fbpx

ADVERTISEMENT

ADVERTISEMENT

Allergic Contact Dermatitis

Updated : January 18, 2024





Background

ACD, also known as allergic contact dermatitis, is a type 4 and DTH (layed-type hypersensitivity reaction) of the innate immunity to a small hapten (below 500 daltons), which comes into touch with skin that has already been sensitized. Sensitization is the mechanism that results in the increase of an allergen-mediated T cell population and is what causes the hapten to interact with a protein to cause the induction or initial phase of ACD.

Re-exposure to the antigens causes allergic dermatitis to form throughout the elicitation stage. 20 percent of contact dermatitis is caused by ACD, & allergens vary widely depending on hobbies, region, & individual habits, as well as common kinds of preservatives that are allowed by law, such as quaternium-15 in the U. S. but never in Europe.

Epidemiology

A cutaneous inflammation that affects a major portion of the population is ACD. It is the type of occupational derma condition that is most prevalent. Women experience the disease more frequently than men. The issue frequently has a correlation with topical treatments in older patients.

Anatomy

Pathophysiology

The touch of the allergens to the skin initiates the pathogenesis of ACD. The skin’s stratum corneum is attacked by this allergen, which Langerhans cells then take up. These cells then dissolve the antigens & express them on their surface layer. The surrounding lymph nodes are then approached by Langerhans cells.

While ingesting antigens, these cells come into contact with the adjacent T lymphocytes. Antigen-specific T cells are released as a result of the clonal expansion & cytokine-induced multiplication processes. The epidermis may then be reached by these lymphocytes as they move through the circulation.

The sensitization stage of ACD refers to the entire process. Elicitation is the stage that comes after repeated exposure to the antigen. Cytokine-induced replication is brought on by the contact of the T lymphocytes that are particular to that antigen with the Langerhans cells that contain that antigen. In turn, this proliferation causes a focused inflammatory reaction.

Etiology

A type 4 hypersensitivity response is what causes allergic contact dermatitis, an inflammatory skin condition. It happens when an irritating substance or antigen comes into touch with the skin and triggers a T-cell-mediated reaction. The best markers of the causative agent are frequently dermatitis’ morphology & location. For instance, when it occurs around the wrist, it can be a sign of an allergic reaction to a watchband or bracelet.

Where the plant comes into touch with the skin, poison ivy manifests as linear stripes and is a typical cause of ACD. Another typical ACD trigger is nickel, which manifests as dermatitis when nickel-containing jewelry is worn, such as necklaces & earrings. Chronic dermatitis can also be brought on by using rubber gloves. Hair dyes, preservatives, scents, textile chemicals, sunscreens, & photo allergens are some other agents.

Genetics

Prognostic Factors

The affected populations continue to live with this condition during their lives. The best course of action is to strictly avoid the allergy. The main objective of treatment is to control the inflammatory reaction.

The longer someone has ACD, the longer it will take for it to go away.

Clinical History

Clinical History

In order to properly assess people with ACD, a thorough medical history must be taken both before and after patch testing. The materials that people are exposed to and potential causes of allergic contact dermatitis should be considered in patch tests. Compared to most other dermatologic conditions, ACD evaluation calls for a significantly more thorough medical history. Keeping up with current trends is also crucial. The COVID-19 pandemic has boosted the usage of face masks, which have been linked to contact dermatitis brought on by formaldehyde releasers.

After the patch test, history is equally crucial. Only a thorough history and interview can reveal whether a patient’s current dermatitis is partially or entirely caused by substances to which they are allergic. A positive patch test may point to sensitivity & not the root of dermatitis that is currently present.

Existing skin conditions

Stasis dermatitis patients are at significant risk of acquiring allergic contact dermatitis from substances & agents applied to their leg ulcers and stasis dermatitis-affected areas. Despite the absence of evidence supporting their effectiveness in treating stasis ulcers, neomycin & bacitracin are significant contributors to allergic contact dermatitis in these people. Topical neomycin & topical corticosteroids are frequent allergens in people with otitis externa. Benzocaine or other drugs used to treat chronic pruritic disorders may cause sensitization in people with pruritus ani & pruritus vulvae. The severe chronic vulvar dermatosis experienced by women with lichen sclerosis et atrophicus is usually complicated by allergic contact dermatitis. Patch testing such patients could reveal crucial details that could aid in the treatment of stubborn and challenging dermatoses.

