Contact Dermatitis: Types, Symptoms, Causes, and Treatment

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1 Contact Dermatitis: Types, Symptoms, Causes, and Treatment

What is contact dermatitis? The simplest answer is contact dermatitis is a type of skin condition or reaction. It occurs when the skin encounters certain substances.

Contact dermatitis has two main causes:

Allergens – substances that trigger an allergic reaction.
Irritants – substances that cause irritation without an allergic reaction.

When an allergen or irritant touches your skin, it can damage the skin barrier. This can trigger inflammation of the skin. The reaction is often an itchy skin rash that can be painful. These symptoms may develop within minutes. But they can also take hours or even days to develop.

Contact dermatitis is very common skin condition. Anyone is at risk for developing contact dermatitis. An estimated 15-20% of people will experience contact dermatitis at some point in their lives.

Contact dermatitis is also the most common cause of work-related (occupational) skin conditions. Up to 95% of occupational skin conditions are from contact dermatitis.

Girl with contact dermatitis rash on face, around the eye and over the nose.

Irritant contact dermatitis

Irritant contact dermatitis (or irritant dermatitis) is the most common form of contact dermatitis. It accounts for up to 80% of all cases of contact dermatitis.

Irritant contact dermatitis is normally caused by repeated exposure to an offending substance. This substance irritates the skin. Over time, that substance breaks down the skin barrier. This leads to more skin irritation and damaged skin cells.

People in certain occupations are at high risk for developing irritant contact dermatitis. They include workers in healthcare, agriculture, construction, hairdressing, and mechanics. These professions often put people in direct contact with irritants. If a substance is especially harsh, a single exposure could cause a quick reaction.

Some of the most common irritants include:

Chemicals
Textiles
Insecticides
Harsh soaps
Bleach and detergents
Cosmetics and skincare products
Metals
Wet diapers or pads

Even something as simple as soap and water can cause irritant contact dermatitis. This happens when frequent hand washing dries out the hands. This can break down the barrier.

Man's hands on his knee showing the contact dermatitis rash on the back of his hands.

Allergic contact dermatitis

Allergic contact dermatitis is a contact allergy. It occurs when the skin makes contact with an allergen. This triggers an immune system response. It causes a skin reaction, such as an itchy rash. This can develop from repeat exposures to the allergen.

Common allergens include:

Plants such as poison ivy, poison oak and poison sumac. People encounter plants like poison ivy or poison oak when gardening, hiking, and doing outdoor activities. Just brushing across one these plants can trigger allergic contact dermatitis.
Cosmetics, hair dyes, and skincare products. Products used on the skin and in hair dye may have ingredients that are allergens. These can include dyes, metals, fragrances, preservatives, and natural rubber. Any could potentially cause allergic contact dermatitis.
Metals. Metals such as nickel, cobalt, chromium, and zinc are common triggers for allergic contact dermatitis. Nickel allergy is the most common cause of allergic contact dermatitis. These metals are found in jewelry and body piercings. They may also be found in tools, cosmetics, and many other household items.
Fragrances. Fragrances used for perfumes and to provide scents to soaps, lotions and cosmetics can affect the skin. Fragrances are the second most common cause of allergic contact dermatitis.
Preservatives. Preservatives such as formaldehyde and parabens are in lots of products. These include fabrics, baby products and cosmetics. They are common triggers for allergic contact dermatitis.
Latex. Natural rubber latex is found in 40,000+ products, including many household items. They are also used in gloves and medical products. Exposure to latex can cause allergic contact dermatitis.
Topical medications. Topical antibiotics such as neomycin and bacitracin are often used on skin. They are common triggers for allergic contact dermatitis.

You can have both irritant and allergic contact dermatitis. A board-certified allergist will be able to determine if your condition is from an allergen or irritant.

Contact dermatitis symptoms

Contact dermatitis symptoms typically involve a rash. But there are some distinctions between irritant and allergic contact dermatitis. If you have symptoms of a contact dermatitis rash, make an appointment with a doctor.

