Contact Dermatitis

Contact dermatitis: Many health care workers develop an allergy to latex, as did this nurse. Her rash is due to touching her face while wearing latex gloves.

Almost everyone gets this type of eczema at least once. We get contact dermatitis when something that our skin touches causes a rash. Some rashes happen immediately. Most take time to appear. 

Allergic contact dermatitis

Some people have an allergic skin reaction. You have had this type of contact dermatitis if you had a rash caused by:

• Poison ivy
• 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

This type is more common. It develops when something irritates the skin. With enough contact, most things will irritate our skin. A person diagnosed with any of the following has irritant contact dermatitis:

• Diaper rash
• Acid burn
• Dry, cracked hands due to lots of contact with water
• Irritated skin around the mouth due to lip licking

When a toxic substance touches our skin, the skin is quickly irritated. You’ve had irritant contact dermatitis if your skin reacted to a toxic substance like: 

• Battery acid
• Bleach
• Pepper spray 

You can also develop irritant contact dermatitis when you have lots of contact with less irritating substances like: 

• Water
• Foods
• Soap

People often develop irritant contact dermatitis at work. Beauticians, nurses, bartenders, and others who spend lots of time with wet hands get this. It often starts with dry, cracked hands. In time, the skin on their hands may begin to sting and burn. The skin becomes very tender. Sometimes, the skin itches and bleeds.

When a rash does not clear within a few weeks, you should see a dermatologist.

When contact dermatitis develops, treatment is important. It can prevent the contact dermatitis from worsening and help your skin heal.

Contact dermatitis: Signs and symptoms

When to seek immediate medical care

A few people develop a severe allergic reaction known as anaphylaxis (an-uh-fuh-lax-sis). Symptoms occur within seconds or minutes. A person may have:

• Difficulty breathing due to swelling in the throat
• Swollen face and/or eyes
• Confusion

In short, the entire body reacts. If you have any of these symptoms, you need immediate medical care.

Allergic contact dermatitis

This skin condition occurs when you have an allergic reaction to something that comes in contact with your skin.

Signs and symptoms rarely appear on contact. It may take a few hours for your skin to react. If this is your first time that your skin has an allergic reaction to that substance, weeks may pass before you notice anything.

When signs and symptoms appear, you may have:

• Itchy skin (often intense)  
• Rash (skin red, swollen, and hot)
• Excessively dry skin
• Burning 
• Stinging
• Hives (round welts on the skin that itch intensely)
• Fluid-filled blisters
• Oozing blisters that leave crusts and scales

If exposure to the allergen continues, your skin may:

• Flake and crack
• Become scaly
• Darken, thicken, and feel leathery

Irritant contact dermatitis

Many substances can irritate our skin. Soap, shampoo, food, and water are mild irritants. With lots of exposure, these can cause irritant contact dermatitis. Getting a strong irritant like battery acid or fiberglass on your skin just once also can cause irritant contact dermatitis.

The signs and symptoms differ for mild and strong irritants. 

Mild irritant: The signs and symptoms develop over time. You’ll gradually notice:

• Dry, chapped skin. 
• With repeat exposure, patches of itchy, red, swollen, and scaly skin develop. By this time, each time something that can irritate the skin touches the affected skin, you may feel stinging and burning right away.
• If exposure continues, the skin may crack, get scaly, and become excessive dry. 
• Sores and blisters may develop and erupt, causing crusts and scales.

The face, neck, and hands are most susceptible to irritant contact dermatitis.

Strong irritant: On contact or within a few hours, the skin can:

• Burn, sting, and/or itch
• Become inflamed (red and swollen) 
• Develop fluid-filled blisters 

When you have irritant contact dermatitis, many things can irritate your skin. You may feel pain on contact. With repeat exposure, the condition worsens.

Reduced quality of life

This skin condition often affects a person’s quality of life. The rash can make many daily activities painful, especially when the rash forms on the hands. The rash can cause:

• Missed work days
• Inability to enjoy leisure activities
• Loss of sleep

Contact dermatitis: Who gets and causes

Who gets contact dermatitis?

Anyone can develop contact dermatitis. People working in certain professions have a higher risk. In fact, this is so common that your doctor may tell you that you have occupational dermatitis.

People who are more likely to get occupational dermatitis include:

• Nurses (and other health care workers)
• Beauticians
• Bartenders 
• Chefs (and others who work with food)
• Florists (and others who work with plants)
• Construction workers
• Janitors
• Mechanics
• Plumbers

Nurses and beauticians often develop dry, cracked skin on their palms and fingers. Wearing latex gloves frequently throughout the day causes some people to develop an allergy to latex. A common sign of this allergy is itchy, inflamed hands. 

