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Skin Care and Diseases

Contact Dermatitis & Eczema: Going Beyond the Rash

Contact Dermatitis

Contact dermatitis is an inflammation of the skin caused by contact with a certain substance.  The substance, which can range from poison ivy to fragrance, prompts an allergic reaction of the skin.  This skin inflammation can vary from redness to widespread rashes with open sores.  Eczema (often used synonymously with the term dermatitis) can also result from an inherited dry, cracked skin with allergies to foods or pollen (atopic dermatitis) or from leg swelling (stasis dermatitis).

Understanding Contact Dermatitis

Atopic dermatitis almost always starts during childhood, but contact dermatitis can first appear at any age.  Patients are often diagnosed with atopic eczema during adulthood; however, this is most likely contact dermatitis.  Contact dermatitis is  curable, which is good news for many undiagnosed patients who continue to use potentially harmful steroids, in both cream and pill form, to treat their "eczema."  Contact dermatitis is triggered by substances that cause an allergic reaction in certain people (allergens).  Examples include:

Allergens cause a contact allergy when they touch the skin, and this reaction is almost always delayed. Immediate reactions can occur such as to latex, but skin takes several days after contact before a rash develops in response to most allergens. Respiratory allergies, in contrast, are much more immediate.  For example, a person with a common allergy to pollen who is running through a grassy field would notice their nose running within minutes.  On the other hand, if that person in the field had an allergy to the poison ivy, the rash may not be visible for three to seven days.  In fact, this single brief contact with poison ivy can cause a rash that lasts for a month.  This makes it difficult for patients to diagnose the source of their contact dermatitis or eczema.  It's understandable to presume that a persistent rash, such as one that lasts for a month, is caused by something you come in contact with frequently.  However, given the delayed reaction associated with contact dermatitis, the source could have been a substance that briefly or infrequently touched the skin.  A contact dermatitis specialist has the tools to accurately determine the particular allergen.

Making the Appointment

When signs of eczema  present, schedule an appointment with a dermatologist or primary care provider.  Symptoms of contact dermatitis include:

If you are diagnosed with eczema or contact dermatitis, it is important that you make an appointment with a contact dermatitis specialist.  These specialists are trained not only in dermatology, but in the best way to diagnose, treat and counsel patients with this condition.  Some patients may think it reasonable to schedule a visit with an allergist; after all, contact dermatitis is an allergic reaction on the skin.  However, allergists are highly trained to see patients with allergies that have an immediate response.  This includes allergies to food and pollen such as ragweed.  Dermatologists and especially contact dermatitis specialists are trained to identify the source of a contact allergy and counsel the patient on alternatives to the irritant.

Patch Testing

Patch testing is the gold standard for diagnosing a contact allergy.  In this test, a dermatologist applies patches that each contain a specific type of allergen.  The patient wears the patches for 48 hours and returns to the office near day three and day seven of the test.  This is because the reaction taking place between the skin and allergen is delayed, meaning it will take the skin time to show visible signs of an allergy.   When the dermatologist notices redness at the test site, they have identified a substance to which the person is allergic.  Physicians belonging to the American Contact Dermatitis Society even have access to unique software that allows the information gathered in the patch test to be translated into a tool for daily life.  The software determines what substances the patient should avoid based on his or her allergy and what substances would make good alternatives.  Even more useful, the substances to avoid and the substances to use are listed by category and brand name.  In addition to useful software, contact dermatitis specialists use a patch test process that tests 75 to 100 allergens in most people.  They can also add tests for other allergens based on the occupation of the patient. By avoiding the allergen causing the contact dermatitis, the patient can actually be cured of the condition.

The Danger of Steroids

Often, contact dermatitis is diagnosed in patients as atopic eczema.  In order to treat the symptoms, some doctors may prescribe corticosteroid skin creams or steroid pills (e.g. Prednisone) for the patient.  However, this does not provide a cure and may present dangerous side effects for the person such as:

The best way to ensure you are getting the latest and safest treatment for your eczema or contact dermatitis is to see a contact dermatitis specialist.  Information on finding a specialist near you can be found through the American Contact Dermatitis Society.  Three ways to know if you should see a specialist are:

  1. If you are refilling prescriptions for corticosteroid ointments or steroid pills to treat your eczema or contact dermatitis
  2. If you are diagnosed with adult onset eczema
  3. If you suspect your job and your rash are related

Contact Dermatitis and Your Job

Many workers develop hand dermatitis.  Repeated handling of substances ranging from hair care products in salons to chemicals at industrial facilities can cause allergic reactions on the skin.  Seeing a contact dermatitis specialist and undergoing patch testing are powerful steps towards avoiding future rash.  It could also allow you to overcome the condition and keep your current job.  These specialists can give you guidance on what substances to avoid both at work and in the home to prevent future outbreaks.

Preparing for Your Contact Dermatitis Consult

If you make an appointment with a contact dermatitis specialist, it is important to remember that you as the patient are a partner in your own health care.  After all, you are your skin's best advocate.  When preparing for a dermatitis consult, take the following steps to make the most of the consultation:

  1. Bring all personal care products that touch the affected area even occasionally
  2. Bring Material Safety Data Sheets (MSDS) for items used at work
  3. Bring topicals used to treat the area after the rash began; second allergies to treatments and protective gear are common!
For example, if you have eyelid dermatitis, you might assemble a bag containing the items in this table:

 
 Item  Possible Allergens
Eye and Hair Cosmetics
  • Preservatives
  • Fragrance
  • Sunscreens
  • Lanolin
Eyelash Curler
  • Metal
Cosmetic Applicators
  • Rubber
Nail Products
  • Polish
  • Adhesive
MSDS for Glue Used Occasionally at Work
  • Adhesive (transferred incidentally to eyelids)
Ointments (prescribed and over-the-counter) Used to Treat the Rash
  • Antibiotics
  • Topical Steroids
  • Excipients

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This article is a NetWellness exclusive.

Last Reviewed: Jul 17, 2013

Susan T Nedorost, MD Susan T Nedorost, MD
Associate Professor of Dermatology
School of Medicine
Case Western Reserve University