Allergic Contact Dermatitis

[ Pathogenesis and pathophysiology ]

Contact dermatitis describes an acute inflammatory condition of the skin or mucosa that results from contact with certain irritant substances or stimulants. The condition occurs in all ages and both sexes, but there is a higher incidence in children than the elderly and women are more commonly affected than men. A characteristic of the disease is a history of exposure to allergenic substances prior to the inflammatory episode. Such substances or stimulants can include medicated plasters, ointment, lacquer, plants, certain materials used in clothing and contact with animals. The distribution of the lesions on the skin corresponds to the points of contact with the irritant and is largely limited to those areas. Contact dermatitis should be distinguished from contact urticaria, in which a rash appears within minutes of exposure and fades away within minutes to hours. The allergic reaction to latex is the best known example of allergic contact urticaria.

[ Diagnosis ]

The disease has an acute onset. Typical symptoms include itchiness, a burning sensation, and swelling and tenderness of the lesions. Systemic involvement can occur in severe cases. Once irritants are removed and proper treatment given, the condition will usually resolve within one to two weeks. However, further exposure to the causative agent will cause a re-occurrence. Having been exposed to externally used chemicals, lesions with well-defined margins suddenly appear in the areas of contact. Erythema, papules, water blisters, even necrosis may be present. The patient may complain of itching, burning, or pain in severe cases.

Contact dermatitis is a skin reaction that occurs after you have been exposed to a substance that either irritates your skin or triggers an allergic response.  If your skin condition is caused by contact with an irritating or harsh substance, you have primary irritant contact dermatitis.  If your skin condition is an allergic reaction to a substance, you have allergic contact dermatitis.  The symptoms and treatment of both types of contact dermatitis are similar.

Fluid-filled bumps or blisters, tenderness and redness of the skin often occur with contact dermatitis.  You may also notice oozing cracks or fissures in the reddened, irritated skin areas.  Usually, these symptoms will occur only in the areas that actually came into contact with the irritant or allergen.  The affected areas will probably itch and burn.

This condition is not contagious.  If you and a friend handle a primary irritant, you will both get a reaction.  And if a friend wears something that you are sensitive to and the two of you are in close contact, you may also develop a skin reaction.  However, in neither case did you "get" the condition from your friend.

[ See ]

1. Urticaria

[ Determining the causes ]

Step one - to determine the cause of your skin reaction, do some detective work.  If your rash has begun recently, it is helpful to identify what you are doing differently.  Have you changed laundry detergents or bath soaps?  Are you using a new kind of perfume or aftershave?  Are you wearing new shoes?  The most common culprits are laundry detergents, fabric softeners, perfumed soaps, perfumes, colognes, makeup, latex gloves, smoke, irritant plants (i.e., poison ivy, poison sumac, poison oak), dyes and nickel.  Nickel may be used in bra stays, hairpins, eyelash curlers, eyeglass frames, necklace clasps, zippers, garter clasps, thimbles, watchbands, insecticides, fungicides, jewelry and more.

Step two - note exactly which parts of your body are involved.  Foot involvement may indicate an allergy to foot powder, leather tanning agents, shoe glue, foot inserts or buckles.  Earlobes are usually irritated by earrings that contain nickel.  A reaction around your eyes signals a response to airborne irritants (i.e., plants, pollen, sprays), fingernail polish or cosmetics.  Mouth irritations are often caused by toothpaste, lip balm or mouthwash.  Your neck may be sensitive to cosmetics, perfume or aftershave (especially if you have also been exposed to sunlight).  Your underarm area may be irritated by antiperspirants, deodorants, clothing or fabrics (especially wool).  Detergents are often implicated if your hands are affected.  If you handle oil or tars, fiberglass, rubber compounds, latex gloves, clothing dyes, chemical finishes, adhesive tape, soaps, detergents, bleaches, cleansers, acids (including vinegar and antiseptics) or metal salts, any part of your body that contacts such substances can develop a skin reaction.

Step three - if you are unable to determine which substance is causing the problem, there are two schemes that may be used to identify the source of your skin reaction.  (1) You can eliminate contact with all suspected items until your rash clears.  Then, you can gradually reintroduce one article at a time to test for reaction.  This method reduces your risk of further irritation and allows you to determine exactly which article is at fault.  (2) A second method is to have your medical practitioner do a "patch test."  This test exposes small amounts of your skin to the substances suspected of causing the reaction.

This test can give fast results, but may not isolate exactly which article is causing your difficulty (i.e., a positive patch test reaction to wool may implicate a sweater that actually does not contact the skin, when the actual culprit is your underarm deodorant).  

In Traditional Chinese medicine (TCM) contact dermatitis is not recognized as a disease as such, but as a collection of symptoms. From a TCM viewpoint, diseases of the skin are included in the category of surgical trauma and they are described in many ancient surgical classics. As there is no general term in TCM for contact dermatitis, the condition is referred to by names which describe both symptoms and causative agent. 

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[ Treatment ]

External treatment

1.
If you have urticaria or contact dermatitis, please see your doctor. Calamine lotion is usually prescribed along with injections and oral medications.


Internal treatment

It is important to prevent a diseased condition from occuring, but once this condition develops, early diagnosis and early treatment should be conducted as soon as possible to prevent the condition from developing further or transmitting to other organs. after invading the human body, the pathogen may deepen its positions until attacking the Zang Fu organs. The outer manifestations are only the symptoms and signs of the imbalance rather than their essences. Thus, to treat stubborn cases, internal administration is necessary.

If you have urticaria or contact dermatitis, please see your doctor. Calamine lotion is usually prescribed along with injections and oral medications.