Symptoms for both types of contact dermatitis are essentially the same and they present as a red rash to begin with. This reaction is immediate in case of irritant dermatitis and delayed for few hours or days in case of allergic dermatitis [2] [7]. This is followed by formation of pustules, blisters or even urticaria of that specific part. The area involved in case of irritant dermatitis is confined to area where the trigger has touched the skin but is widely distributed in case of allergic dermatitis.

This progresses to itching, burning and increased sensitivity of the skin. The skin looks rough, dry, parched. In case of systemic contact dermatitis, pre-sensitized individuals may produce a reaction to the allergen entering via any route - oral, inhalant, contact, etc. The commonest manifestation of this is the Baboon syndrome characterized by widespread erythema over inner thighs, buttocks and axillae [8].

• Burning Pain

  Irritant contact dermatitis When dermatitis is caused by an irritating substance, the main symptoms include: Redness; Burning pain; Stinging; Soreness; A reaction that resembles a burn, and; Dry, rough skin. [healthand.com]

  Symptoms include pruritus and sometimes a burning pain. Skin changes include erythema, scaling, skin swelling, and sometimes blistering and ulceration. The location depends on the site of contact. [merckmanuals.com]

  The symptoms of shingles often start as a burning pain or tingling in the affected area, followed shortly by a painful, blistering rash. The condition is most commonly diagnosed in people over 50. Early treatment can help minimize the symptoms. [dermrochester.com]

• Pruritus Ani

  Individuals with a skin condition (such as stasis dermatitis, otitis externa, or pruritus ani) requiring frequent application of topical agents can develop allergic contact dermatitis over time. [skinsight.com]

  ani and pruritus vulvae may develop allergic contact dermatitis Nickel is the most common metal present in artificial jewelry which is the cause of allergic contact dermatitis. [ncbi.nlm.nih.gov]

  While sometimes eliciting small reductions in allergenicity in individual patients, they more generally result in pruritus ani, generalized pruritus, urticaria, and other rashes. [telemedicine.org]

• Venous Insufficiency

  "Contact dermatitis in patient with chronic venous insufficiency". Trakia Journal of Science. 12 (3): 245–249. doi:10.15547/tjs.2014.03.005. [en.wikipedia.org]

• Burning Eyes

  Some people experience difficulty breathing, coughing, burning eyes, and a runny nose when they’re having an allergic reaction. Other allergic reactions cause changes in the skin. [healthline.com]

• Blister

  Blister-like bumps? Chances are it’s contact dermatitis, but only the doctor can say if it’s a simple case of irritation or a more serious allergy. [nailsmag.com]

  Blisters or pustules may or may not be present. If blisters are present, they may weep and ooze before crusting over. An intense itching or burning or even pain may be present. Sometimes the skin actually will feel warm to the touch. [allergystore.com]

  All 3 patients presented with blistering around their incisions within 2 weeks of surgery and responded to treatment involving removal of the offending agent and use of oral diphenhydramine and hydroxyzine and topical triamcinolone. [ncbi.nlm.nih.gov]

  The rash is not caused by the fluid from the blisters. Thus, once the person has washed the oil off the skin, the rash is usually not contagious. [mountsinai.org]

  Both types of contact dermatitis can cause the skin to become: cracked red blistered thickened dry itchy Contact dermatitis can cause the skin to become red, inflamed, cracked, blistered, thickened or dry. [healthdirect.gov.au]

• Eczema

  […] between smoking and contact dermatitis or hand eczema. [ncbi.nlm.nih.gov]

  Contact dermatitis/eczema, Contact dermatitis NOS (disorder), Eczema - contact, Dermatitis - contact, Contact dermatitis syndrome, Contact dermatitis, Dermatitis venenata, CD - Contact dermatitis, Contact eczema, Contact dermatitis (disorder), contact [fpnotebook.com]

  Other types of eczema include: atopic eczema (also called atopic dermatitis) – the most common type of eczema; it often runs in families and is linked to other conditions, such as asthma and hay fever discoid eczema – circular or oval patches of eczema [nhs.uk]

• Erythema

  We present two cases of culture-proven fungal keratitis on natamycin treatment which developed periocular erythema, oedema, burning sensation and pruritus within 48 hours of the addition of topical voriconazole. [ncbi.nlm.nih.gov]

