Contact dermatitis is an
inflammation of the skin that results from direct contact with certain
substances, such as soap, cosmetics, jewelry or weeds, including poison
ivy or poison oak. The resulting red, itchy rash isn't contagious or
life-threatening, but it can be very uncomfortable.
Successful contact dermatitis treatment consists primarily of
identifying what's causing the inflammation. Then, if you can avoid the
offending agent, the rash usually resolves in two to four weeks.
Self-care measures, such as wet compresses and anti-itch creams, can
help soothe your skin and reduce inflammation.
Signs and symptoms of contact dermatitis include:
* Red rash or bumps
* Itching, which may be severe
* Dry, red patches, which may resemble a burn
* Blisters and draining fluid from the involved skin in severe cases
* Skin rash limited to the exposed area
* Pain or tenderness
In contact dermatitis, only the areas of skin exposed to the offending
substances react. The area with the greatest exposure reacts most
Based on the cause, contact dermatitis falls into two categories.
* Irritant contact dermatitis. This type of dermatitis is more
common and results from repeated contact with a substance, such as soap,
cosmetics or skin products, including deodorant, that irritates the
skin. The exposure produces red, dry itchy patches usually on the hands,
fingers and face. Some substances, such as bleach or strong acids, can
cause irritant contact dermatitis after just one exposure. These
substances typically remove oil and the protective barriers from the
* Allergic contact dermatitis. This type of dermatitis is caused by a
reaction to substances called allergens. The resulting reaction is your
body's response to the sensitive agent. Allergic contact dermatitis
produces a red rash, bumps and sometimes blisters when severe. Common
allergens include rubber, metals such as nickel, costume jewelry,
perfume, cosmetics, hair dyes and weeds, including poison ivy. It may
take several years for an allergy to develop. Once an allergy has
developed to a specific substance, however, it remains for life.
Exposure to even a small amount of the allergen will reliably result in
When to see a doctor
See your doctor if:
* You're so uncomfortable that you're losing sleep or are distracted from your daily routines
* Your skin is painful
* You suspect your skin is infected
* You've tried self-care steps without success
* You suspect the dermatitis is job-related
The cause of contact dermatitis is direct contact with one of many irritants or allergens. These include:
* Strong detergents or soaps
* Skin cleaning products
* Cosmetics or makeup
* Clothing or shoes
* Household cleaning products
* Formaldehyde and other chemicals
* Rubber or latex
* Metals, such as nickel
* Perfume or fragrances
* Weeds and plants, such as poison ivy or poison oak
* Medicinal lotions, such as antihistamines, antibiotics or antiseptics
Some substances are both allergens and irritants. Examples include ingredients in soaps, detergents and some cosmetics.
It takes a greater exposure to an irritant over a longer time to cause
dermatitis than it takes for an allergen. If you're sensitized to an
allergen, just brief exposure to a small amount can cause contact
dermatitis. If re-exposure to a substance always results in dermatitis,
then this substance is more likely an allergen than an irritant. The
allergen might be something that you had been in contact with for years
without trouble until now. Once an allergy has developed to a specific
substance, however, it remains for life.
Some substances cause dermatitis only when they contact skin exposed to
sunlight (photocontact dermatitis). Typical examples include shaving
lotion, sunscreens, ointments containing sulfa drugs, some perfumes and
coal tar products. Other causes of contact dermatitis may be airborne,
such as ragweed pollen and insecticide spray.
Occupational contact dermatitis occurs when a person is exposed to
allergens or irritants on the job. Frequent exposure to water, friction,
chemicals, fuels, dyes, cleaning agents, industrial solvents or dust
(for example, cement dust, sawdust or paper dust) can lead to contact
Prolonged itching and scratching may increase the intensity of the itch,
possibly leading to neurodermatitis (lichen simplex chronicus).
Neurodermatitis is a condition in which an area of skin that's
frequently scratched becomes thick and leathery. The patches can be raw,
red or darker than the rest of your skin. Persistent scratching can
also lead to a bacterial skin infection and permanent scars or changes
in skin color.
Preparing for your appointment
You're likely to start by first seeing your family doctor or a primary
care doctor. However, in some cases when you call to set up an
appointment, you may be referred directly to a specialist in skin
Because appointments can be brief, and because there's often a lot to
cover, it's a good idea to be well prepared for your appointment. Here's
some information to help you get ready for your appointment, and what
to expect from your doctor.
