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
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
Risk factors
- occupation with frequent exposure to water or caustic material
- atopic dermatitis
Diagnostic tests
1st tests to order
- patch testing
Tests to consider
- repeated open application test (ROAT) or provocative use test (PUT)
- skin biopsy
Treatment algorithm
irritant contact dermatitis
allergic contact dermatitis (ACD)
contact dermatitis
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Johnston GA, Exton LS, Mohd Mustapa MF, et al. British Association of Dermatologists' guidelines for the management of contact dermatitis 2017. Br J Dermatol. 2017 Feb;176(2):317-29.Full text Abstract
Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing: recommendations on best practice. Contact Dermatitis. 2015 Oct;73(4):195-221.Full text Abstract
Fonacier L, Bernstein DI, Pacheco K, et al; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma & Immunology; Joint Council of Allergy, Asthma & Immunology. Contact dermatitis: a practice parameter - update 2015. J Allergy Clin Immunol Pract. 2015 May-Jun;3(3 Suppl):S1-39.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Atopic dermatitis
- Nummular eczema
- Dyshidrotic eczema
More DifferentialsGuidelines
- 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 GuidelinesPatient information
Dermatitis
More Patient information
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