Atopic dermatitis

Atopic dermatitis patients are more likely to experience irritating contact dermatitis & non-specific hand dermatitis. They have a lesser chance of developing poison ivy-related allergic contact dermatitis. Contact sensitization & severe atopic dermatitis were found to be mutually exclusive. With the exception of scent sensitization & topical medication sensitivity, all categories of allergenic metals and chemicals were associated in the opposite direction.

Eyelid dermatitis

Dermatitis can appear on the eyelids as well as other exposed skin after being exposed to airborne allergens and allergens that have been touched there. A reaction to eyelid makeup allergies can also cause contact dermatitis.

Contact urticaria

Contact urticaria is indicated by immediate symptoms, such as visible lesions appearing less than thirty min after exposure (not ACD). This is especially true if the lesions have an urticarial appearance or if the skin response is accompanied by additional symptoms such as anaphylaxis, wheezing, ophthalmedema, or distant urticaria.

Latex

Currently, the main cause of allergic contact urticaria is rubber latex. The word “hypoallergenic” may apply to gloves without rubber latex or gloves without sensitizing additives, although it may not necessarily mean that the gloves are latex-free.

Some people could have delayed particular contact sensitivity to rubber latex; however, contact urticaria rather than allergic contact dermatitis to latex is much more prevalent. People who have hand dermatitis, hospital employees, youngsters with spina bifida, & atopic people are more likely to experience contact urticaria in response to rubber latex. To chemical additives to rubber gloves and to latex, certain people may develop allergic contact dermatitis and contact urticaria.

There have been a few rare cases of anaphylactic responses to topical agents (e.g., bacitracin).

Occupational dermatitis

One of the ten most prevalent occupational disorders is contact dermatitis. It might make people unable to work. Both at the workplace and at home, the hands are the body parts that are most frequently in contact with allergies & irritants. However, people with chronic dermatitis may not exhibit the typical pattern of weekend and holiday improvement. Allergic contact dermatitis in reaction to workplace items may initially improve on weekends and over vacations.

If there are numerous affected employees at the workplace, irritant contact dermatitis is more likely to occur. Most allergens rarely cause a significant proportion of people to become sensitized.

Hobbies

The cause of allergic contact dermatitis may be hobbies. Examples include processing film with color-developing chemicals that can cause cutaneous lesions of lichen planus from direct skin contact or work with exotic tropical timbers in carpentry.

Physical Examination

Physical examination

Pupils and vesicles with a pruritic basis and an erythematous background are the hallmarks of acute allergic contact dermatitis. Persistent allergic contact dermatitis may be indicated by lichenified pruritic plaques. Occasionally, integument-wide allergic contact dermatitis can occur (i.e., exfoliative dermatitis, erythroderma). The best indication of the likely cause of allergic contact dermatitis is frequently provided by the first site of dermatitis.

Hands

Particularly at work, hands are a common site for allergic contact dermatitis.

Topical medication sites

In situations of otitis externa, topical medicines are also significant contributors to ACD. Dermatitis around the eyes may be brought on by an allergy to substances in ophthalmologic procedures.

Hair dyes

P-phenylenediamine, a component of hair color, may cause allergic contact dermatitis. The ears and surrounding faces of those who are allergic to hair dyes often have the most severe dermatitis, instead of the scalp.

Airborne ACD

Allergy-induced airborne contact dermatitis can be brought on by chemicals in the air. This dermatitis typically affects the eyelids the most, but it can also affect other places that are exposed to toxins in the air, especially the head and neck.

Stasis dermatitis & stasis ulcers

When topical treatments are administered to inflamed or ulcerated skin, people with stasis dermatitis and stasis ulcers are at significant risk of developing allergic contact dermatitis. There is a considerable risk of allergic contact dermatitis to treatment (such as neomycin) in these patients because of the chronic nature of the illness and the frequent blockage of administered drugs. Topical drugs applied to leg ulcers or cross-reacting systemic treatments given intravenously can cause people to develop extensive dermatitis. For instance, administering intravenous gentamicin to a patient who is allergic to neomycin may cause systemic contact dermatitis.

Erythema multiforme

Erythema multiforme is a severe cutaneous reaction characterized by targetoid lesions. It usually develops in response to exposure to specific drugs or after an infection, most frequently the herpes simplex virus.

Rare occurrences of EM have been documented following allergic contact dermatitis brought on by exposure to nickel, hair dye, poison ivy, tropical woods, and nickel. An allergy to intraoral metal may cause mucositis that resembles lichen planus and is linked to intraoral squamous cell cancer.