What you can do
* Write down your signs and symptoms, when they occurred, and how
long they lasted. Also, it may help to write down any new products
you've used and any substances that regularly come in contact with the
* Make a list of all medications, including vitamins, herbs and
over-the-counter drugs, that you're taking. Even better, take the
original bottles and a written list of the dosages and directions.
* Write down questions to ask your doctor. Don't be afraid to ask
questions or to speak up when you don't understand something your doctor
List your questions from most important to least important in case your
time with your doctor runs out. For contact dermatitis, some basic
questions you might ask your doctor include:
* What might be causing the signs and symptoms?
* Are tests needed to confirm the diagnosis?
* What treatment approach do you recommend, if any?
* Is this condition temporary or chronic?
* Can I wait to see if the condition goes away on its own?
* What are the alternatives to the primary approach that you're suggesting?
* What skin care routines do you recommend to improve my symptoms?
What to expect from your doctor
Your doctor is likely to ask you several questions. Being ready to
answer them may reserve time to go over any points you want to discuss
more. Your doctor may ask:
* When did you first begin experiencing symptoms?
* How often do you experience these symptoms?
* Have your symptoms been continuous or occasional?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?
Tests and diagnosis
Your doctor may diagnose contact dermatitis after talking to you about
your signs and symptoms and examining your skin. If the cause of your
rash isn't apparent or if your rash recurs often, your doctor may
recommend a patch test (contact delayed hypersensitivity allergy test).
During a patch test, small quantities of potential allergens are applied
to small patches, which are then placed on your skin to check for a
reaction. The patches remain on your skin for two days before being
evaluated by your doctor. If you're allergic to a particular substance
being tested, you develop a raised bump or a reaction limited to the
skin just beneath the patch.
Treatments and drugs
Contact dermatitis treatment consists primarily of:
* Avoiding the irritant. This involves identifying what's causing
your irritation and then avoiding it. If this is done, it may take two
to four weeks for the rash and irritation to clear up.
* Topical self-care measures. In mild to moderate cases, self-care
measures, such as using creams containing hydrocortisone or applying wet
dressings, can help relieve redness and itching.
* Oral medications. In severe cases, oral corticosteroids and
antihistamines may be necessary to reduce the inflammation and relieve
the intense itching.
Lifestyle and home remedies
To help reduce itching and soothe inflamed skin, try these self-care measures:
* Try to identify and avoid substances that irritate your skin or
that cause an allergic reaction. These can include nickel, jewelry,
perfume, cleaning products and cosmetics.
* Apply an anti-itch cream or calamine lotion to the affected area. A
nonprescription hydrocortisone cream, containing at least 1 percent
hydrocortisone, can temporarily relieve the itch. A nonprescription oral
antihistamine, such as diphenhydramine (Benadryl, others), may be
helpful if itching is severe.
* Avoid scratching whenever possible. Cover the itchy area if you
can't keep from scratching it. Trim nails and wear gloves at night.
* Apply cool, wet compresses. Covering the affected area with
bandages and dressings can help protect the skin and prevent scratching.
* Take a comfortably cool bath. Sprinkle the bath water with baking
soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal
that is made for the bathtub (Aveeno, others).
* Wear smooth-textured cotton clothing. This will help you avoid irritation.
* Choose mild soaps without dyes or perfumes. Be sure to rinse the
soap completely off your body. And after washing, apply a moisturizer to
protect your skin.
Preventing contact dermatitis means avoiding coming into contact with
those substances such as poison ivy or harsh soaps that may cause it.
Prevention strategies include:
* Rinse your skin with water and use a mild soap if you come in
contact with a substance. Prompt washing can remove many of the
irritants or allergens from your skin. Be sure to rinse the soap
completely off your body.
* Wear cotton or plastic gloves when doing housework to avoid contact with cleaners or solutions.
* If on the job, wear protective clothing or gloves to shield your skin against harmful agents.
* Apply a barrier cream or gel to your skin to provide a protective
layer. Also, use a moisturizer to restore the outermost layer of skin
and to prevent the evaporation of moisture.
* Use a mild, unscented laundry detergent when washing clothes,
towels and bedding. Try using the extra rinse cycle on your washing