6/25/2019 Allergic Contact Dermatitis - American Osteopathic College of Dermatology (AOCD)

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ALLERGIC CONTACT DERMATITIS

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Allergic contact dermatitis is caused by your body's reaction to something that directly
contacts the skin. Many di erent substances can cause allergic contact dermatitis,
which are called 'allergens'. Usually these substances cause no trouble for most people,
and may not even be noticed the rst time the person is exposed. But once the skin
becomes sensitive or allergic to the substance, any exposure will produce a rash. The
rash usually doesn't start until a day or two later, but can start a soon as hours or as late
as a week.
Allergic contact dermatitis is not usually caused by things like acid, alkali, solvent, strong
soap or detergent. These harsh compounds, which can produce a reaction on anyone's
skin, are known as 'irritants'. Although some chemicals are both irritants and allergens,
allergic contact dermatitis results from brief contact with substances that don't usually
provoke a reaction in most people.
The dermatitis usually shows redness, swelling and water blisters, from tiny to large.
The blisters may break, forming crusts and scales. Untreated, the skin may darken and
become leathery and cracked. Allergic contact dermatitis can be di cult to distinguish
from other rashes, especially after it been present for a while.
The dermatologist and patient will discuss the materials that touch the person's skin at
work and home, and try to identify the allergen. The dermatologist may also perform
patch tests. Patch testing is a safe and quick way to diagnose contact allergies. A small
amount of the suspected allergen is applied to the skin for a xed time, usually two
days. Some things like nickel, rubber, dyes, and poison ivy, poison oak and related
plants are fairly common allergens.
(/resource/resmgr/ddb_high/nickel_allergy_1_high.jpg)Nickel, part of certain metals, is
found in many products. Many chrome-plated objects contain enough nickel to produce
a reaction in sensitive people. Stainless steel also contains nickel, but it is bound in such
a way that makes stainless steel safe for most nickel-sensitive individuals.
Earrings containing nickel can cause earlobe dermatitis, a very common problem in
people allergic to nickel. Needles used to pierce ears, and earrings may trigger this. Only
sterile stainless needles should be used for piercing. After piercing wear only nickel-free
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earrings for at least the rst three weeks.

Clothing accessories made of nickel buckles, zippers, buttons and

metal clips can cause dermatitis. Nickel-sensitive people can
substitute nylon accessories.
Sweating increases dermatitis in nickel-sensitive people. In the
summer, items containing nickel can cause an itchy, prickly sensation
within 15 to 20 minutes of touching perspiring skin. A rash may
appear within a day or two. These same items can be worn for several
hours without any symptoms, if perspiration is not present.

Rubber products (latex) often cause allergic contact dermatitis. Rubber can also cause
immediate allergic reactions, including itching or burning and hives (welts) under the
rubber object. Some people experience itching and tearing eyes and, occasionally,
shortness of breath. This is more common in people who wear tight tting rubber
gloves, such as medical workers. Rubber gloves may also cause dermatitis on the skin of
the hands under the glove. Vinyl or other synthetic gloves may be substituted.

Many women with rubber allergy can wear foundation garments of non-sensitizing
spandex if they do not have rubber-backed fasteners or edges. Some manufacturers
market girdles and bras containing no rubber.
Ingredients in the rubber used in the shoe's construction cause most cases of allergic
contact dermatitis from footwear. Adhesives, both rubber and non-rubber, can also
cause problems. Even leather shoes may contain these. Shoes without rubber should be
substituted.
Paraphenylenedeamine (PPDA) is an ingredient found in permanent hair dyes. This
ingredient is mixed with an oxidizing agent, such as peroxide, before application. People
allergic to PPDA should not use any permanent hair dyes. About one fourth of the
people allergic to PPDA are also allergic to ingredients in semi-permanent dyes. Follow
the package instructions for a patch test before using any hair dye. Most PPDA allergic
people can use temporary dyes or rinses, to blend in gray and brighten hair. A few
people, however, will react to these dyes also.
A nal option to color hair is henna (vegetable dyes). However, henna doesn't work on
all hair. Metallic or Progressive dyes are also called hair-color restorers are safe to use if
the scalp is not irritated.
While PPDA dyes are rarely used in clothing, other dyes that may cross-react with PPDA
are in clothing. As a result, some PPDA-sensitive patients cannot wear dark clothing, but
can wear fabrics dyed in lighter shades. About 25% of PPDA sensitivity people are
allergic to certain widely used local anesthetics that are chemical relatives of PPDA.
Substitutes may be used.
Chromates, compounds containing chromium, are commonly responsible for allergic
contact dermatitis from contact with cement, leather, some matches, paints and anti-
rust compounds. Occupational exposure to chromium is common in jobs in the
automobile, welding, foundry, cement, railroad and building repair industries.
Chromates are used to tan leather for shoes and clothing. 'Shoe dermatitis' may result
from leather containing chromates. Vegetable-tanned footwear can be substituted.
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Some matches contain chromates. Touching unlit matches can contaminate ngers.
Fumes from a lit match and the charred match head also contain traces of chromates.
Placing used matches in a pocket will contaminate the pocket lining, as will book
matches.
(/resource/resmgr/ddb_high/poison_ivy_2_high.jpg)Poison ivy and its
relatives include poison ivy (/?page=PoisonIvyDermatiti), poison oak
and poison sumac. In the U.S. these plants produce many cases of
allergic contact dermatitis. The reaction looks the same whether
caused by poison ivy, oak or sumac. Often patients develop lines of
small blisters on the skin where the plant brushed against them.
People sensitive to poison ivy, oak and sumac are often allergic to oils
from plants from other countries. A furniture lacquer obtained from
the Japanese lacquer tree contains such oil, as do mango rinds and
cashew shells.
People with allergic contact dermatitis should:
1. Avoid the allergen that causes the reaction, and materials that cross-react with it.
Your dermatologist can help you identify items to avoid.
2. Substitute products made of materials that do not cause reactions.

Patch testing by a dermatologist can alert patients to which substances to avoid.

 

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The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic

College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a

physician - patient relationship. If you have a speci c question or concern about a skin lesion or disease, please consult a

dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed

written permission is given by the American Osteopathic College of Dermatology.

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