Irritant contact dermatitis is caused by direct toxicity without prior sensitisation, and allergic contact dermatitis is a delayed hypersensitivity reaction.
Results in localised burning, stinging, itching, blistering, redness, and swelling at the area of contact with the allergen or irritant.
Patch testing may aid identification of the causative agent. Skin biopsy may also be helpful, but may not be able to distinguish between other causes of dermatitis.
Treatment involves removal of the causative agent, future avoidance of the causative agent, topical corticosteroids, and/or a short course of oral corticosteroids.
Rarely, contact dermatitis can become generalised, leading to areas of dermatitis in locations distant from the site of contact with the causative agent.
Other allergic conditions may be triggered by exposure to an allergen, such as allergic rhinitis, asthma, and anaphylaxis.
Contact dermatitis is an allergic or irritant skin reaction caused by an external agent.
History and exam
Key diagnostic factors
- occupational history of exposure
- history of atopic dermatitis
- previous episodes of similar dermatitis
- acute onset
- affecting hands and face
- affecting sun-exposed skin
- sparing of non-exposed areas of skin
- vesicles and bullae
- lichenoid lesions
- corrosion or ulceration
- pustules and acneiform lesions
Other diagnostic factors
- social history of exposure
- persistence of symptoms
- erythema multiforme
- cellulitic lesions
- granulomatous lesions
- occupation with frequent exposure to water or caustic material
- atopic dermatitis
1st investigations to order
- patch testing
- repeated open application test (ROAT) or provocative use test (PUT)
Investigations to consider
- skin biopsy
- reflectance confocal microscopy (RCM)
irritant contact dermatitis
allergic contact dermatitis (ACD)
Gerard Guillet, MD
Professor of Dermatology
Department of Dermatology and Allergology
University Hospital Poitiers
GG declares that he has no competing interests.
Dr Gerard Guillet would like to gratefully acknowledge Dr David M. Ozog and Dr Snehal Desai, previous contributors to this topic.
DMO and SD declare that they have no competing interests.
Christen Mowad, MD
Department of Dermatology
Geisinger Medical Center
CM declares that he has no competing interests.
John English, MBBS, FRCP
Department of Dermatology
Queen's Medical Centre
Nottingham University Hospitals
JE declares that he has no competing interests.
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- British Association of Dermatologists' guidelines for the management of contact dermatitis 2017
- European Society of Contact Dermatitis guideline for diagnostic patch testing – recommendations on best practice
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