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Updated: Oct 24 2022

Contact Dermatitis

  • Snapshot
    • A 3-year-old boy presents to his pediatrician's for a rash on his left lower leg. He had been playing in a wooded area yesterday. He reported a very itchy rash on his left lower leg since this morning. On exam, there are erythematous papules and vesicles in a linear pattern, as though he had brushed something. He is given topical corticosteroids and reassurance.
  • Introduction
    • Clinical definition
      • erythematous and pruritic rash caused by cutaneous exposure to
        • allergens
          • most common form of contact dermatitis
        • irritants
          • often involves hands
          • often from occupational exposures
    • Epidemiology
      • prevalence
        • 15-20%
      • demographics
        • female > male
      • risk factors
        • exposure to potential allergens or irritants
        • occupations with higher risk of contact dermatitis
          • healthcare
          • food production
          • cosmetics
    • Etiology
      • most common allergens include
        • poison ivy
        • poison oak
        • nickel
      • most common irritants include
        • chemicals
        • alcohol
    • Pathogenesis
      • allergic contact dermatitis
        • immunologic reaction to allergen causing type IV hypersensitivity reaction
        • delayed T-cell mediated reaction
        • activation of Th1 cells
        • memory CD4+ cells are created and dermatitis develops upon re-exposure or cross-reaction
      • irritant contact dermatitis
        • nonimmunologic reaction to substance that causes direct damage to the skin
        • release of inflammatory cytokines activated by non-immune pathways
    • Prognosis
      • typically resolves with treatment
  • Presentation
    • Symptoms
      • presents 12-48 hours after exposure to allergen
      • pruritic
      • burning or stinging
    • Physical exam
      • linear or geometric rash, corresponding to topical exposure, composed of papules and vesicles
        • can progress to blisters and bullae
        • for example, patients allergic to the adhesive in a bandaid will present with a square or rectangular-shaped rash
      • eczematous rash
        • lichenification
        • fissuring
        • scaling
  • Studies
    • Labs
      • none
    • Patch testing to
      • identify potential allergens
      • help prevent future exposures
    • Histology
      • spongiosis (epidermal intercellular edema)
  • Differential
    • Atopic dermatitis
  • Treatment
    • Conservative
      • skin moisturizer
        • indication
          • decrease irritation in nonimmunologic contact dermatitis
    • Medical
      • topical corticosteroids
        • indication
          • localized or mild-to-moderate disease
          • first-line therapy
      • systemic corticosteroids
        • indications
          • widespread or severe disease
          • disease that involves mucosa
  • Comlications
    • Secondary bacterial infection
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