Symptoms of irritant contact dermatitis

With irritant contact dermatitis, symptoms are often found on the hands. They are often symmetrical with clear borders. Normally, the rash does not spread.

Symptoms of irritant contact dermatitis include:

Itchy rash
Painful skin irritation
Swelling
Red patches on light skin, brown or purplish patches on dark skin.
Blisters or pustules (pus filled pockets of skin)
Broken blood vessels in the skin (called hemorrhage)
Crusty skin
Scaly skin
Skin breakdown

Symptoms of allergic contact dermatitis

With allergic contact dermatitis, symptoms are often found on the back of hands or forearms. Often the rash is asymmetrical without clear borders. It may start in one area but spread to another. Let’s say your hands touch some poison ivy. You may get a rash on the hand that touched it. But then maybe you rub your face or mouth. That’s how the rash spreads.

Symptoms of allergic contact dermatitis include:

Very noticeable itchy rash
Red or darkened skin patches
Scaly skin
Dry skin
Leathery skin
Cracks in skin
Skin shedding

Allergic contact dermatitis symptoms often appear in phases instead of all at once. Leathery, cracked, itchy skin is more consistent with allergic reactions.

Close up of a parent's hands putting lotion on a young child's foot, that has a contact dermatitis rash.

How is irritant or allergic contact dermatitis diagnosed?

Skin problems can be hard to diagnose. If you think you have a contact dermatitis rash, make an appointment with a healthcare provider. An allergist or dermatologist will be able to make the diagnosis.

There is no specific test or procedure to confirm a diagnosis of contact dermatitis. Your healthcare provider will take your medical history and perform a physical exam. Some questions to expect:

When did your symptoms start?
Have you started using any new products at home?
Have you started wearing new jewelry?
What do you do for work?
Are you routinely exposed to any harsh soaps or irritating chemicals?

You may want to come to an appointment with a doctor with a list of any new soaps, detergents, skincare or cleaning products you are using.

If there is concern about a potential workplace exposure, let your doctor know. Come to the appointment with a list of potential substances that you’re around at work.

If you suspect you have allergic dermatitis, your doctor may recommend a procedure called patch testing. A patch test involves placing a patch containing allergens on your skin. The patch stays on your skin for 48 hours. Your doctor will look for signs of an allergic reaction where the patch was placed. If an allergen is identified, you are diagnosed with allergic contact dermatitis.

If your doctor suspects other causes for your skin reaction, you may need to undergo further testing. Some of the tests will be to rule out other skin diseases or infections.

Image of hands rubbing contact dermatitis medication on the other hand.

Treatment options for contact dermatitis

How is irritant or allergic contact dermatitis treated? Treatment focuses on managing and reducing symptoms. This gives the skin time to heal. Treatment also aims to reverse any skin damage.

Contact dermatitis involves different healing stages. Some treatments are needed for certain stages. Work with your healthcare provider to determine the right treatment for your symptoms.

Contact dermatitis treatment includes:

Over the counter (OTC) treatments

Burrow’s solution, calamine lotion, or oatmeal baths for oozing phase
Cold compresses for itchy rash
Antihistamines to help with sleep
OTC topical corticosteroids – hydrocortisone cream

Prescription treatments

Prescription topical steroids (for when a stronger medication is needed than OTC hydrocortisone)
Oral or intravenous corticosteroids – usually given in a short course or burst for severe cases
Topical immunomodulators – anti-inflammatory medications, may include tacrolimus or pimecrolmus

If your treatment is not working, your doctor may recommend phototherapy. This is an in-office procedure to expose affected skin to ultraviolet light. It provides relief from itching and swelling and allows the skin time to heal. Phototherapy is a second-line treatment for skin conditions. It is only recommended when other treatments have not worked.

As the skin heals, talk to your healthcare provider about moisturizing your skin regularly. Prevention is key. More irritant contact dermatitis or allergic contact dermatitis may occur in the future. Also ask for advice on being skin-safe when outdoors in the sun.

The back of a child's knee showing an infected contact dermatitis rash.

What if my contact dermatitis becomes infected?

Contact dermatitis can become infected if you constantly scratch the affected area. This opens up the skin and allows bacteria or fungi to grow.

