Contact dermatitis causes itching and burning. It's characterized by redness, which can progress to vesiculation, oozing, weeping, scaling, and fissuring. Right after a number of days of itching and rubbing, the patient might develop secondary bacterial infection with purulence and crusting in the region. Sometimes, the reaction is so intense that swelling happens in the get in touch with site and dermatitis occurs at distant sites. The latter phenomenon is known as an id reaction. Get in touch with dermatitis may be divided into two groups: irritant and allergic.
Irritant get in touch with dermatitis happens every time the patient comes into get in touch with using the substance. This dermatitis can create in a couple of minutes or in several hours. Any person is subject to irritant dermatitis if he or she is in contact with an irritating substance long enough to produce a reaction. The duration of exposure required to produce dermatitis varies. Maybe the most common get in touch with irritant is soap, especially in the wintertime, when the skin is already dry and irritated. Other common irritants include detergents, cutting oils, solvents, and cement.
Allergic get in touch with dermatitis develops within 24 to 48 hours of exposure to an allergen to which the patient has previously been sensitized. Rhus dermatitis, caused by poison oak, poison ivy, or poison sumac, will be the prototypical allergic response. This dermatitis lasts for 10 to 20 days because the rhus oil becomes embedded in the skin. A clue to the diagnosis is its linear pattern. Other common contact allergens include nickel, neomycin, rubber (latex), paraphenylenediamine, lanolin, topical anesthetics, topical antihistamines, and fragrances.
It's worth remembering that most metal jewelry contains nickel, even when it's advertised as solid gold. The alloy is used to strengthen the gold or silver and also to save expenses. Generally, 18-kt gold has an insufficient quantity of nickel to trigger trouble. Topical neomycin is the most common trigger of iatrogenic allergic contact dermatitis.
Get in touch with dermatitis is often distinctive because of its localization. Occasionally, it might be confused with atopic dermatitis limited to the antecubital or popliteal fossae or with nummular dermatitis scattered on the physique. Because dermatitis on the hands may be nondescript, the term hand dermatitis is utilized to cover numerous dermatitides: atopic, get in touch with, and psoriatic.
The history is most important. If the patient recognizes these symptoms and indicators every time he or she has get in touch with having a particular item, then the etiologic battle is won. Sometimes, the offending agent is more challenging to locate, and patch testing is necessary. This involves placing a series of chemicals on the skin, generally the back; covering the applications having a type of nonirritating and nonallergenic dressing such as paper tape; and keeping the area covered for 2 to 3 days. Reaction in the website of the chemical helps confirm the diagnosis.
Eliminating the contactant is essential, even though topical corticosteroid ointments and creams are most helpful in reducing the dermatitis. The strength of the steroid depends on the severity of the dermatitis. With a severe reaction, such as a reaction to paraphenylenediamine in hair dye or to poison ivy, oral prednisone, 40 to 60 mg daily for 10 days, may be needed in addition to high-potent or super-potent topical corticosteroids.
The dermatitis generally clears within a few days right after the elimination of the contactant. Reexposure, particularly chronic reexposure, results in chronic dermatitis and lichenification.
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