What are the main differences between hives and contact dermatitis. How can you identify and treat these common allergic skin conditions. What triggers cause hives and different types of dermatitis. How do allergists diagnose and manage various forms of skin allergies.

Understanding Allergic Skin Conditions: An Overview

Allergic skin conditions are common irritations triggered when the immune system responds to an allergen. These conditions can manifest in various forms, often leading to confusion due to their diverse presentations and nomenclature. An allergist, a specialist in allergy and immunology, is best equipped to diagnose and treat these conditions effectively.

Hives (Urticaria): Causes, Symptoms, and Management

Hives, medically known as urticaria, are red, itchy, raised areas on the skin. They can appear anywhere on the body and vary in size. But what exactly causes hives?

• Acute triggers: Food allergies, drug reactions, insect stings
• Chronic triggers: Often idiopathic (unknown cause)
• Physical factors: Cold, heat, exercise, pressure, sunlight exposure
• Infections: Viral or bacterial

Most cases of hives are acute, resolving within days or weeks. However, chronic hives can persist for months or years. How are hives typically treated? Antihistamines are the primary treatment, with avoidance of identified triggers being crucial. It’s important to note that routine testing for chronic hives is generally not recommended, as it rarely identifies a cause or alters treatment strategies.

Angioedema: A Close Relative of Hives

Angioedema often accompanies hives but affects deeper layers of skin. It typically involves swelling of the eyelids, lips, tongue, hands, or feet. Unlike hives, angioedema is usually not red or itchy. What causes angioedema? Similar to hives, it can be triggered by food, drug, or insect sting allergies.

Dermatitis: Inflammation of the Skin

Dermatitis refers to skin inflammation resulting in a red, scaly, itchy rash. Two primary types of dermatitis are atopic dermatitis (eczema) and contact dermatitis. How do these conditions differ, and what are their characteristics?

Atopic Dermatitis (Eczema): A Chronic Skin Condition

Atopic dermatitis, commonly known as eczema, is a chronic condition often beginning in infancy or early childhood. It frequently coexists with food allergies, allergic rhinitis, and asthma. What are the common triggers for eczema flare-ups?

• Food allergies (especially in young children)
• Skin staph infections
• Environmental allergens (animal dander, dust mites)
• Irritants (wool, harsh soaps)
• Sweating

How is eczema managed? The primary goal is to prevent itching and avoid identified triggers. Treatment options include:

1. Cold compresses
2. Moisturizing creams and ointments
3. Topical corticosteroids and other anti-inflammatory creams (pimecrolimus, tacrolimus, crisaborole)
4. Antihistamines (though often of limited effectiveness)
5. For severe cases: injectable biologics (dupilumab), oral corticosteroids, or stronger immunosuppressants
6. Antibiotics if a skin staph infection is suspected

Contact Dermatitis: When Skin Meets Irritants or Allergens

Contact dermatitis occurs when certain substances come into contact with the skin, causing a rash. There are two main types: irritant contact dermatitis and allergic contact dermatitis. How do these types differ?

Irritant Contact Dermatitis: Direct Skin Damage

Irritant contact dermatitis results from substances that directly damage the skin upon contact. It’s often more painful than itchy and commonly affects the hands. What factors influence the severity of irritant contact dermatitis?

• Duration of skin contact with the irritant
• Strength or concentration of the irritating substance

How can irritant contact dermatitis be managed? The key is to avoid the offending substance. Wearing protective gloves can be helpful in many cases, especially for workplace exposures.

Allergic Contact Dermatitis: Delayed Hypersensitivity Reaction

Allergic contact dermatitis is a delayed hypersensitivity reaction, with symptoms typically appearing 24 to 48 hours after exposure. The classic example is the itchy, red, blistered reaction to poison ivy. What causes this reaction?

In the case of poison ivy, a chemical called urushiol triggers the allergic response. Interestingly, the reaction can occur from indirect contact with items that have touched the plant. However, once the skin is washed, the rash itself is not contagious.

How long does an allergic contact dermatitis reaction last? Even with treatment, it may take 14 to 28 days for the reaction to fully resolve.

Common Allergens in Contact Dermatitis

While poison ivy is a well-known cause of allergic contact dermatitis, numerous other substances can trigger similar reactions. What are some common allergens that cause contact dermatitis?