You also have a greater risk of developing contact dermatitis if you have (or had) one of these medical conditions:

• Asthma
• Hay fever
• Atopic dermatitis (often called eczema)

Your environment also plays a role. Extreme heat or cold, high humidity, and very dry air make the skin more vulnerable.

What causes contact dermatitis?

A person develops contact dermatitis when something that touches the skin does one of the following:

• Irritates the skin 
• Causes an allergic reaction

When the skin is irritated, a person develops irritant contact dermatitis. Anyone can develop this type of contact dermatitis. It happens when something damages the outer layers of skin.

Almost any chemical, including water, can damage the skin with enough contact. Toxic substances like fiberglass and turpentine quickly damage the skin. Many people develop irritant contact dermatitis when they work with hair dyes, solvents, oils, paints, varnishes, foods, or metalworking fluids.

An allergic reaction causes allergic contact dermatitis. People develop allergic reactions to many substances. Some of the most common causes of allergic contact dermatitis are:

• Poison ivy
• Nickel (used in cell phones, jewelry, eyeglass frames, zippers, belt buckles)
• Nail cosmetics: Nail polish, adhesives
• Fragrances
• Latex
• Cement

Many people touch a substance for years before an allergy develops.

Sometimes a trigger is needed for an allergic reaction to occur. Allergic contact dermatitis may only occur when the skin:

• Sweats
• Has ultraviolet rays (sun, tanning bed) hit it

More than 3,600 substances can cause allergic contact dermatitis. These substances include preservatives in cosmetics, antibiotics applied to the skin, animal dander, dyes in clothing and shoes, and rubber.

With thousands of causes, successfully treating this skin condition can take a bit of detective work. Dermatologists frequently treat this condition. In fact, this is one of the most common reasons to see a dermatologist.

Contact dermatitis: Tips for getting rid of the rash

Many things can cause a rash, including your wedding ring, glasses, clothing, and cell phone.

Sometimes you can get rid of a rash yourself. These dermatologists’ tips can help you find the cause.

Once you know what’s causing your rash, avoiding it often clears the rash.

To help you find the cause, follow these steps: 

• Ask yourself the questions on this page (below) that are relevant. 
• If you answered yes to a question, stop using/wearing what you think caused the rash. 
• If the rash begins to clear, you may have found the culprit. If the rash worsens or remains for 2 weeks, make an appointment to see a dermatologist. You’ll need help to get rid of the rash.

Rash beneath jewelry, shoes, or clothing

If a rash develops where jewelry, shoes, gloves or other clothing, a zipper, a buckle, or a fastener touches your skin:

• Stop wearing the item for a few days. 

If the rash begins to clear when you stop wearing the item, you may have an allergy to a metal, dye, or fabric finisher.

Some people develop an allergy to jewelry that they’ve worn for years. The cause is often nickel, a metal found in many pieces of jewelry. A wedding ring can cause this problem. In fact, this rash is so common that it has a name, wedding-ring dermatitis. 

If this happens, ask your dermatologist for tips to prevent getting a rash from your wedding ring.

Rash on face

It can be a challenge to find the cause of this rash, but you can start by answering the following questions:

• Have you recently tried a new makeup, eye cream, or fragrance? 
• Some people are allergic to ingredients in these products.
• Do you use an eyelash curler or tweezers? 
• These items often contain nickel, which is a common cause of allergic contact dermatitis. Brief direct contact with an eyelash curler or tweezers can cause an allergic skin reaction.
• Do you rub your eyes? 
• If you find yourself rubbing your eyes, try to stop. Indirect contact with an allergen can cause a rash on your face. Even nickel used in a doorknob or keys can end up on your face when you rub your eyes. 
• Do you wear nail polish or artificial nails?
• These products can cause a rash when you touch your face. Even when you don’t develop a rash on your hands, the skin on your face can react. 
• Has a fragrance touched your skin? 

Directly applying a fragrance can cause a rash. You can also get a rash from indirect contact. Touching a a towel or pillow that has a fragrance on it could cause a rash.

Rash on side of face, neck, hairline, or chest

You can often find the cause of a rash in one of these areas by asking yourself these questions:

Do you hold your cell phone against your face?

A rash that appears on one side of the face may indicate that you have an allergy to nickel or chromium. Some cell phones contain one of these metals. You also could have an allergy to something in the case you use for your cell phone. 

