Contact Dermatitis
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Contents |
More Specific Terms
Introduction
- Mediated by type IV delayed cell-mediated hypersensitivity reaction.
Etiology
-
- inexpensive pierced earrings
- belt buckles
- rubber
- sterile gloves
- shoes
- cream & lotion preservatives: methylparaben
- lanolin
- topical antihistamines
- topical antimicrobials, especially neomycin
- topical local anesthetics
Pathology
- type-4 hypersensitivity reaction
- prior exposure & immunologic sensitization to the causative agent must have occurred
Clinical-manifestations
- symptoms
- acute lesions:
- erythematous plaque covered with numerous small vesicles
- subacute lesions:
- scaling, erythematous lesions without clear borders
- chronic lesions:
- thick plaques with accentuated skin lines
Laboratory
- standard patch testing
- controlled application of suspected offending agent
Differential-diagnosis
Management
-
- topical
- systemic:
- systemic reaction or widespread skin involvement
- prednisone 40-60 mg PO QD for 5-14 days, followed by cautious taper
- antihistamines
- avoidance
- cool, wet compresses
- Follow-up:
- lesions should be monitored for signs of secondary infection
- counseling regarding avoidance of offending agent
More General Terms
Additional Terms
- common causes of allergic contact dermatitis
- patch testing
- type 4 hypersensitivity; T-cell-mediated (delayed) hypersensitivity
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 924
- Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