• Nickel (commonly found in jewelry and belt buckles)
• Perfumes and fragrances
• Dyes (in clothing and cosmetics)
• Rubber (latex) products
• Cosmetics and skincare products
• Topical medications

It’s important to note that reactions to these substances can vary widely between individuals. What causes a severe reaction in one person may have no effect on another.

Diagnosing Allergic Skin Conditions

Accurate diagnosis of allergic skin conditions is crucial for effective management. How do allergists approach the diagnosis of these diverse conditions?

1. Detailed medical history: This includes information about the onset, duration, and pattern of symptoms, as well as potential triggers.
2. Physical examination: A thorough skin examination helps identify characteristic features of different conditions.
3. Patch testing: This is particularly useful for identifying specific allergens in cases of contact dermatitis.
4. Blood tests: These may be used to check for specific antibodies or markers of inflammation, though they’re not always necessary or informative.
5. Skin prick tests: These can help identify immediate hypersensitivity reactions, which may be relevant in some cases of urticaria.

Why is professional diagnosis important? Many skin conditions can mimic each other, and accurate identification is crucial for appropriate treatment and management strategies.

Treatment Strategies for Allergic Skin Conditions

While specific treatments vary depending on the condition and its severity, some general principles apply to managing allergic skin conditions. What are the key components of treatment?

• Allergen avoidance: Identifying and avoiding triggers is crucial for long-term management.
• Topical treatments: These may include corticosteroids, calcineurin inhibitors, or other anti-inflammatory agents.
• Systemic medications: Antihistamines, oral corticosteroids, or immunosuppressants may be necessary in severe cases.
• Skin care: Proper moisturizing and gentle skin care practices can help maintain skin barrier function.
• Patient education: Understanding the condition and its triggers is essential for successful self-management.

How do treatment approaches differ between acute and chronic conditions? Acute conditions often focus on symptom relief and trigger avoidance, while chronic conditions may require ongoing management strategies and possibly systemic treatments.

Emerging Therapies in Allergic Skin Conditions

The field of allergy and immunology is constantly evolving, with new treatments emerging for various allergic skin conditions. What are some of the latest developments in this area?

• Biologic therapies: Medications like dupilumab for severe atopic dermatitis target specific components of the immune system.
• Janus kinase (JAK) inhibitors: These newer oral medications show promise for conditions like atopic dermatitis and chronic urticaria.
• Microbiome-based therapies: Research is exploring the role of skin microbiome in allergic conditions and potential therapeutic interventions.
• Personalized medicine approaches: Tailoring treatments based on individual genetic and immunological profiles is an area of active research.

How might these emerging therapies change the landscape of allergic skin condition management? While many of these treatments are still in development or early stages of use, they offer hope for more targeted and effective management of challenging cases.

Living with Allergic Skin Conditions: Practical Tips

Managing allergic skin conditions extends beyond medical treatments. What practical strategies can help individuals cope with these conditions in daily life?

1. Identify and avoid triggers: Keep a diary to track potential allergens and irritants.
2. Maintain a consistent skincare routine: Use gentle, fragrance-free products suitable for sensitive skin.
3. Manage stress: Stress can exacerbate many skin conditions, so finding effective stress-management techniques is crucial.
4. Choose appropriate clothing: Opt for soft, breathable fabrics and avoid materials that irritate your skin.
5. Stay hydrated: Proper hydration supports overall skin health.
6. Use protective measures: Wear gloves when necessary and apply sunscreen to protect your skin from environmental factors.
7. Be prepared: Carry necessary medications or treatments with you for quick relief if symptoms flare up.

How can these lifestyle modifications complement medical treatments? While they may not replace prescribed therapies, these strategies can significantly improve quality of life and help manage symptoms more effectively.

The Psychological Impact of Allergic Skin Conditions

Allergic skin conditions can have a significant impact on mental health and quality of life. How do these conditions affect individuals psychologically?

• Self-esteem issues: Visible skin conditions can affect body image and confidence.
• Social anxiety: Fear of flare-ups or visible symptoms may lead to social withdrawal.
• Sleep disturbances: Itching and discomfort can significantly impact sleep quality.
• Stress and frustration: Managing chronic conditions can be emotionally taxing.
• Depression: Persistent symptoms and lifestyle limitations may contribute to depressive symptoms.

What resources are available to help individuals cope with the psychological aspects of allergic skin conditions? Support groups, counseling, and cognitive-behavioral therapy can be valuable tools in addressing the mental health impact of these conditions.

Prevention Strategies for Allergic Skin Conditions

While not all allergic skin conditions can be prevented, certain strategies may reduce the risk or frequency of flare-ups. What preventive measures can individuals take?

