Contact dermatitis

Last reviewed: 7 Jun 2022
Last updated: 14 May 2019

Summary

Definition

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
  • pruritus
  • burning
  • erythema
  • vesicles and bullae
  • urticaria
  • lichenoid lesions
  • corrosion or ulceration
  • pustules and acneiform lesions
More key diagnostic factors

Other diagnostic factors

  • social history of exposure
  • persistence of symptoms
  • scaling
  • lichenification
  • crusting
  • erythema multiforme
  • cellulitic lesions
  • leukoderma
  • hypopigmentation
  • hyperpigmentation
  • purpura
  • miliaria
  • alopecia
  • granulomatous lesions
Other diagnostic factors

Risk factors

  • occupation with frequent exposure to water or caustic material
  • atopic dermatitis
More risk factors

Diagnostic investigations

1st investigations to order

  • patch testing
  • repeated open application test (ROAT) or provocative use test (PUT)
More 1st investigations to order

Investigations to consider

  • skin biopsy
More investigations to consider

Emerging tests

  • reflectance confocal microscopy (RCM)

Treatment algorithm

ACUTE

irritant contact dermatitis

allergic contact dermatitis (ACD)

ONGOING

contact dermatitis

Contributors

Authors

Gerard Guillet, MD

Professor of Dermatology

Department of Dermatology and Allergology

University Hospital Poitiers

Poitiers

France

Disclosures

GG declares that he has no competing interests.

Acknowledgements

Dr Gerard Guillet would like to gratefully acknowledge Dr David M. Ozog and Dr Snehal Desai, previous contributors to this topic.

Disclosures

DMO and SD declare that they have no competing interests.

Peer reviewers

Christen Mowad, MD

Assistant Professor

Department of Dermatology

Geisinger Medical Center

Danville

PA

Disclosures

CM declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals

Nottingham

UK

Disclosures

JE declares that he has no competing interests.

  • Contact dermatitis images
  • Differentials

    • Atopic dermatitis
    • Nummular eczema
    • Dyshidrotic eczema
    More Differentials
  • Guidelines

    • 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
    More Guidelines
  • Patient leaflets

    Dermatitis

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer