Contact dermatitis - symptoms and treatment in 2024

What is contact dermatitis
Contact dermatitis is a skin rash that develops after skin contact with allergens or irritants. It can occur at any age and therefore also in children.
"In the initial stage, a severely itchy, red, swollen lesion with small papulovesicles (pimples to vesicles) and oozing appears. Later it turns into scabs," says Milan Junášek, MD, adding: "In the chronic course, cracks and dryness develop, often in places where the skin has not come into contact with the allergen."

How long does contact dermatitis last?
Contact dermatitis has two phases:
1. the sensitization phase, in which hypersensitivity is induced. In this phase, the body's defence system is activated and usually lasts from 4 days to several weeks. For stronger allergens it may take 14 days, for weaker allergens usually months to years of repeated skin contact with the allergen.
The 2nd equipping phase, in which contact with the allergen occurs again. The defence system remembers that it has already encountered this allergen, the body starts to defend against it and an allergic reaction occurs on the skin. This period is 18 to 72 hours long after skin contact with the allergen. It lasts for several days and decreases without contact with the allergen.

Types of contact dermatitis
There are two main types of contact dermatitis: allergic and irritant.

Allergic contact dermatitis
This is a specific form of skin inflammation caused by an immune reaction to an allergen. This reaction often occurs after repeated contact with a substance that gradually becomes the trigger for the allergic reaction. "This is the most common form of eczema we encounter in our surgeries," says MUDr. Junášek.

Causes and triggers of allergic contact dermatitis
People with impaired skin immunity, allergy sufferers, people with immune system disorders are predisposed, but family disposition to allergic diseases also plays an important role.
There are many allergens that can trigger allergic contact dermatitis. Among the most common are:
Nickel sulfate: Used in jewelry, buttons and other metal objects.
Fragrances: Found in cosmetics, perfumes and cleaning products.
Formaldehyde: Found in paints, varnishes, adhesives, particleboard and cosmetic products.
Potassium dichromate: Contains e.g. in tanned leather or cement.
Isothazolines: Preservatives used e.g. in cleaning products or cosmetics.
Para-phenylenediamine (PDD): Found e.g. in hair dyes.
Antibiotics applied to the skin: Antibiotic ointments or creams.
Bronopol: Found in cosmetic products such as shampoos, conditioners, soaps or toothpastes.
Essential oils: Natural fragrances found in cosmetics or used in aromatherapy.
Cobalt chloride: Found as an additive in tire compounds or textile dyes.
Some plants or their extracts. Arnica, Peruvian balsam, yarrow, etc.

Symptoms of allergic contact dermatitis
Symptoms of allergic contact dermatitis can appear within hours to days after contact with the allergen and include:
- redness and swelling,
- itching and burning,
- blistering and wetting,
- dryness and cracking of the skin.
These symptoms can affect any part of the body, but usually the rash in contact dermatitis appears on the hands or face because they are often exposed to allergens.

Contact dermatitis on the face
Facial contact dermatitis most often occurs around the eyelids, lips or ears. It is caused by cosmetic products, perfumes or other substances that come into contact with the skin of the face.

Contact dermatitis of the eyelids can occur on both the upper and lower eyelids and is characterised by itching, burning or stinging, the eyelids are red and may develop scales or swelling. If the inflammation does not subside, the eyelids may become lichenified. The inflammation may also spread to the edges of the eyelids, causing blepharitis.

Contact dermatitis around the eyes tends to be painful because the skin around the eyes is very sensitive (about three times thinner than the skin on the face) and reacts to substances that do not irritate the skin in other areas.

Treatment of contact dermatitis around the eyes consists of avoiding contact with irritant allergens (or irritants in the case of irritant dermatitis) and ensuring the barrier function of the skin. It is important not to rub or scratch the skin of the eyelids, touch them only with washed hands, wash them with clean water and use hypoallergenic products designed for sensitive skin. If the contact eczema is caused by airborne allergens (dust, etc.), use protective goggles.
Topical corticosteroids or calcineurin inhibitors can be used in the short term, and oral corticosteroids are used in more severe cases.

Contact dermatitis of the scalp
Contact eczema of the scalp is another common type of this disease. It is caused by allergens contained in hair dyes, shampoos or other hair products. Manifestations include redness, itching and peeling of the scalp.

Contact dermatitis of the hands
Contact dermatitis on the hands is commonly encountered because the hands are in frequent contact with allergens or irritants such as detergents, soaps or chemicals. This type of dermatitis is manifested by redness, itching, dryness and cracking of the skin on the hands, which can be very uncomfortable and painful.

