Allergic Contact Dermatitis – Causes, Symptoms and Management

What is Contact Dermatitis?

Contact Dermatitis is also known as Allergic Eczema. Contact Dermatitis occurs as a result of an individual’s skin coming in touch with an allergen. Allergen is any material or product which causes allergy in an individual. Researchers also do not understand why dermatitis occurs only in a few individuals and not all. The condition occurs either due to activation of the environmental factors or as a result of genetics.

Types of Contact Dermatitis (Allergic Eczema)

According to the National Eczema Association, contact dermatitis is divided into three types:

Allergic Contact Dermatitis:

This is a result of allergen coming in touch with the skin. Allergens could be Nickel, pain, hair dye, flowers and more. Allergic Contact Dermatitis occurs post 48-96 hours after an individual is exposed.

Contact Urticaria:

Instantly, after coming in touch with an allergen, it causes swelling and redness.

Irritant Contact Dermatitis:

When the skin comes in touch with an irritant such as soap, friction or heat, it causes inflammation of the skin. Irritant contact dermatitis is majorly seen in individuals with a wound or atopic dermatitis (hyperallergic).

What is Allergic Contact Dermatitis?

Allergic contact dermatitis is considered to be the “second most common type of contact dermatitis.”

Initially, when the skin comes in touch with a substance or product that causes the allergy, it sends s the allergen to the immune system for analyzing it and further storing it in the memory bank of the immune system, but does not result in any response. This process is known as sensitization. The immune system remembers it; if the product comes in touch with the skin repeatedly, it results in an itchy reaction. For the chemical or product to be identified, it takes some days. The symptoms occur a few days post the “actual exposure.”

After coming in touch with an irritating product or allergen, your skin becomes red and itchy, which depicts a possibility of suffering from contact dermatitis. It is a reaction of the skin, which is delayed and majorly occurs post 12-72 hours after being exposed.

There are two significant kinds of contact dermatitis which are a result of skin exposure to things that you are either sensitive or allergic to. The latter is known as allergic contact dermatitis.

Symptoms of Allergic Contact Dermatitis

The symptoms for Allergic contact dermatitis lasts from approximately two to four weeks post-exposure.

An allergic reaction, also known as an anaphylactic reaction and allergic contact dermatitis are different from each other. Allergic reactions result in the release of an antibody known as IgE, which is not produced in allergic contact dermatitis reactions. Allergic reactions also cause problems or issues in breathing.

• Dry, scaly and flaky (peeling off and blisters)
• Hives (raised, itchy parts of the skin)
• Blisters (fluid-filled bubble)
• Redness of the skin
• Skin gets dark and leathery
• Burns on the surface, sometimes burning sensations but no visible skin sores
• Itchy sensations on the skin
• Sensitive to sun
• Swelling in the eyes, face, groin parts or genital areas (in major cases)

Irritant Contact Dermatitis

• Irritant contact dermatitis leads to symptoms like:
• Blisters
• Skin cracks due to dryness of the skin.
• Swelling
• Skin becomes hard and rigid.
• Ulcers
• Open sores “that forms a crust.”

Causes of Allergic Contact Dermatitis

• Allergens do not affect everyone, but few individuals get allergic to a few things which they have tolerated in the past for many years. Post many exposures, or even one exposure causes the skin to develop an allergy to a particular product.
• If an individual is suffering from allergic contact dermatitis, then the body activates an immune system which results in the skin is itchy and irritated.
• Airborne products such as ragweed pollen and spray insecticides.
• Products or materials that cause allergic dermatitis includes:
• Antibiotics (Medicines) or anti-itch preparations. These are undiagnosed and which later results in an allergic reaction or makes the initial problem worse.
• Antifungal or antibacterial substances such as methylisothiazolinone.
• Antibacterial ointments like neomycin and bacitracin are used for the treatment of scratches and hurts, few of the individuals form allergic reactions.
• Metals such as Nickel and others. Nickel present in costume jewellery or snaps or jeans. The areas which come in touch with the metal results in allergic dermatitis. For example, ears under the earrings. It should be known that wearing jeans with a metal snap, even for some hours, once in a month would start the process all over again. Older kids could also develop reactions or allergies when the skin comes in touch with watches, belt buckles, earrings, chain. Including Nickel, cobalt seen in metals which results in people being allergic to both Nickel and cobalt. Cobalt saw in several products which are used for personal use such as dyes used for hair and antiperspirants.
• There are some products which cause both allergic and irritant dermatitis such as chromium salts seen in paints, cement and leather products.
• Poison oak and ivy
• Preservatives like formaldehyde and sulfites. Formaldehyde is found in house-hold disinfectant, vaccines, glues and adhesives, cigarette smoking.
• Products made of rubber latex. This allergy occurs as a result of work-based. It results in instant allergic reactions, like itching, burning, welts (hives), water from the eyes or breathlessness.
• Sunscreens: This results in a rash which looks like a hive (red and elevated itchy skin rashes), which occurs post few hours or days after exposure to the sun.
• The ink used for making tattoos
• Black Henna, used for dying of hair or creating tattoos
• Paraphenylenediamine (PPD), is a chemical which is present in hair dyes. This chemical in many products comes in use for the skin, such as temporary tattoos. Also used for dying the shoes black.
• Fragrances: They are present in perfumes, soaps, lotions, shampoos, and tooth-paste.
• Also occurs via Cosmetics.