1. Identify and avoid known allergens: This is particularly important for contact dermatitis.
2. Maintain skin barrier function: Regular moisturizing and gentle skincare practices can help prevent eczema flares.
3. Manage environmental factors: Control dust mites, pet dander, and other common allergens in the home.
4. Practice good hand hygiene: This can help prevent the spread of infections that may trigger skin reactions.
5. Be cautious with new products: Patch test new skincare products or cosmetics before widespread use.
6. Manage underlying health conditions: Keeping related conditions like asthma or allergies under control may help reduce skin symptoms.

Why is a proactive approach to prevention important? By taking steps to prevent flare-ups, individuals can reduce the need for reactive treatments and improve their overall quality of life.

The Role of Diet in Allergic Skin Conditions

The relationship between diet and allergic skin conditions is complex and often individualized. How can diet influence these conditions?

• Food allergies: In some individuals, particularly children, certain foods can trigger eczema flares.
• Anti-inflammatory diets: Some evidence suggests that diets rich in omega-3 fatty acids and antioxidants may help manage inflammatory skin conditions.
• Hydration: Adequate fluid intake supports overall skin health.
• Probiotics: Some studies indicate potential benefits of probiotics in managing atopic dermatitis, though more research is needed.

Should everyone with an allergic skin condition alter their diet? While dietary modifications can be helpful for some individuals, it’s important to consult with a healthcare provider or registered dietitian before making significant changes to your diet.

When to Seek Professional Help for Skin Allergies

While many allergic skin conditions can be managed with over-the-counter treatments and self-care, certain situations warrant professional medical attention. When should individuals consult an allergist or dermatologist?

• Persistent or worsening symptoms despite home treatment
• Symptoms that significantly impact daily life or sleep
• Signs of infection (increased redness, warmth, swelling, or pus)
• Sudden or severe reactions, especially if accompanied by difficulty breathing
• Uncertainty about the cause of symptoms
• Need for stronger treatments or prescription medications

Why is timely professional intervention important? Early diagnosis and appropriate treatment can prevent complications, reduce symptom severity, and improve long-term outcomes for individuals with allergic skin conditions.

The Future of Allergic Skin Condition Management

As research in allergy and immunology continues to advance, what does the future hold for the management of allergic skin conditions?

1. Precision medicine: Tailoring treatments based on individual genetic and immunological profiles.
2. Immunotherapy advancements: Developing more effective desensitization therapies for allergic conditions.
3. Novel drug delivery systems: Improving the efficacy and ease of use of topical treatments.
4. Artificial intelligence in diagnosis: Enhancing the accuracy and speed of skin condition identification.
5. Microbiome-based interventions: Developing therapies that target the skin’s microbial ecosystem.

How might these advancements change patient care? As our understanding of allergic skin conditions deepens and new technologies emerge, we can anticipate more personalized, effective, and less burdensome treatments for individuals living with these conditions.

Allergic Skin Conditions | Skin Allergy

Most people are bothered by skin irritations at some point in time. These irritations are so common and varied that they are called by different names, which can lead to confusion. When an allergen is responsible for triggering an immune system response, the irritation is an allergic skin condition.

There are several types of allergic skin conditions. An allergist / immunologist, often referred to as an allergist, has advanced training and expertise to determine which condition you have and develop a treatment plan to help you feel better.

Hives and Angioedema

Urticaria is the medical term for hives, which are red, itchy, raised areas of the skin. They can range in size and appear anywhere on your body. Most cases of hives are known as acute and go away within a few days or weeks, but some people suffer from chronic hives with symptoms that come and go for several months or years. Your allergist may prescribe antihistamines to relieve your symptoms.

If the cause can be identified, you should avoid that trigger. However, the majority of chronic cases are not related to allergy. Routine testing, such as blood counts or allergy screens, are not recommended as they are unlikely to determine a cause and do not make a difference in treatment strategies.

While related to hives, angioedema is swelling that affects the deeper layers of the skin. It is usually not red or itchy and often involves the eyelids, lips, tongue, hands and feet. Angioedema commonly occurs with hives, but can occur on its own.

Food, drug or insect sting reactions are a common cause of acute hives and angioedema. Viral or bacterial infections can also trigger acute hives. Hives can also be caused by physical factors such as cold, heat, exercise, pressure and exposure to sunlight.

Dermatitis

An inflammation of the skin that produces a red, scaly, itchy rash is known as dermatitis. Two of the most common types are atopic dermatitis (often called eczema) and contact dermatitis.

Atopic Dermatitis (Eczema)

Eczema is a chronic skin condition that usually begins in infancy or early childhood and is often associated with food allergy, allergic rhinitis and asthma.

Certain foods can trigger eczema, especially in young children. Skin staph infections can cause flare-ups in children as well. Other potential triggers include animal dander, dust mites, sweating, or contact with irritants like wool or soaps.

Preventing the itch is the main goal of treatment. Do not scratch or rub the rash. Applying cold compresses and creams or ointments is helpful. It is important to avoid all irritants that aggravate your condition. If a food is identified as the cause, eliminate it from your diet.

Corticosteroid and other anti-inflammatory creams such as pimecrolimus, tacrolimus and crisaborole that are applied to the skin are most effective in treating the rash. Antihistamines are often recommended to help relieve the itchiness even though they often have limited effectiveness. In severe cases, a regular injectable biologic medication called dupilumab may be helpful, and oral corticosteroids or other stronger immunosuppressants can also be prescribed for severe disease. If a skin staph infection is suspected to be a trigger for an eczema flare-up, antibiotics are often recommended.

Contact Dermatitis

When certain substances come into contact with your skin, they may cause a rash called contact dermatitis. There are two kinds of contact dermatitis: irritant and allergic.

Irritant contact dermatitis occurs when a substance damages the part of skin the substance comes in contact with. It is often more painful than itchy. The longer your skin is in contact with the substance, or the stronger the substance is, the more severe your reaction will be. These reactions appear most often on the hands and are frequently due to substances contacted in the workplace.

For irritant contact dermatitis, avoid the substance causing the reaction. Wearing gloves can sometimes be helpful. Avoiding the substance will relieve your symptoms and prevent lasting damage to your skin.

Allergic contact dermatitis is best known by the itchy, red, blistered reaction experienced after you touch poison ivy. This allergic reaction is caused by a chemical in the plant called urushiol. Reactions can happen from touching other items the plant has come into contact with. However, once your skin has been washed, you cannot get another reaction from touching the rash or blisters. Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it may take 14 to 28 days to go away, even with treatment.

Nickel, perfumes, dyes, rubber (latex) products and cosmetics also frequently cause allergic contact dermatitis. Some ingredients in medications applied to the skin can cause a reaction. A common offender is neomycin, an ingredient in antibiotic creams.

Treatment depends on the severity of the symptoms. Cold soaks and compresses can offer relief for the early, itchy blistered stage of a rash. Topical corticosteroid creams may be prescribed. For severe reactions such as poison ivy, oral prednisone may be prescribed as well.

To prevent the reaction from returning, avoid contact with the offending substance. If you and your allergist cannot determine what caused the reaction, your allergist may conduct tests to help identify it.

Healthy Tips

• If you have red, bumpy, scaly, itchy or swollen skin, you may have a skin allergy.

• Urticaria (hives) are red, itchy, raised areas of the skin that can range in size and appear anywhere on your body. Angioedema is a swelling of the deeper layers of the skin that often occurs with hives.

• Atopic dermatitis (eczema) is a scaly, itchy rash that often affects the face, elbows and knees.

• When certain substances come into contact with your skin, they may cause a rash called contact dermatitis.

Feel Better. Live Better.

An allergist / immunologist, often referred to as an allergist, is a pediatrician or internist with at least two additional years of specialized training in the diagnosis and treatment of allergies, asthma, immune deficiencies and other immunologic diseases.

By visiting the office of an allergist, you can expect an accurate diagnosis, a treatment plan that works and educational information to help you manage your disease and feel better.

The AAAAI’s Find an Allergist / Immunologist service is a trusted resource to help you find a specialist close to home.

Find out more about skin allergies.

This article has been reviewed by Andrew Moore, MD, FAAAAI

Reviewed: 9/28/20

Contact urticaria | DermNet NZ

Author: Vanessa Ngan, Staff Writer, 2006.

What is contact urticaria?

Contact urticaria is an immediate but transient localised swelling and redness that occurs on the skin after direct contact with an offending substance. Contact urticaria should be distinguished from contact dermatitis where a dermatitis reaction develops hours to days after contact with the offending agent.

Contact urticaria can be immunological (due to allergy) or non-immunological. It is a form of inducible urticaria.

Contact urticaria

Who gets contact urticaria?