It has been documented that an intraoral squamous cell cancer developed close to a dental restoration made of a metal the patient was allergic to. Patients with venous insufficiency may experience allergic contact dermatitis as a direct cause of skin ulceration. Venous ulcers may not form if allergic contact dermatitis is diagnosed and treated early.

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Differential Diagnosis

There are significant anatomical parallels between the clinical manifestations of atopic dermatitis & irritating contact dermatitis.

Drug eruptions, urticarial bullous pemphigoid, rosacea, urticaria, scabies seborrheic dermatitis, psoriasis, and periorificial dermatitis are further skin disorders that need to be checked out.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

All patients with suspected or confirmed ACD should be informed of the fact that the only effective treatment for the condition is the discovery and elimination of the offending chemical. When ACD only affects more than 20% of the body, oral corticosteroids are the first-line medical treatment. Topical steroids are also used when ACD only affects less than 20 percent of the body.

PDE4 blockers or topical calcineurin blockers may also be helpful if ACD affects a delicate area like the eyelids or skin folds. Once the allergy has been identified, careful avoidance is required to stop a recurrence. Topical hydrocortisone, oral antihistamines, & cool water soaks are all used to treat symptoms. Vesicles shouldn’t be ruptured because doing so increases the danger of infection.

Moisturizer use is advised as an add-on. Topical immunomodulators such as tacrolimus may be helpful in severe situations. Using UV, A and psoralen together for phototherapy may be beneficial for some patients. One may occasionally need immunosuppressive medications example, mycophenolate, in severe situations. Conduct patch testing to find the culprit in cases of persistent or resistant ACD.

The right chemicals must be chosen for testing, the patient must be counseled about the results of the patch test, and the test must be positive for the relevant allergens. A “safe list” of goods that do not contain the patient’s allergens can also be created using the Contact Allergen Management Program (CAMP) from the American Contact Dermatitis Society. Systemic treatment may be required if allergens cannot be avoided.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK532866/

ADVERTISEMENT 

Allergic Contact Dermatitis

Updated : January 18, 2024




ACD, also known as allergic contact dermatitis, is a type 4 and DTH (layed-type hypersensitivity reaction) of the innate immunity to a small hapten (below 500 daltons), which comes into touch with skin that has already been sensitized. Sensitization is the mechanism that results in the increase of an allergen-mediated T cell population and is what causes the hapten to interact with a protein to cause the induction or initial phase of ACD.

Re-exposure to the antigens causes allergic dermatitis to form throughout the elicitation stage. 20 percent of contact dermatitis is caused by ACD, & allergens vary widely depending on hobbies, region, & individual habits, as well as common kinds of preservatives that are allowed by law, such as quaternium-15 in the U. S. but never in Europe.

A cutaneous inflammation that affects a major portion of the population is ACD. It is the type of occupational derma condition that is most prevalent. Women experience the disease more frequently than men. The issue frequently has a correlation with topical treatments in older patients.

The touch of the allergens to the skin initiates the pathogenesis of ACD. The skin’s stratum corneum is attacked by this allergen, which Langerhans cells then take up. These cells then dissolve the antigens & express them on their surface layer. The surrounding lymph nodes are then approached by Langerhans cells.

While ingesting antigens, these cells come into contact with the adjacent T lymphocytes. Antigen-specific T cells are released as a result of the clonal expansion & cytokine-induced multiplication processes. The epidermis may then be reached by these lymphocytes as they move through the circulation.

The sensitization stage of ACD refers to the entire process. Elicitation is the stage that comes after repeated exposure to the antigen. Cytokine-induced replication is brought on by the contact of the T lymphocytes that are particular to that antigen with the Langerhans cells that contain that antigen. In turn, this proliferation causes a focused inflammatory reaction.

A type 4 hypersensitivity response is what causes allergic contact dermatitis, an inflammatory skin condition. It happens when an irritating substance or antigen comes into touch with the skin and triggers a T-cell-mediated reaction. The best markers of the causative agent are frequently dermatitis’ morphology & location. For instance, when it occurs around the wrist, it can be a sign of an allergic reaction to a watchband or bracelet.

Where the plant comes into touch with the skin, poison ivy manifests as linear stripes and is a typical cause of ACD. Another typical ACD trigger is nickel, which manifests as dermatitis when nickel-containing jewelry is worn, such as necklaces & earrings. Chronic dermatitis can also be brought on by using rubber gloves. Hair dyes, preservatives, scents, textile chemicals, sunscreens, & photo allergens are some other agents.