  In cumulative irritant dermatitis hyperkeratosis, lichenification and fissures predominate, leading to pain and itching, but erythema and vesicles may also be present. [eczema.dermis.net]

  Erythema Multiforme-Like Contact Dermatitis Of all noneczematous clinical variants, the erythema multiforme-like (or “contact erythema multiforme”) is the most common. [hindawi.com]

• Urticaria

  CUS can be described in two broad categories: nonimmunologic contact urticaria (NICU) and immunologic contact urticaria (ICU). [dermatologyadvisor.com]

  Contact urticaria Contact urticaria, also known as hives, is a less common form of contact dermatitis. With contact urticaria, swelling and redness usually happen right away after the skin comes in contact with an irritating substance. [nationaleczema.org]

  Contact Urticaria is a rapid onset localised urticaria seen in chefs and food handlers. [allergy-clinic.co.uk]

  BACKGROUND: Contact urticaria (CU) and protein contact dermatitis (PCD) are mainly induced by an immediate, IgE-mediated immunological mechanism. Immediate sensitization is also linked to asthma and/or allergic rhinitis. [ncbi.nlm.nih.gov]

  When the allergic reaction occurs soon (minutes) after contact and causes welts and redness, it is called “contact urticaria”. When the reaction is delayed hours to a day or so after contact, it is called “allergic contact dermatitis” or ACD. [dermcoll.edu.au]

• Eruptions

  After treatment, the eruption turned brown, the itching was resolved, and there were no facial swelling as well. This case report highlights the need to consider the occurrence of SCD in patients following bone plate fixation. [ncbi.nlm.nih.gov]

  As a general rule, the eruption from color developers spares the oral mucosa [79]. [hindawi.com]

  In addition, other eczematous eruptions must be considered and rejected. Contact dermatitis generally requires treatment with topical steroid creams, but if extensive, may require taking steroids orally. [medicinenet.com]

• Pruritus Vulvae

  Patients with pruritus vulvae and lichen sclerosus are at high risk of contact sensitivity. Lewis et al.[19] studied 121 women with vulval problems. [ncbi.nlm.nih.gov]

The appearance of the skin clinically confirms the diagnosis. Blood tests show an elevated erythrocyte sedimentation rate (ESR) and immunoglobulin E (IgE) levels [9]. History of allergic substances and contact with irritant chemicals or solvents helps in identifying the type of dermatitis.

Patch testing is one of the most reliable tests done which identifies the specific irritant or allergen to which the individual is sensitive. In this test an appropriate chemical is applied to the affected skin and is allowed to remain on skin for at least a day. The test results are read after 48 hours. In individuals with negative testing results, despite of suspected allergic tendency, a repeat testing is done. A delayed positive reaction is observed due to certain chemicals especially neomycin [10].

Topical steroids are used as the primary line of treatment. The use of long term steroids is known to cause local atrophy of skin along with systemic complications. In patients not responding to corticosteroids and with severe allergic dermatitis, are benefited with phototherapy.

Symptomatically, large vesicles are treated by drainage. Then they are covered through dressing containing antibiotics or containing Burrow’s solution to avoid further bacterial infection. For pruritis, oral and topical antihistaminic agents are used. Doxepin cream is a common antihistaminic used. For acute vesicular lesions cool soaks in Burrow’s solution or saline are helpful [11].

For irritant contact dermatitis, local application of restoraderm cream or impruv cream are useful. They act by preserving the epidermal layer of skin from the irritant exposed. Alcohol based hand cleansers are used to reduce further skin damage and irritation. Emollients such as white petroleum jelly are useful for long term chronic disorder.

Rarely, immunosuppressants are utilized. In cases of severe dermatitis caused due to chemical burns, hospital admission might be indicated [12].

Contact dermatitis results in more of morbidity than mortality. Very few deaths have been reported in the US. Morbidity is due to the chronicity of the disease. The disease persists for many years, and older the disease, more amount of time is taken to overcome it. Also, this condition has a strong relapsing tendency.