Irritant Contact Dermatitis is a result of toxins, like detergents and chemicals in products used for cleaning. It also occurs as a result of constant exposure to products or materials that are non-toxic.

Soap is a product that results in both allergic and or irritant contact dermatitis.

Risk Factors

There are higher risks of facing this condition, in some jobs and hobbies like:

• Health care and dental employees
• An individual working in metals
• Workers on construction sites
• Cosmetologist and hairdressers
• Auto-mechanics
• Due to the presence of rubbers in face masks or goggles, scuba divers and swimmers are at risk
• Cleaners
• Gardeners and Workers in the agricultural field
• Cooks or other individuals dealing with food

When is it required to visit a doctor?

If the skin has a rash or you still have an on-going irritation on the surface, take an appointment of the health care provider.

• To visit the doctor if the presence of other symptoms such as fever or infection.
• To visit a doctor, when rashes distract you from regular daily routine.
• Rashes spread to different parts of the body.
• Symptoms are the same, and there is no improvement.
• If the physician thinks that the condition is due to an allergy, they will refer to an allergy specialist.

Diagnosis of Allergic Contact Dermatitis

Initially talk to the doctor if the symptoms are significant and not improving over time. The physician will take a medical history, and your skin will undergo an examination. Questions included will be:

• First time the symptoms were observed?
• What makes the symptoms better or worse?
• Just before the rash started, did you go for a hike?
• The products used on the skin daily?
• What is it done for a living?

Patch Test:

An allergy specialist will perform Patch testing. That includes skin exposure to tiny quantities of materials or products that result in allergies.

The skin patch will be worn for 48 hours, “keeping it as dry as possible.” A day later go to your physician, so they can see the “skin exposed to the patch.” You will have to re-visit the physician again after a week for further inspection of the skin.

If rashes occur within seven days of exposure, you tend to suffer from an allergy. Few individuals have an instant reaction to the skin.

Few of the individuals maintain a diary related to the symptoms of skin and try to identify the substances or products they were surrounded by when the reaction took place.

Treatment for Allergic Contact Dermatitis

The treatment recommended by the physician depends on the cause of the reaction and its severity.

Examples of conventional treatments:

For mild reactions:

• Antihistamine medicines like diphenhydramine, cetirizine and loratadine. The medications will be got either on prescription or over the counter (OTC).
• Topical Corticosteroids, like the hydrocortisone
• Oatmeal baths
• Creams or lotions that are soothing
• Light Therapy

If specific reactions result in swelling of the face, or rashes that cover the mouth:

• Prednisone
• Wet Dressings

If the infection is there, antibiotics are recommended.

Scratching of rashes needs to be avoided as it results in infections.

Prevention of Contact Dermatitis

To prevent contact dermatitis, avoid exposing to irritants. Follow the below-given tips:

• Go for products that are “hypoallergenic” or “unscented.”
• If the presence of latex allergy, avoid using them. Instead, go for vinyl gloves.
• When going for a hike in the wilderness, wear full-sleeved t-shirts and pants.
• Stop using the substance or material instantly if a product is causing any kind of irritation.

If your skin is sensitive, a spot test needs to be done with new products. A new product can be applied to one place on the forearm. Do not expose it soap or water, instead cover it adequately. Post 48-96 hours after applying it, check for a reaction. Do not use the product if the skin turns red or gets irritated.

General Prevention Steps include

• Avoid irritants and allergens: Important to identify the products substances that result in an allergic reaction or that irritates your skin.
• Wash your skin: Important to wash the skin properly, which might help to eliminate most of the rash-causing products or substances. It’s essential to wash clothes and other things that come in touch with the allergen such as poison ivy or others.
• Wear proper clothes and gloves: Number of items like face-masks, goggles, gloves or others protects from irritant substances, including the house-hold cleaners.
• “Apply an iron-on patch to cover metal fasteners next to your skin”: This helps to prevent allergic reactions caused by jean snaps.
• Apply a barrier cream or gel: This protects the layer of the skin. The skin reaction caused by poison ivy decreases by using an over the counter drugs (OTC) cream named bentoquatam (IvyBlock).
• Use moisturizer: Important to apply lotions that are moisturizers, helps in restoring the outermost layer of the skin and keeps your skin flexible.
• Protect around the pets: Poison ivy, which is an allergen from the plants, can be attached to the pets and then be transferred to different people.

Conclusion

This condition is a skin disorder resulting in itching or irritation of the skin which happens to post the exposure of the skin to particular allergens. The reactions might occur instantly or delayed. The treatment requires over the counter drugs (OTC), that includes topical hydrocortisone if any allergen needs to be avoided.

If open sores result in significant reactions, they should consult a physician for “antibiotics or prescription treatments.”

References

1. https://www.sciencedirect.com/science/article/abs/pii/S0889856116300777
2. https://onlinelibrary.wiley.com/doi/full/10.1111/ddg.12143
3. https://link.springer.com/article/10.1007%2Fs40257-017-0340-7