Contact dermatitis

Last reviewed: 27 Aug 2023
Last updated: 20 Jun 2023



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

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

Treatment algorithm


irritant contact dermatitis

allergic contact dermatitis (ACD)


contact dermatitis



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




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.


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


GG, DMO, and SD declare that they have no competing interests.

Peer reviewers

Christen Mowad, MD

Assistant Professor

Department of Dermatology

Geisinger Medical Center




CM declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals




JE declares that he has no competing interests.

  • Contact dermatitis images
  • Differentials

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

    • Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children
    • ​Pediatric allergic contact dermatitis. Part 2: Patch testing series, procedure, and unique scenarios
    More Guidelines
  • Patient leaflets


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

Use of this content is subject to our disclaimer