Anyone is able to get contact urticaria, however, there are some groups of people that are at increased risk for the condition to occur. Occupational groups at risk and the substances that cause contact urticaria are listed below. In most cases, exposure has occurred over time and the response is of the immunological type of contact urticaria.

• Agricultural and dairy workers: cow dander, grains and feeds
• Bakers: ammonia persulfate, flour, alpha-amylase
• Dental workers: latex, acrylate and epoxy resins, toothpaste
• Electronic workers: acrylate and latex
• Food workers: foodstuffs, such as cheese, egg, milk, fish, shellfish, fruit, flour, wheat
• Hairdressers: ammonia persulfate, latex
• Medical/veterinary workers: latex 

What causes contact urticaria?

Contact urticaria is caused by a variety of compounds, such as foods, preservatives, fragrances, plant and animal products, metals, and rubber latex. The mechanism by which these provoke an immediate urticarial rash at the area of contact can be divided into two categories: non-immunological contact urticaria and immunological (allergic) contact urticaria.

• Non-immunological contact urticaria typically causes mild localised reactions that clear within hours, for example, stinging nettle rash. This type of urticaria occurs without prior exposure to a patient’s immune system to an allergen.
• Immunological contact urticaria occurs most commonly in atopic individuals (people who are prone to allergy). Hence prior exposure to an allergen is required for this type of contact urticaria to occur.

Commonly reported causes of the different types of contact urticaria are shown below.

Non-immunological contact urticaria

• Ingredients of cosmetics and medicaments
• Sorbic acid, a commonly used preservative in many foods
• Raw meat, fish, and vegetables

Immunological contact urticaria

What are the clinical features of contact urticaria?

Contact urticaria reactions appear within minutes to about one hour after exposure of the offending substance to the skin. Signs and symptoms of affected skin areas include:

• Local burning sensation, tingling or itching
• Localised or generalised red swellings or weals may occur, especially on the hands. The severity of redness and swelling can range from slight redness or spots with minimal swelling to fiery redness with tense swelling and weals.
• Rash usually resolves by itself within 24 hours of onset.

Signs and symptoms may occur in other organs other than the skin. These are known as extracutaneous reactions and are more likely to occur in patients with immunological contact urticaria. Features of extracutaneous reactions include:

• Wheezing (bronchial asthma)
• A runny nose, watery eyes
• Lip swelling, hoarse throat, difficulty swallowing
• Nausea, vomiting, diarrhoea, cramps
• Severe anaphylactic shock (this can be life-threatening)

Contact urticaria

How is contact urticaria diagnosed?

Sometimes it is easy to recognise contact urticaria and no specific tests are necessary. RAST tests (specific IgE blood test) where available, can be used to confirm the allergy. Skin prick test and scratch patch tests confirm the diagnosis of contact urticaria but do not differentiate between allergic and non-allergic mechanisms.

What is the treatment for contact urticaria?

The patient should have an understanding of the nature of their urticarial reaction (non-immunological vs immunological). Patients with immunological contact urticaria should wear medical alert tags and be aware of the potential life-threatening reactions of the condition.

In most cases, the rash rapidly clears up completely once the offending substance is no longer in contact with the skin. 

The main aim of treatment is to avoid the substances that cause the urticarial reaction and find suitable alternatives. Gloves may be used to protect hands from contact with materials of concern, but avoid rubber gloves if allergic to latex.

Medications that may be used to minimise the reaction include antihistamines and adrenaline for more severe reactions.

Eczema & Hives | Allergy Rash

There are two major types of skin allergies: eczema allergy rash (atopic dermatitis) and hives (urticaria or angioedema). Both are allergic reactions where symptoms occur on or just under the skin.

Eczema

Eczema, or atopic dermatitis, is a skin condition usually caused by allergies in which the skin becomes red, itchy and develops into an allergy rash. The most common type of eczema is known as atopic dermatitis or atopic eczema. Atopic refers to a group of diseases with an often inherited tendency to develop other allergic conditions, such as asthma and hay fever.

Cases of atopic eczema in on the rise, affecting 9 to 30% of the U.S. population. It is particularly common in young children and infants. While many infants who develop the condition outgrow it by their second birthday, some continue to experience symptoms on and off throughout life. Proper treatment can control the disease in the majority of sufferers.

Eczema Treatment

The key to treating eczema is to control the itching. Triggers that can make your itch worse are rough clothes, exposure to allergens (such as foods or dust mites), sweating, using irritating products (including soaps and lotions), local skin infections, or getting emotionally upset.

