Contact Dermatitis: What It Is And Why You Should Get Tested

itchy skin contact dermatitis

Why Does My Skin Itch?

Our skin is the body’s biggest organ, which makes it susceptible to flare-ups, rashes, irritations, and diseases. Even if you take excellent care of your body – using sunscreen, cleansers, moisturizers, and the like – you can suddenly develop a strange rash or skin irritation. If you have no idea where that rash came from, the issue could be contact dermatitis. The World Allergy Organization estimates that over 5.7 million people visit the doctor for contact dermatitis-related issues every year. But what is contact dermatitis exactly?

What is contact dermatitis? Be careful what you touch.

If we break down the phrase “contact dermatitis,” it will translate to a skin (derm) inflammation (itis) on contact. In other words, contact dermatitis is a rash or skin reaction caused by direct contact with a substance. The condition is not life-threatening but could be uncomfortable and unsightly. 

What does contact dermatitis look like?

Contact dermatitis looks like a red rash (sometimes with bumps) that can develop into a darker red, scaly patch. It can be itchy, burn, and become difficult to manage in some cases. Other symptoms include dry, cracked skin. More severe cases show signs of swelling, tenderness, and a slight oozing discharge. Interestingly enough, the reaction often takes the shape of the item that touched the skin. 


Contact dermatitis can appear anywhere, including the face, arms, neck, chest, and back. Some people may experience a rash, burning, and irritation around the eyes, while others will get similar symptoms only at the exact site of contact. It can be easily confused with other itchy skin conditions like eczema.


Causes of Contact Dermatitis

There are two types of the condition: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD).

Irritant Contact Dermatitis


Irritant Contact Dermatitis (ICD) happens when the skin comes in contact with a chemical irritant. The ingredients in the particular chemical can cause an unwanted reaction. Typical irritants include:

  • household cleaners
  • Solvents (including chlorine from swimming pools and water). Yes, constant hand washing can cause ICD!
  • Bleach
  • Fertilizers and pesticides
  • Detergents 
  • Shampoos and soaps
  • Sawdust, wool dust, or fiberglass dust


ICD is dose-dependent. You can develop irritant contact dermatitis from a high concentration of a particular chemical like a pesticide. In some cases, repeated exposure to something that’s not considered an irritant – like a gentle soap or shampoo – can cause dermatitis. 


Because it is dose-dependent and purely due to the chemical, the immune system would not respond, and the rash would not spread to other areas of the body. The exposure has simply damaged the skin enough to cause a reaction. With this in mind, anyone can develop contact dermatitis. In fact, ICD happens in 80% of cases of contact dermatitis. 


Allergic Contact Dermatitis


Allergic contact dermatitis (ACD) happens in the remaining 20% of cases. With ACD, you’re exposed to a particular substance that causes an immune response (an allergic reaction).  This reaction is not dose-dependent. In fact, just a small dose when the immune system is on high alert can cause an adverse reaction. With ACD, trace amounts of the substance enter the skin and attach to proteins, which are then attacked by immune cells. That’s why ACD is often called a Type IV Hypersensitivity reaction. Typical irritants include:


  • Nickel – the most common substance causing ACD, found in belt buckles and jewelry
  • Cobalt
  • Insecticides
  • Diapers, baby wipes, diaper rash cream, and dyes in baby clothing
  • Trace metals found in personal care products like deodorants, hair dyes, cosmetics, and nail polish
  •  Poison ivy, which contains urushiol, a highly allergic substance
  • Some sunscreens and medications that irritate when exposed to the sun
  • Topical medications like antibiotics, some hydrocortisone creams, and antihistamines
  • Essential oils
  • Ink and dyes from tattoos or Mehndi
  • Plus hundreds of other chemicals and substances 


In some cases, the allergic reaction does not happen right away. You could be exposed to the substance, then days, weeks, or even years after, you’ll experience an allergic reaction the next time you’re exposed. The response is delayed, taking about 12 to 72 hours to appear on the skin. Unlike ICD, ACD can spread to other parts of the body. 


Systemic reactions

A person already diagnosed with ACD may have a systemic reaction through consuming the allergen. For instance, you may have ingested, inhaled, or injected the metal, medication, or substance causing the reaction. This is common when you consume canned goods, certain spices, jams, preservatives, or fish containing mercury. Some foods like chocolate, coffee, oats, and soy contain trace elements of nickel and can cause systemic reaction. With Systemic Contact Dermatitis, the reaction spreads to a larger surface area of the body, particularly the back, buttocks, and thighs. 


Risk factors of contact dermatitis

Because there are so many irritants that could cause contact dermatitis, the risk factors are wide and varied. Most cases occur in those whose occupations that expose them to specific chemicals and irritants. The jobs with the highest risk include:

  • Painters
  • Cleaners
  • Metalwork
  • Hairdressers
  • Healthcare professionals
  • Gardeners


Constant contact with certain fragrances and perfumes is also a major risk factor. Popular cosmetics and skincare products contain dyes, parabens, fragrances, and surfactants that can irritate the skin. These often cause ACD.


Why is my contact dermatitis spreading?

Irritant Contact Dermatitis should not spread. The irritant affects the area where it came in contact with the skin. If the rash spreads to other parts of the body, you may have an Allergic Contact Dermatitis reaction. This type of contact dermatitis is immune-related and can spread away from the site of the rash. If this happens, speak with a dermatologist immediately. You will require some further treatment – We’ll discuss this later,.

Will it clear on its own?