Diagnosis of allergic contact dermatitis
"A careful medical history helps us in the diagnosis - that is, to ask the patient what he or she was doing, what he or she came into contact with at the time of onset, and we must also take into account the individual resistance of the skin," explains Dr Junášek.
The diagnosis itself is performed using skin epicutaneous tests (patch tests). A closed patch test involves applying a small amount of allergen to the skin in the form of a patch, usually on the back, and monitoring the reaction after 24, 48 or up to 72 hours. Another type of test is an open test, where the allergen is applied directly to the skin several times a day (particularly suitable for testing e.g. shower gels or disinfectants). It is evaluated after 48-72 hours.

Prevention of allergic contact dermatitis
Prevention of allergic contact dermatitis consists primarily of identifying and avoiding allergens. Experts recommend:
- use of hypoallergenic cosmetics and cleaning products without known allergens,
- keeping dry skin moisturised with oily creams,
- use protective gloves and protective clothing when handling potential allergens.

Treatment of allergic contact dermatitis
Treatment of allergic contact dermatitis begins with avoiding contact with the allergen or removing the allergen from the skin.
Oily ointments and barrier creams are helpful in the treatment of contact eczema, while sprays, foams or solutions are used for acute dermatitis. One of the effective creams for dermatitis is Dermaguard, which protects the skin from the penetration of allergens while keeping it moisturised. You can order Dermaguard from our e-shop.
In the treatment of contact eczema, contact dermatitis ointments containing antihistamines are often prescribed to relieve itching and inflammation. Topical corticosteroids, which are applied topically, also provide relief from symptoms. However, these can only be used in the short term as they have the side effect of thinning the skin. In severe cases, systemic treatment with corticosteroids or other immunosuppressants is necessary.
Ointments or pastes with salicylic acid, urea or tar help with chronic eczema.
Classical treatments include compresses of hypermanganese, pine water or Jarisch solution.

Grandmother's advice and home remedies for the treatment of contact dermatitis
Some natural and home remedies also help to relieve the symptoms of contact dermatitis and promote skin healing. These include:
Cold compresses.
There are a number of different instructions on how to prepare such a bath. For example, you can try the following. When the oats have cooled, strain them and stir them in the bath water. Bathe in this bath for 15 to 20 minutes and then gently pat your skin dry. Oatmeal baths are known for their soothing and anti-inflammatory properties.
Coconut oil: Natural coconut oil moisturizes the skin and reduces inflammation. Apply a small amount of coconut oil to the affected area several times a day.
Aloe vera: Aloe vera gel has cooling and healing properties that soothe irritated skin. Apply fresh aloe vera leaf gel directly to the affected area and allow it to dry.
Herbs: Use a poultice of calendula or chamomile.
Tea tree oil: Oil extracted from the Australian tea tree has soothing and anti-inflammatory properties.

Photoallergic contact dermatitis is a specific type of allergic contact dermatitis that occurs when a substance on the skin reacts with sunlight. Typical symptoms are redness, itching, blisters and rashes on exposed parts of the body such as the face, neck and hands. Common triggers include certain ingredients in sunscreens, perfumes and cosmetic products. For prevention, it is important to choose products without photosensitizing agents and to use protective clothing and broad-spectrum sunscreens when in the sun.
The photoepicutaneous test (photo patch test) is used to diagnose this type of dermatitis.

Irritant contact dermatitis
In addition to allergic contact dermatitis, there is irritant contact dermatitis (irritant contact dermatitis), which is not an allergy but a skin irritation.
This type of dermatitis is a direct result of damage to the skin barrier by irritants that can be all around us (from soaps and detergents, to solvents and cleaning agents, hair and beauty products, to frequent contact with water).
Irritant contact dermatitis manifests itself more quickly than allergic contact dermatitis - it occurs within minutes to hours after contact. It is characterised by pain rather than itching and is sharply circumscribed. It can become chronic, when the skin scales and gradually thickens. Symptoms include:
- redness and inflammation,
- dryness and cracking,
- blisters and erosions.
These symptoms most often appear on the hands, face and other parts of the body that are frequently exposed to irritants.

Conclusion
Contact dermatitis can negatively affect your quality of life, but with the right practices and habits, you can effectively prevent its symptoms. It is important to avoid known allergens and irritants, but also to regularly care for your skin with appropriate products. Remember that your skin is the first line of defence against external influences and therefore deserves the best care.

Sources

https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-20352742
https://www.nhs.uk/conditions/contact-dermatitis/