Allergic Contact Dermatitis

Aka: Allergic Contact Dermatitis, Contact Urticaria

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II. Pathophysiology

  1. Only occurs in a genetically predisposed person
  2. Type 4 Hypersensitivity Reaction (delayed-type)
  3. Agent specific immunologic cell-mediated response
    1. Requires sensitization
    2. Reaction can be induced by over 3000 chemical agents

III. Course

  1. Develops 24-48 hours after exposure (6 hours to 7 days)
    1. Can develop after years of continued exposure
  2. Resolves after 2-3 weeks after removal of causative agent

IV. Causes: Common

  1. Nickel (less expensive jewelry)
    1. Reaction occurs in 6% of persons exposed
    2. Consider Patch Testing for nickel allergy
    3. Nickel allergic patients can test jewelry for nickel
      1. Spot test is commercially available
    4. Consider irritant dermatitis from jewelry
      1. Remove Jewelry when washing hands
      2. Jewelry traps soap and lotions
  2. Black hair dye
  3. Topical Medications
    1. Mycolog
    2. Neomycin
    3. Benzocaine
    4. Ethylenediamine
    5. Merthiolate (Thimerosal)
  4. Latex Allergy (10-17% of health care workers)
  5. Rhus Dermatitis (reaction in 70% of those exposed)
  6. Cosmetics (Fragrances and preservatives)
  7. Occupational exposures
    1. Potassium dichromate (cement, dyes, textiles)
      1. Welders
      2. Painters, dyers, leather tanners, lithographers
      3. Battery workers
    2. Epoxy resin (adhesives, electrical casings)
      1. High-tech workers (e.g. computers)
      2. Cable workers
      3. Pipe workers
    3. Rosin (adhesives)
    4. Rubber (thiuram, mercaptobenzothiazole, Carbamate)
    5. Surgery and cosmetic (acrylates: methyl methacrylate)
      1. Dentists and Dental Technicians
      2. Orthopedic surgeons
    6. Dyes
      1. Glyceryl monothioglycolate
      2. Para-phenylene diamine (in paint-on Tattoos)
  8. Sports participation
    1. See Sport-related Contact Dermatitis

V. Causes: Tattoo related reactions

  1. Topical Antibiotic reaction (e.g. Neosporin)
  2. Dye reaction
    1. Mercuric Sulfide (Red): Irritant
    2. Cadmium (Yellow): Photo-reaction to sunlight

VI. Symptoms

  1. Severe Pruritus (early symptom)
  2. Mild Pain or burning at dermatitis site

VII. Signs

  1. Sharply demarcated lesion in region of topical agent exposure
    1. Distribution is single most important clue
  2. Characteristics
    1. Marked local erythema and edema (differentiate from Cellulitis)
    2. Lesions may have drainage with crusting
    3. Papules or Vesicles may occur
    4. Skin may appear scaled, thickened or atrophic in longstanding exposure
  3. Numerous Vesicles
    1. Contrast with Pustules in Irritant Contact Dermatitis

VIII. Differential Diagnosis

  1. See Annular Lesion
  2. Cellulitis
  3. Irritant Contact Dermatitis
  4. Atopic Dermatitis or nummular Eczema
  5. Localized Psoriasis
  6. Squamous Cell Carcinoma

IX. Diagnostics

  1. Consider in atypical cases without obvious cause
  2. Patch Test (preferred, performed by allergists)
  3. Lesion Skin Biopsy
    1. Epidermal Spongiosis
    2. Spongiotic Vesicles
    3. Infiltrating Lymphocytes

X. Management

  1. Withdraw offending agent
  2. Localized Allergic Contact Dermatitis
    1. Topical Corticosteroids (e.g. Triamcinolone cream 0.1%)
    2. Topical Tacrolimus
  3. Widespread involvement
    1. Systemic Corticosteroids (see Rhus Dermatitis for example protocol)
  4. Refractory cases (typically via dermatology or allergy referral)
    1. Phototherapy
    2. Systemic Immunosuppressants (e.g. Methotrexate, Cyclosporine)

XI. Resources

  1. Haz-Map (Occupational Exposure Database)
    1. http://www.haz-map.com

XII. References

  1. Habif (1996) Clinical Dermatology, p. 84-94
  2. Lushniak (2000) Prim Care 27(4):895-916 [PubMed]
  3. Peate (2002) Am Fam Physician 66(6):1025-40 [PubMed]
  4. Owen (2018) Am J Clin Dermatol 19(3): 293-302 [PubMed]
  5. Vedela (2022) Am Fam Physician 106(6): 709-10 [PubMed]

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Related Studies

Ontology: Dermatitis, Allergic Contact (C0162820)