The affected populations continue to live with this condition during their lives. The best course of action is to strictly avoid the allergy. The main objective of treatment is to control the inflammatory reaction.

The longer someone has ACD, the longer it will take for it to go away.

Clinical History

In order to properly assess people with ACD, a thorough medical history must be taken both before and after patch testing. The materials that people are exposed to and potential causes of allergic contact dermatitis should be considered in patch tests. Compared to most other dermatologic conditions, ACD evaluation calls for a significantly more thorough medical history. Keeping up with current trends is also crucial. The COVID-19 pandemic has boosted the usage of face masks, which have been linked to contact dermatitis brought on by formaldehyde releasers.

After the patch test, history is equally crucial. Only a thorough history and interview can reveal whether a patient’s current dermatitis is partially or entirely caused by substances to which they are allergic. A positive patch test may point to sensitivity & not the root of dermatitis that is currently present.

Existing skin conditions

Stasis dermatitis patients are at significant risk of acquiring allergic contact dermatitis from substances & agents applied to their leg ulcers and stasis dermatitis-affected areas. Despite the absence of evidence supporting their effectiveness in treating stasis ulcers, neomycin & bacitracin are significant contributors to allergic contact dermatitis in these people. Topical neomycin & topical corticosteroids are frequent allergens in people with otitis externa. Benzocaine or other drugs used to treat chronic pruritic disorders may cause sensitization in people with pruritus ani & pruritus vulvae. The severe chronic vulvar dermatosis experienced by women with lichen sclerosis et atrophicus is usually complicated by allergic contact dermatitis. Patch testing such patients could reveal crucial details that could aid in the treatment of stubborn and challenging dermatoses.

Atopic dermatitis

Atopic dermatitis patients are more likely to experience irritating contact dermatitis & non-specific hand dermatitis. They have a lesser chance of developing poison ivy-related allergic contact dermatitis. Contact sensitization & severe atopic dermatitis were found to be mutually exclusive. With the exception of scent sensitization & topical medication sensitivity, all categories of allergenic metals and chemicals were associated in the opposite direction.

Eyelid dermatitis

Dermatitis can appear on the eyelids as well as other exposed skin after being exposed to airborne allergens and allergens that have been touched there. A reaction to eyelid makeup allergies can also cause contact dermatitis.

Contact urticaria

Contact urticaria is indicated by immediate symptoms, such as visible lesions appearing less than thirty min after exposure (not ACD). This is especially true if the lesions have an urticarial appearance or if the skin response is accompanied by additional symptoms such as anaphylaxis, wheezing, ophthalmedema, or distant urticaria.

Latex

Currently, the main cause of allergic contact urticaria is rubber latex. The word “hypoallergenic” may apply to gloves without rubber latex or gloves without sensitizing additives, although it may not necessarily mean that the gloves are latex-free.

Some people could have delayed particular contact sensitivity to rubber latex; however, contact urticaria rather than allergic contact dermatitis to latex is much more prevalent. People who have hand dermatitis, hospital employees, youngsters with spina bifida, & atopic people are more likely to experience contact urticaria in response to rubber latex. To chemical additives to rubber gloves and to latex, certain people may develop allergic contact dermatitis and contact urticaria.

There have been a few rare cases of anaphylactic responses to topical agents (e.g., bacitracin).

Occupational dermatitis

One of the ten most prevalent occupational disorders is contact dermatitis. It might make people unable to work. Both at the workplace and at home, the hands are the body parts that are most frequently in contact with allergies & irritants. However, people with chronic dermatitis may not exhibit the typical pattern of weekend and holiday improvement. Allergic contact dermatitis in reaction to workplace items may initially improve on weekends and over vacations.

If there are numerous affected employees at the workplace, irritant contact dermatitis is more likely to occur. Most allergens rarely cause a significant proportion of people to become sensitized.

Hobbies

The cause of allergic contact dermatitis may be hobbies. Examples include processing film with color-developing chemicals that can cause cutaneous lesions of lichen planus from direct skin contact or work with exotic tropical timbers in carpentry.

Physical examination

Pupils and vesicles with a pruritic basis and an erythematous background are the hallmarks of acute allergic contact dermatitis. Persistent allergic contact dermatitis may be indicated by lichenified pruritic plaques. Occasionally, integument-wide allergic contact dermatitis can occur (i.e., exfoliative dermatitis, erythroderma). The best indication of the likely cause of allergic contact dermatitis is frequently provided by the first site of dermatitis.

