and recurring and resistant to treatment. Dyshidrotic Eczema. Dyshidrotic eczema is also known as pompholyx and is another form of dermatitis that commonly occurs on the hands and feet. It is characterised by tiny and intensely itchy blisters. The blisters can then cause peeling and cracks in the skin. Infection is a common complication. It usually appears suddenly especially after dramatic changes in the weather (from cold to hot) or with stress. It tends to recur. Soaking the affected hands in feet in weak potassium permanganate (Condys crystals) and strong topical steroids can help this condition. Reviewed by Dr Eleni Yiasemides, a specialist dermatologist.