Definition (NCI) An inflammatory skin condition caused by an immune response to direct contact between the skin and an allergen. It consists of a delayed type of allergic reaction at the affected site with resulting red, swollen, and blistered skin that may itch or leak.
Definition (MSH) A contact dermatitis due to allergic sensitization to various substances. These substances subsequently produce inflammatory reactions in the skin of those who have acquired hypersensitivity to them as a result of prior exposure.
Concepts Disease or Syndrome (T047)
MSH D017449
ICD10 L23 , L23.9
SnomedCT 200841005, 238575004
English Allergic Contact Dermatitis, Dermatitis, Allergic Eczematous, Dermatitis, Contact, Allergic, Dermatitis, Allergic Contact, Allergic Contact Dermatitides, Allergic Eczematous Dermatitides, Allergic Eczematous Dermatitis, Contact Dermatitides, Allergic, Contact Dermatitis, Allergic, Dermatitides, Allergic Contact, Dermatitides, Allergic Eczematous, Eczematous Dermatitides, Allergic, Eczematous Dermatitis, Allergic, ACD - Allergic contact derm, Allergic contact dermatitis, unspecified cause, Dermatitis, Allergic Contact [Disease/Finding], contact allergic dermatitis, dermatitis contact allergic, allergic contact dermatitis, contact dermatitis allergic, allergic contact dermatitis (diagnosis), Contact allergy, Allergic contact dermatitis, ACD - Allergic contact dermatitis, Allergic contact dermatitis (disorder), Dermatitis contact/allergic, contact; dermatitis, allergic, dermatitis; contact, allergic
Dutch allergische contactdermatitis, Contacteczeem, contact; dermatitis, allergisch, dermatitis; contact, allergisch, Allergisch contacteczeem, oorzaak niet gespecificeerd, Allergisch contacteczeem, Allergische contactdermatitis, Contactdermatitis, allergische, Contacteczeem, allergisch, Dermatitis, allergische eczemateuze
French Dermite allergique de contact, Dermatite allergique eczémateuse, Dermatite allergique de contact, Dermatite de contact allergique, Dermatite eczémateuse allergique, Dermite des prés, Eczéma allergique de contact, Eczéma de contact allergique
German allergische Kontaktdermatitis, Allergische Kontaktdermatitis, nicht naeher bezeichnete Ursache, Allergische Kontaktdermatitis, Dermatitis, Kontakt-, allergische, Dermatitis, allergische Kontakt-, Dermatitis, allergische, ekzematöse
Portuguese Dermatite de contacto alérgica, Dermatite Alérgica de Contato, Dermatites Alérgicas de Contato, Dermatite de Contato Alérgica, Dermatite Alérgica Eczematosa
Spanish Dermatitis alérgica de contacto, Dermatitis por Contacto Alérgica, dermatitis por contacto alérgica (trastorno), dermatitis por contacto alérgica, Dermatitis Alérgica Eccematosa, Dermatitis Alérgica por Contacto
Swedish Dermatit, allergisk kontakt
Japanese ｱﾚﾙｷﾞｰｾｲｾｯｼｮｸﾋﾌｴﾝ, 皮膚炎-アレルギー性接触, アレルギー性湿疹皮膚炎, アレルギー性接触性皮膚炎, アレルギー性接触皮膚炎, 接触性アレルギー皮膚炎, 接触皮膚炎-アレルギー性, 皮膚炎-アレルギー性湿疹, 皮膚炎-接触-アレルギー性
Czech dermatitida kontaktní alergická, Alergická kontaktní dermatitida
Finnish Allerginen kosketusihottuma
Russian ALLERGICHESKII KONTAKTNYI DERMATIT, DERMATIT ALLERGICHESKII EKZEMATOZNYI, DERMATIT ALLERGICHESKII KONTAKTNYI, DERMATIT KONTAKTNYI ALLERGICHESKII, АЛЛЕРГИЧЕСКИЙ КОНТАКТНЫЙ ДЕРМАТИТ, ДЕРМАТИТ АЛЛЕРГИЧЕСКИЙ КОНТАКТНЫЙ, ДЕРМАТИТ АЛЛЕРГИЧЕСКИЙ ЭКЗЕМАТОЗНЫЙ, ДЕРМАТИТ КОНТАКТНЫЙ АЛЛЕРГИЧЕСКИЙ
Italian Dermatite allergica eczematosa, Dermatite allergica da contatto
Korean 상세불명 원인의 알레르기성 접촉피부염, 알레르기성 접촉피부염
Croatian DERMATITIS, ALERGIJSKI KONTAKTNI
Polish Zapalenie skóry kontaktowe alergiczne, Alergiczny wyprysk kontaktowy, Zapalenie skóry alergiczne wypryskowe
Hungarian Allergiás kontakt dermatitis
Norwegian Allergisk kontaktdermatitt, Allergisk kontakteksem
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Contact urticaria (C0263333)

Concepts Disease or Syndrome (T047)
ICD10 L50.6
SnomedCT 19364004
Italian Orticaria da contatto
Dutch contact urticaria, contact; urticaria, urticaria; contact, Contact-urticaria, urticaria contact
Spanish Urticaria de contacto, urticaria de contacto (trastorno), urticaria de contacto, urticaria por contacto, Urticaria por contacto
Japanese 接触蕁麻疹, ｾｯｼｮｸｼﾞﾝﾏｼﾝ
Czech Kontaktní kopřivka
English Urticaria contact, contact urticaria (diagnosis), contact urticaria, urticaria contact, Contact urticaria, Contact urticaria (disorder), contact; urticaria, urticaria; contact
Korean 접촉 두드러기
Hungarian Kontakt urtica, Kontakt urticaria
Portuguese Urticária de contacto
French Urticaire de contact
German Kontakturtikaria
Derived from the NIH UMLS (Unified Medical Language System)

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