Hands

Particularly at work, hands are a common site for allergic contact dermatitis.

Topical medication sites

In situations of otitis externa, topical medicines are also significant contributors to ACD. Dermatitis around the eyes may be brought on by an allergy to substances in ophthalmologic procedures.

Hair dyes

P-phenylenediamine, a component of hair color, may cause allergic contact dermatitis. The ears and surrounding faces of those who are allergic to hair dyes often have the most severe dermatitis, instead of the scalp.

Airborne ACD

Allergy-induced airborne contact dermatitis can be brought on by chemicals in the air. This dermatitis typically affects the eyelids the most, but it can also affect other places that are exposed to toxins in the air, especially the head and neck.

Stasis dermatitis & stasis ulcers

When topical treatments are administered to inflamed or ulcerated skin, people with stasis dermatitis and stasis ulcers are at significant risk of developing allergic contact dermatitis. There is a considerable risk of allergic contact dermatitis to treatment (such as neomycin) in these patients because of the chronic nature of the illness and the frequent blockage of administered drugs. Topical drugs applied to leg ulcers or cross-reacting systemic treatments given intravenously can cause people to develop extensive dermatitis. For instance, administering intravenous gentamicin to a patient who is allergic to neomycin may cause systemic contact dermatitis.

Erythema multiforme

Erythema multiforme is a severe cutaneous reaction characterized by targetoid lesions. It usually develops in response to exposure to specific drugs or after an infection, most frequently the herpes simplex virus.

Rare occurrences of EM have been documented following allergic contact dermatitis brought on by exposure to nickel, hair dye, poison ivy, tropical woods, and nickel. An allergy to intraoral metal may cause mucositis that resembles lichen planus and is linked to intraoral squamous cell cancer.

It has been documented that an intraoral squamous cell cancer developed close to a dental restoration made of a metal the patient was allergic to. Patients with venous insufficiency may experience allergic contact dermatitis as a direct cause of skin ulceration. Venous ulcers may not form if allergic contact dermatitis is diagnosed and treated early.

Differential Diagnosis

There are significant anatomical parallels between the clinical manifestations of atopic dermatitis & irritating contact dermatitis.

Drug eruptions, urticarial bullous pemphigoid, rosacea, urticaria, scabies seborrheic dermatitis, psoriasis, and periorificial dermatitis are further skin disorders that need to be checked out.

All patients with suspected or confirmed ACD should be informed of the fact that the only effective treatment for the condition is the discovery and elimination of the offending chemical. When ACD only affects more than 20% of the body, oral corticosteroids are the first-line medical treatment. Topical steroids are also used when ACD only affects less than 20 percent of the body.

PDE4 blockers or topical calcineurin blockers may also be helpful if ACD affects a delicate area like the eyelids or skin folds. Once the allergy has been identified, careful avoidance is required to stop a recurrence. Topical hydrocortisone, oral antihistamines, & cool water soaks are all used to treat symptoms. Vesicles shouldn’t be ruptured because doing so increases the danger of infection.

Moisturizer use is advised as an add-on. Topical immunomodulators such as tacrolimus may be helpful in severe situations. Using UV, A and psoralen together for phototherapy may be beneficial for some patients. One may occasionally need immunosuppressive medications example, mycophenolate, in severe situations. Conduct patch testing to find the culprit in cases of persistent or resistant ACD.

The right chemicals must be chosen for testing, the patient must be counseled about the results of the patch test, and the test must be positive for the relevant allergens. A “safe list” of goods that do not contain the patient’s allergens can also be created using the Contact Allergen Management Program (CAMP) from the American Contact Dermatitis Society. Systemic treatment may be required if allergens cannot be avoided.

https://www.ncbi.nlm.nih.gov/books/NBK532866/

Free CME credits

Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.

Digital Certificate PDF

On course completion, you will receive a full-sized presentation quality digital certificate.

medtigo Simulation

A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.

medtigo Points

medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
 
  • Registration with medtigo = 10 points
  • 1 visit to medtigo’s website = 1 point
  • Interacting with medtigo posts (through comments/clinical cases etc.) = 5 points
  • Attempting a game = 1 point
  • Community Forum post/reply = 5 points

    *Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.

All Your Certificates in One Place

When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.

Our Certificate Courses