Symptoms of contact dermatitis infection may include:

increased pain on the affected area
an oozing discharge from the skin
you feel hot or you have the shivers

Contact dermatitis can turn severe with an infection. Schedule an appointment with a doctor. In addition to over-the-counter and prescription medications, your doctor may give you pills such as antibiotics to help fight the infection.

Tips for preventing contact dermatitis.

Try your best to avoid scratching affected skin. This will prevent contact dermatitis from worsening. If you must scratch, try stroking the itchy area using the top side of your hand instead of your fingernails.
Identify allergens and irritants and develop strategies to avoid contact with them.
Avoid excessive handwashing.
Use mild, fragrance-free soaps, detergents and cleansers.
Use soft, non-scratching cloths on the skin.
Ensure that clothes and other items made of leather, cotton, or other materials are soft and don’t irritate the skin.
Avoid tight-fitting clothes.
Don’t use belt buckles with metal or wear jewelry if you’re allergic to nickel.
See a doctor if a rash doesn’t improve after trying home remedies.

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Questions & Answers (Q&A) on Contact Dermatitis

You may have specific questions about irritant and allergic contact dermatitis. Here’s a Q&A with some common questions about this condition. If there’s a topic you’d like to see answered in this Q&A, please email Gary Fitzgerald, Senior Editor.

Is contact dermatitis contagious?

No, contact dermatitis is not contagious. But if you have symptoms and you touch someone else, you can transfer it to them under certain conditions. For example, if you have poison ivy on your hands and you touch someone, you could transfer the poison ivy to that person. It is important to quickly wash your hands after making contact with an allergen or irritant.

Can I get contact dermatitis on my lips?

Yes, you can get contact dermatitis on your lips. If an allergen or irritant touches your lips, it can cause contact dermatitis.

How does someone get contact dermatitis vaginally?

Vaginal (vulvar) dermatitis is caused be contact with an allergen or irritant. Some potential triggers could be soaps, feminine hygiene products, or scented toilet paper. Talk with a doctor.

What is the treatment for contact dermatitis on hands?

Treatment for contact dermatitis on the hands is no different than other areas of the body. Use OTC lotions or creams. If symptoms don’t improve, talk with your doctor about prescription treatments.

You may also want to limit your handwashing and use a mild fragrance-free soap.

What is the difference between contact dermatitis vs atopic dermatitis?

Atopic dermatitis is a chronic inflammatory skin condition. It can cause itchiness on red, brown, purple or ashen gray patches (depending on your skin color). Atopic dermatitis also involves dry, scaly or thickened skin, and open, oozing, crusty sores.

Like contact dermatitis, atopic dermatitis can be triggered by allergens and irritants. But contact dermatitis strictly involves physical contact with the allergen or irritant.

Does contact dermatitis look different on Black skin or Brown skin?

Yes, contact dermatitis often looks different in skin of color. Symptoms appear red on light skin, but on Black or Brown skin, they may appear brown or purplish. This can sometimes make diagnosis a challenge in skin of color.

Contact dermatitis looks different on people with Brown or Black skin. It shows an image of the purple and dark rash on dark skin.

Can contact dermatitis be an allergic reaction to ChapStick?

Yes, you can develop contact dermatitis from an allergic reaction to ChapStick. Ingredients for the product typically include fragrances, dyes, and other substances that are possible allergens.

Is there a cure for contact dermatitis?

There is no cure for contact dermatitis – other than to avoid your trigger(s). For many, that can be easier said than done. It may take time, patience, and trial and error to figure out your trigger. Then you must develop ways to avoid touching your trigger. Working closely with your healthcare provider can help you reduce the risk of getting contact dermatitis again.

Can contact dermatitis go away on its own?

Yes, but until it does, symptoms are often a problem without treatment. You could also risk getting an infection. That’s why healthcare providers recommend you take medications and avoid allergens and irritants.

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Reviewed by:
William E. Berger, MD, FACAAI, is a board-certified allergist and immunologist who serves as Medical Director with Allergy & Asthma Network. He is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).