Individuals with allergic contact dermatitis (see the image below) may have persistent or

relapsing dermatitis, particularly if the material(s) to which they are allergic is not identified
or if they practice inappropriate skin care. The longer an individual has severe dermatitis, the
longer, it is believed, that the dermatitis will take to resolve once the cause is identified.

Chronic stasis dermatitis with allergic contact

dermatitis to quaternium-15, a preservative in moisturizer. Allergic contact dermatitis
produces areas of erythema in areas of atrophie blanche and varicose veins.
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See 5 Body Modifications and Piercing: Dermatologic Risks and Adverse Reactions, a
Critical Images slideshow, to help recognize various body modifications and the related
potential complications.

Signs and symptoms

Acute allergic contact dermatitis is characterized by pruritic papules and vesicles on an

erythematous base. Lichenified pruritic plaques may indicate a chronic form of the condition.

Individuals with allergic contact dermatitis typically develop the condition within a few days
of exposure, in areas that were exposed directly to the allergen. Certain allergens (eg,
neomycin), however, penetrate intact skin poorly; in such cases, the onset of dermatitis may
be delayed for up to a week following exposure.

Individuals may develop widespread dermatitis from topical medications applied to leg ulcers
or from cross-reacting systemic medications administered intravenously.

Intraoral metal contact allergy may result in mucositis that mimics lichen planus, which has
an association with intraoral squamous cell carcinoma.
See Clinical Presentation for more detail.

Diagnosis

Diagnostic studies for allergic contact dermatitis include the following:

Potassium hydroxide preparation and/or fungal culture: To exclude tinea; these tests
are often indicated for dermatitis of the hands and feet

Patch testing: To identify external chemicals to which the person is allergic

Repeat open application test (ROAT): To determine whether a reaction is significant

in individuals who develop weak or 1+ positive reactions to a chemical

Dimethylgloxime test: To determine whether a metallic object contains enough nickel

to provoke allergic dermatitis

Skin biopsy: May help to exclude other disorders, particularly tinea, psoriasis, and
cutaneous lymphoma

See Workup for more detail.

Management

The definitive treatment for allergic contact dermatitis is the identification and removal of
any potential causal agents; otherwise, the patient is at increased risk for chronic or recurrent
dermatitis. Treatments also include the following:

Corticosteroids: Topical corticosteroids are the mainstay of treatment, although acute,

severe allergic contact dermatitis, such as from poison ivy, often needs to be treated
with a 2-week course of systemic corticosteroids

Topical immunomodulators (TIMs): Approved for atopic dermatitis, but they are also
prescribed for cases of allergic contact dermatitis when they offer safety advantages
over topical corticosteroids

Phototherapy: Administered to individuals with chronic allergic contact dermatitis

that is not controlled well by topical corticosteroids; these patients may benefit from
treatment with a combination of psoralen (a photosensitizer) and ultraviolet-A
(PUVA)

Immunosuppressive agents: Chronic immunosuppressive agents are, in rare instances,

used to treat recalcitrant cases of severe, chronic, widespread allergic contact
dermatitis or severe hand dermatitis that prevents a patient from working or
performing daily activities

Disulfiram: Occasionally, an individual who is highly allergic to nickel and has severe
vesicular hand dermatitis will benefit from treatment with disulfiram (Antabuse); the
drug has a chelating effect
See Treatment and Medication for more detail.