Irritant contact dermatitis is a result of direct local contact of the irritant on the skin. A significant amount of exposure with respect to its concentration and duration is considered to result in such an inflammation. The agents can be chemicals such as chromic acid, nitric acid, sulfuric acid or strong alkalis like calcium oxide, sodium hydroxide, potassium cyanide, bromine etc.

Dermatitis also results due to local friction from tight undergarments, use of diapers, prosthetic limbs or dressing materials used. Other causes are handling certain plants such as cactus, plastic/rubber materials etc. [3] [4].

Allergic dermatitis generally results after exposure to an allergen that the person has been previously exposed to. Exposures to nickel are one of the frequent causes seen in allergic dermatitis. It is seen in metal workers, clerks, cleaners etc. Certain preservatives used in skin moisturizers, cosmetics leads to an allergic reaction too.

The prevalence of occupational dermatitis is very high and about 1,700 cases are observed every 100,000 individuals. Highest amount of people affected are hairdressers, cooks and people employed in baking industry. It accounts to 95% of all skin disorders. Annually, about 10-20 cases are noted per 10,000 employees.

It affects all age group people. Statistics show that hand eczema is most frequently seen and is more common in females than males. Allergic dermatitis is frequently seen in infants more than in an adult age group [5].

Allergic contact dermatitis is induced through sensitization of haptens which activate the innate immunity. Haptens are self proteins that are identified by the immune system under the skin. These then activate the inflammatory mechanism resulting in the activation of the dendrite cells. The cells then acquire the antigens and settle in the lymph nodes [2] [5] [6]. Here, the antigens are presented to the memory cells. Finally on exposure to antigens, these T cells release cytokines and interferons- gamma to kill the hapten cells, resulting in an inflammatory response in the form of an inflammatory rash on the skin. The initial response occurs after few days of exposure to the allergen, but once the sensitization takes place, individuals develop a reaction within hours of exposure.

There are mainly three pathological changes occurring in case of irritant contact dermatitis. These are epidermal changes, destruction of the skin barrier and release of the cytokines. Keratinocytes play a major role in initiation of the inflammatory response by releasing cytokines. Skin irritation is mainly due to significant irritation caused by using harsh soaps repeatedly especially in individuals who are involved in repeated hand washing multiple times in a day. This leads to loss of essential fats and skin’s protective oils.

Patients must discontinue the use of irritants that produce a skin reaction. They must read about the product or the cosmetic to be used before application. The allergen must be known to them. In diet they should refrain from allergens that would cause an adverse reaction, use of nickel is avoided [7] [13]. A patch test should be done before trying out any new toiletry or cosmetic.

Contact dermatitis is the result of an inflammatory reaction of the skin due to direct exposure to either allergens, called allergic dermatitis, or to an irritant, called irritant contact dermatitis [1]. The substances leading to dermatitis are hapten-specific T cells which are non protein chemical cells. These activate the immune system leading to a delayed type of hypersensitive reaction.

The immune reaction can be innate or acquired depending on the substance for which the skin is exposed. Irritant contact dermatitis generally results due to destruction of the external layer of the skin after a significant exposure. In children, it results in the form of napkin irritation on the genitals, or on thumb due to thumb sucking. In adults hands are commonly affected due to continued contact with detergents commonly called as housewife’s dermatitis.

Allergic contact dermatitis is an antigen-antibody reaction occurring within 48 to 72 hours of contact [1] [2].

Contact dermatitis is a chronic, intermittent, skin inflammatory disease in which there is intense swelling, vesicles, redness and itching caused after the exposure to the irritant. In cases of allergic contact dermatitis, the response can be delayed by few hours or days. The dermatitis caused by irritant products such as detergents, soaps, alkalis etc leads to superficial skin disruption. This is seen in employees working in a chemical industry or those who are involved with domestic work, cleansers etc. repeated and prolong exposure results in irritant dermatitis.

The approach to such a condition is firstly abstinence from the prolonged exposure. The individual must avoid the contact with the substance known to cause dermatitis. Secondly, certain medications such as antihistaminics are used to reduce irritation and itching. In cases of severe allergy steroidal applications are used. After this certain barrier creams are used for long term protection. Cleansers that are alcohol based are recommended as they can help in skin protection and renewal. In severe cases immune modulator drugs, immune suppressants are used.

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