When someone comes to you with a skin rash, one of the first orders of business is diagnosing and treating their ailment. This is not as easy as it should be, though, in many cases. Usually a positive diagnosis of contact dermatitis is best diagnosed through a positive indicator of response to an allergen. Such a test result can inevitably help you help your client. Getting there, however, is not always easy or simple.

 

Presentation of Contact Dermatitis

While not all cases will look the same, for the most part those suffering from contact dermatitis will have the following signs and symptoms that can be associated with the use of a new skin care product or detergent. There are actually two types of this disorder, which the American Academy of Dermatology refers to as an “eczema,” and as pointed out by Healthline; each of which has a slightly different set of indicators.

Allergic contact dermatitis includes:

• dry, scaly, flaky skin
• hives
• oozing blisters
• skin redness
• skin that appears darkened or leathery
• skin that burns
• extreme itching
• sun sensitivity
• swelling, especially in the eyes, face, or groin areas

Irritant contact dermatitis includes:

• blistering
• cracking skin due to extreme dryness
• swelling
• skin that feels stiff or tight
• ulcerations
• open sores that form crus

Still, many people may seek your help presenting with symptoms like these only to have something else going on. So how, as a medical professional, do you best assure that you know what you are being asked to treat?

 

Diagnosing Contact Dermatitis

One of the first things to find out when anyone presents with these symptoms is what they think they were in contact with that preceded them, or could be affiliated with them. As noted by the American Academy of Dermatology the following are the most common substances that trigger a reaction.

Contact Dermatitis

• Poison ivy
• Nickel
• Makeup you applied once or few times
• Jewelry you wore for a long time without a reaction, such as a wedding ring
• Jewelry you wore for only a few hours or days
• Latex gloves

Irritant Contact Dermatitis

• Battery acid
• Bleach
• Pepper spray

Other substances such as foods, plants, and cleaning products can also trigger a response. This can happen even when something is not new to the person. The best way to diagnose an allergy is with the patch test, especially because the skin can demonstrate an allergy the very first time it comes in contact with a substance, or after it has come into contact with a substance hundreds or thousands of times without a reaction.

Patch tests are an elegantly simple way to detect allergies. This, combined with taking a patient’s history and a physical exam, should assure that you accurately diagnose contact dermatitis, making it possible to treat.

As noted by the Mayo Clinic, “during a patch test, small amounts of potential allergens are applied to adhesive patches, which are then placed on your skin. The patches remain on your skin for two to three days, during which time you’ll need to keep your back dry. Your doctor then checks for skin reactions under the patches and determines whether further testing is needed.”

 

Treating Contact Dermatitis

While the best treatment for contact dermatitis is avoidance of the allergen, if there is a rash and irritation, your patient needs relief. Also, it is not always possible to simply avoid the irritant or irritants, and without treatment, that may make the allergy chronic. To avoid this, treatment options can include the following for immediate relief (as noted by the American Academy of Allergy Asthma and Immunology)

• • Cold compresses can help with the itch.
  • For patients with oozing lesions, Burrow’s solution (aluminum triacetate), calamine, and/or oatmeal baths can also be utilized.
  • In hand dermatitis, avoiding excessive hand washing and using non-irritating moisturizers is recommended. Choose mild soaps, moisturizers, and detergents without dyes or perfumes. Wear gloves to protect your hands and other body parts from exposure.
  • In foot dermatitis, the use of barrier socks may be helpful.
  • Wash skin immediately after contact with an allergen to limit the spread and severity of the reaction (such as after known contact with a plant allergen like poison ivy).
  • Apply covers over metal fasteners in clothing to avoid contact with nickel.

As noted, medical intervention may include the use of topical or oral steroids, antihistamines, topical immunomodulators, topical antibiotics, systemic steroids, and phototherapy. There are also new treatments with lasers that are coming into practice. For more information on contact dermatitis and other skin disorders that you will frequently see, follow the TSLMS blog here, and attend SCALE 2019 Music City next month.