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Contact dermatitis

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Last reviewed: 5 Sep 2023
Last updated: 20 Jun 2023

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

  • scaling
  • lichenification
  • social history of exposure
  • persistence of symptoms
  • crusting
  • erythema multiforme
  • cellulitic lesions
  • leukoderma
  • hypopigmentation/depigmentation
  • 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
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Diagnostic investigations

1st investigations to order

  • patch testing
More 1st investigations to order

Investigations to consider

  • repeated open application test (ROAT) or provocative use test (PUT)
  • skin biopsy
More investigations to consider
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Treatment algorithm

ACUTE

irritant contact dermatitis

allergic contact dermatitis (ACD)

ONGOING

contact dermatitis

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Contributors

Authors

JiaDe Yu, MD, FAAD

Assistant Professor of Adult and Pediatric Dermatology

Director of Contact and Occupational Dermatology

Department of Dermatology

Massachusetts General Hospital

Harvard Medical School

Boston

MA

Disclosures

JY was on the board for the American Contact Dermatitis Society from 2019-2022 (term ended and unpaid). JY has received a career development grant from the Dermatology Foundation and research grants from the Pediatric Dermatology Research Alliance and the American Contact Dermatitis Society. JY has received honorarium from the National Eczema Association for consultant work as part of its SEAL of approval project, and is on the editorial board for the Pediatric Dermatology journal and the Dermatitis journal.

Acknowledgements

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

Disclosures

GG, 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.

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