• Have you recently switched shampoo or conditioner?
• If you are allergic to an ingredient in a shampoo or conditioner, a rash can appear where the product runs down your body when you rinse. 
• Have you recently used a hair dye or perm solution? 

These can cause a rash. 

Rash after hiking or being in a wooded area

If you were in a wooded area, you may have touched poison ivy, poison oak, or poison sumac without knowing it. Poison ivy is one of the most common causes of allergic contact dermatitis. 

The following tips can help:

• Poison ivy: Tips for treating and preventing

A rash from poison ivy, poison oak or poison sumac is caused by an oil found in these plants called urushiol (you-ROO-shee-all). When this oil touches your skin, it often causes an itchy, blistering rash.

Most people can safely treat the rash at home. However, if you experience any of the following symptoms, go to the emergency room right away.

If you have any of the following, go to the emergency room right away:

• You have trouble breathing or swallowing.
• The rash covers most of your body.
• You have many rashes or blisters.
• You experience swelling, especially if an eyelid swells shut.
• The rash develops anywhere on your face or genitals.
• Much of your skin itches, or nothing seems to ease the itch.

If you do not have the above symptoms, the rash appears on a small section of your skin, and you are absolutely certain that your rash is due to poison ivy, poison oak, or poison sumac, you may be able to treat the rash at home.

To treat a rash from poison ivy, poison oak, or poison sumac and help stop the itch, dermatologists recommend the following:

1. Immediately rinse your skin with lukewarm, soapy water. If you can rinse your skin immediately after touching poison ivy, poison oak, or poison sumac, you may be able to rinse off some of the oil. If not washed off, the oil can spread from person to person and to other areas of your body.
2. Wash your clothing. Thoroughly wash all of the clothes you were wearing when you came into contact with the poisonous plant. The oil can stick to clothing, and if it touches your skin, it can cause another rash.
3. Wash everything that may have the oil on its surface. Besides clothing, the oil from poison ivy, poison oak, and poison sumac can stick to many surfaces, including gardening tools, golf clubs, leashes and even a pet’s fur. Be sure to rinse your pet’s fur, and wash tools and other objects with warm, soapy water.
4. Do not scratch, as scratching can cause an infection.
5. Leave blisters alone. If blisters open, do not remove the overlying skin, as the skin can protect the raw wound underneath and prevent infection.
6. Take short, lukewarm baths. To ease the itch, take short, lukewarm baths in a colloidal oatmeal preparation, which you can buy at your local drugstore. You can also draw a bath and add one cup of baking soda to the running water. Taking short, cool showers may also help.
7. Consider calamine lotion or hydrocortisone cream. Apply calamine lotion to skin that itches. If you have a mild case, a hydrocortisone cream or lotion may also help.
8. Apply cool compresses to the itchy skin. You can make a cool compress by wetting a clean washcloth with cold water and wringing it out so that it does not drip. Then, apply the cool cloth to the itchy skin.
9. Consider taking antihistamine pills. These pills can help reduce itching, however use with caution. You should not apply an antihistamine to your skin, as doing so can worsen the rash and the itch.

If your rash is not improving after seven to 10 days, or you think your rash may be infected, see a board-certified dermatologist. A dermatologist can treat your rash and any infection and help relieve the itch.

Rash from musical instrument

Metals in musical instruments, such as nickel, cobalt, palladium, silver, and gold, can cause a rash. So too can cane reeds and exotic woods. Stains, glues, and varnishes also cause contact dermatitis.

Dermatologists recommend the following to people who get a rash from playing a musical instrument:

• Stop playing the instrument while your skin heals. 
• See a dermatologist. You may need medication to treat the rash. Patch testing also can be very helpful. This medical test helps to find allergens. It is important to know if you have an allergy to something in the instrument that you play.  
• Once the cause is found, your dermatologist can help you make some changes so that you can play again.

When to see a dermatologist

You’ll want to make an appointment If you have a rash that:

• Is severe (raw skin, blisters, oozing, or intense itch).
• Does not clear in a few weeks.
• Comes and goes.
• Is caused by something in your workplace.

Sometimes we can find one cause but miss others. For example, many people develop an allergy to nickel. This metal is so common that it may be in your wedding ring and dozens of products that you regularly use.

A dermatologist can help you find out if you have any allergies. If you have an allergy, your dermatologist can create a plan to help you avoid things that cause your rash.

Many dermatologists use databases that can tell them what products you should avoid if you have an allergy and what products you can use. This alone could save you lots of time and money.