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Patient education: Dermatitis/ RASH
Dermatitis is defined as an inflammation of the skin resulting in redness, itching, and/or scale. Contact dermatitis refers to dermatitis that is caused by contact between the skin and a substance. The substance can be an allergen (a substance that provokes an allergic reaction) or an irritant (a substance that damages the skin). Irritants are responsible for about 80 percent of cases of contact dermatitis.
In most cases, self-care measures and drug therapy can control the symptoms and prevent complications of contact dermatitis.
IRRITANT CONTACT DERMATITIS
Irritant contact dermatitis occurs when the skin comes in direct contact with a substance that physically, mechanically, or chemically irritates the skin, causing the normal skin barrier to be disrupted.
The most common causes of irritant dermatitis are products used on a daily basis, including soap, cleansers, and rubbing alcohol. People with other skin conditions, dry skin, and light-colored or “fair” skin are at greatest risk, although anyone can develop irritant dermatitis.
Mild irritants cause redness, dryness, fissures (small cracks), and itching. Strong irritants may cause swelling, oozing, tenderness, or blisters. The hands are commonly affected, often between the fingers. Irritant dermatitis can also affect the face, especially the thin skin of the eyelids.
The goal of treatment of irritant contact dermatitis is to restore the normal skin barrier and protect the skin from future injury. Reducing or avoiding altogether exposure to known irritants is essential. In some cases, simply reducing the use of soap and using an emollient cream or ointment completely alleviates symptoms. Wearing gloves when working with irritants may help as well.
In more severe cases, topical corticosteroids (steroids) may be recommended. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available in the United States without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription.
Steroid treatments for contact dermatitis are most effective when applied and covered with a barrier, a dressing, cotton gloves, or petroleum jelly. Oral steroids (eg, prednisone) may be used briefly to treat severe dermatitis, but are not recommended for long-term treatment of irritant contact dermatitis.
ALLERGIC CONTACT DERMATITIS
Allergic contact dermatitis occurs when the skin comes in direct contact with an allergen. This activates the body’s immune system, which triggers inflammation. Allergic contact dermatitis can occur after being exposed to a new product or after using a product for months or years. Weak allergens require exposure of weeks to months before they cause dermatitis. The patient can help find the cause of allergic contact dermatitis by providing a history of exposures. As an example, if the patient presents with sudden-onset allergic contact dermatitis with blisters, plant exposure history is most helpful. In contrast, with chronic allergic contact dermatitis with skin redness and thickening, exposure to everyday items, such as clothing, shoes, cosmetics, and metals, should be mentioned.
Poison ivy, poison oak, and poison sumac contain an oil called urushiol, which is the most common cause of allergic contact dermatitis. Ginkgo fruit and the skin of mangos also contain urushiol and can cause allergic contact dermatitis.
Other common allergens include nickel in jewelry perfumes and cosmetics, components of rubber, nail polish, and chemicals in shoes (both leather and synthetic)
Allergic contact dermatitis can also be triggered by certain medications, including hydrocortisone cream, antibiotic creams (sample brand names: Neosporin, Bacitracin), benzocaine, and thimerosal. Laundry detergents are an uncommon cause of allergic contact dermatitis.
Allergic contact dermatitis usually resolves within two to four weeks after the allergen is eliminated, although it can take more time in some cases. Several measures can minimize symptoms during this time and help to control symptoms in people who have chronic allergic contact dermatitis.
Whenever possible, identify and stop all exposure to the allergen.
Oatmeal baths or soothing lotions such as calamine lotion can provide relief in mild cases.
Topical corticosteroids (steroids) may be recommended for people with mild to moderate symptoms. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available in the United States without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription.
In people with severe dermatitis, a short course of steroid pills (eg, prednisone) may be recommended to get symptoms under control. .
You should contact your private physician for follow-up care. If you are unable to get a timely appointment, or if you are worsening, call us. If you need assistance in finding a primary provider or dermatologist, please call 410-601-9355.