Irritant Contact Dermatitis can go away on its own by removing the harmful substance or cleaning the skin with a gentle, fragrance-free cleanser. In about two to four weeks, the rash should clear up. If you have Allergic Contact Dermatitis, the condition may not clear without medical help. You’ll need to visit your dermatologist, who can help with the right diagnosis and testing. 

Time to ‘Patch’ things up: An Allergy Patch Test Near Me

In order to treat Allergic Contact Dermatitis and prevent further breakouts, your dermatologist may ask questions about recent exposure to irritants and substances and past allergies. Sometimes, these questions aren’t enough to get to the root cause, so your dermatologist would perform an Allergy Patch Test. 


An allergy patch test helps your dermatologist get an idea of the substances causing your reaction. It’s an FDA-approved kit that contains samples of 30 to 80+ different potential allergens on adhesive patches. If the skin reacts to one or more of these samples, we can then put the right plan in place to treat the skin reaction. 


Consultation and applying your patch

The patch test is broken up into 3-4 appointments over the course of one week. The first step involves meeting your dermatologist and discussing your history and possible allergens. This information can help your dermatologist decide which allergies to test. You may need to bring along your skincare products and detergent samples to include in the test. 


We then prepare the samples, label each one, and apply them to your clean back. The patches will stay on your back for about 48 hours. During this time, you would be unable to take medication for the itching (as this could alter the results of the patch testing), and your back must remain dry during the entire procedure. You will then return to your dermatologist to remove the patches. @ days later, you will return to have the patches removed. This is quick and painless.


Your follow-up appointment

In 1-2 subsequent appointments, your dermatologist will look at all the sites on your back where the samples were placed, to see which ones you react to and how severe the reaction is. From here, you’ll be given the necessary prescription to address the allergic reaction. Finding a dermatologist who can perform a patch test can be challenging. Search for ‘allergy test near me’ or ‘patch testing near me’ for a list of board-certified dermatologists. At Eternal Dermatology, we provide allergy tests in the Columbia MD, Howard County, Silver Spring, Dc /DMV and Baltimore areas.

What allergens are tested in a patch test?

Your test will contain up to 80+ different substances. Some samples will come from products at home, which can increase the number of chemicals that end up in the patch test. The doctor will use the provided cosmetics along with:

  • A range of metals like chrome, cobalt, and nickel
  • Parabens and formaldehyde-releasing preservatives
  • Emulsifiers found in perfumes and cosmetics
  • Topical corticosteroids and sunscreen
  • A range of plant allergens
  • Textile resins, acrylics, and m methacrylic monomer in plastics


It’s not uncommon for dermatologists to apply upwards of 60 different allergens. The goal is to have a wide enough sample space to narrow down the root cause of your allergy.


How do I treat my contact dermatitis?

With a clear idea of what’s behind your skin reactions, your dermatologist can put together a treatment plan to clear your skin. Both patient and doctor must work together to relieve the symptoms and clear up the rash.


Your doctor will…

Provide the right medication to help fight dermatitis internally and externally. For instance, you may receive a topical steroid cream or ointment that can soothe inflammation. If the rash becomes severe and is at risk of spreading, oral steroid medication may help. Your doctor may also include antibiotics or antihistamines in your treatment. 


The patient will…

  • Make sure to follow your provided prescription. Consistency ensures you reduce the rash and associated symptoms. 
  • There are additional over-the-counter topical and oral medications you can use to prevent itching.
  • Reduce contact with the allergen as much as possible. Sometimes, the allergen can be work-related. Speak with your superiors to find ways to limit exposure. 
  • Avoid rubbing or scratching the affected area. Scratching increases inflammation. Cover the affected area, if possible, with a light bandage. 
  • A great skincare routine can help with irritation. Take warm (not hot) baths and fragrance-free cleansers. Then you can follow up with a gentle, bland skin moisturizer. 

After a few weeks, have a follow-up appointment with your dermatologist to review your progress. 


Preventing future outbreaks.

With consistent care, the treatment plan can improve your rash in a few weeks. But it does not make you immune to future rashes or reactions. There are a few steps you can take to prevent future breakouts. For starters, know your triggers. If you’re allergic to metal, remove jewelry, belts, or other items that can cause irritation. The same applies to skincare products, makeup, perfumes, and sunscreen. Look for products that are hypoallergenic, unscented, and free of metals and parabens. 


If you come into contact with solvents and chemicals as part of your job, take precautions immediately. Use gloves, protective clothing, and remove allergens if possible. It’s also important to establish a proper skincare routine. Use a gentle cleanser after work or being outside, followed by a moisturizer to protect your skin. Ask your dermatologist for more suggestions to protect yourself and your skin. 


Get help with your contact dermatitis today.

If you believe that something you’ve come in contact with has caused an unwanted skin reaction, this could be a sign of contact dermatitis. Sometimes the response is immediate, and in some cases, it will take some time for the reaction to appear. Look for rashes, bumps, and irritation, especially after touching chemicals, solvents, or metals like nickel. Keep the skin clean and clear, then seek help from your dermatologist. We’ll make sure to perform a patch allergy test to find the root cause of the issue. 


Should you need more information on contact dermatitis, nickel allergy testing, or patch testing, contact Eternal Dermatology today. Our board-certified dermatologist, Ife Rodney, MD, FAAD, is the leading expert for contact dermatitis and skin allergy testing in Maryland.  The Contact Dermatitis Center at Eternal Dermatology is located in Fulton MD and servers Columbia, Laurel, Silver Spring, Howard County MD, DC/ DMV and Baltimore areas. Contact us today or book an appointment to address your contact dermatitis today.


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