There are several things you can do to control the itch:

• Avoid rough or tight clothing. Clean, breathable soft cotton is best.
• Wash new clothing several times before wearing.
• Use plain soap powder (not enzyme detergents) when washing clothes and be sure to rinse thoroughly.
• Avoid soap and baths as much as possible. Use soap substitutes.
• Take quick showers or baths with only slightly warm water.
• Pat dry (never rub) after bathing.
• Apply a lubricating moisturizer after bathing while the skin is still damp. Apply the moisturizer several times a day to areas of the skin that are very dry.
• Antihistamines are nearly always helpful to control the itching and should be taken on a regular daily basis. This is one place where a sedating antihistamine taken at bedtime can be beneficial.
• Topical corticosteroid creams or ointments applied to the areas of rash (as prescribed) will help control the rash and itching. These are also most effective if applied after washing and before the skin is dry. As the rash clears, you can decrease the use of cream. Potent steroids should never be applied to the face unless an allergist or dermatologist gives specific instructions. Contact your doctor, if you are not sure what your topical prescription is.
• If the skin gets extremely red, or if pus appears, there may be an infection, and you should see your doctor immediately. If you do not clear the infection, your skin condition will not clear.

Hives

Hives are red, itchy, swollen areas of the skin. They often appear in clusters with new clusters appearing as others clear. Hives can arise suddenly, may leave as quickly as one or two hours, or last as long as 24 hours. 20% of the population has suffered from hives at least once in their lives.

What Causes Hives?

Hives are often triggered by foods or medications. Among the most common foods that cause hives are peanuts, tree nuts (almonds, walnuts, etc.) and shellfish (crab, shrimp, oysters, etc.). Common medications associated with hives include penicillin, sulfa, phenobarbital, and aspirin.

Types of hives that are not triggered by an allergy:

• Cholinergic urticaria is the medical term for hives that appear after an activity that increases the body temperature like hot tub use, exercise, fever, or emotional stress. The hives usually occur as the skin cools after being warmed.
• Cold-induced hives occur after exposure to cold wind or water and often appear on the lips or mouth.
• Solar hives are caused by exposure to sunlight or a sunlamp, and a reaction can occur within one to three minutes.
• Exercise can trigger hives. With exercise-induced hives, some individuals may develop a lung obstruction and may lose consciousness. This severe reaction is called anaphylaxis and may be fatal.
• Chronic urticaria are hives that continue either daily or frequently for longer than four weeks.

Treatment of Hives

If foods or medication triggers your hives, avoidance is the only method of treatment. For the treatment of symptoms, antihistamines are used to treat recurrent episodes. Many of the newer, non-sedating antihistamines have been approved for the treatment of hives. If you suffer from hives, an allergy specialist is specially trained to diagnose and create a treatment plan that is best for you.

Don’t suffer from hives caused by untreated allergies. Schedule an appointment today with one of our board-certified allergists, and move towards a clearer tomorrow.

Contact Dermatitis: Causes, Symptoms, Treatments

Contact dermatitis is a rash that crops up on your skin when you touch or have a reaction to a certain substance. It’s red, itchy, and uncomfortable, but it’s not life-threatening.

The rash could be caused by an allergy or because the protective layer of your skin got damaged. Other names for it include allergic contact dermatitis and irritant contact dermatitis.

Contact Dermatitis Symptoms

Symptoms of a contact allergy usually show up near where you touched the thing you’re allergic to.

 You’ll notice your skin may be:

Irritant contact dermatitis (skin damage) tends to burn and be more painful than itchy.

When something is irritating or damaging your skin, you’ll probably see a rash right away. With an allergy, it may be a day or two before the rash shows up.

Many of the symptoms can be the same. In both cases, your skin may blister, or you may get a raised red rash. Your skin will itch and maybe burn.

Contact Dermatitis Causes

If it’s caused by an allergy, your immune system is involved. After you touch something, it mistakenly thinks your body is under attack. It springs into action, making antibodies to fight the invader. A chain of events causes a release of chemicals, including histamine. That’s what causes the allergic reaction — in this case, an itchy rash. It’s called allergic contact dermatitis.

Usually, you won’t get a rash the first time your skin touches something you’re allergic to. But that touch sensitizes your skin, and you could have a reaction the next time. If you get an allergic rash, chances are you’ve touched that trigger before and just didn’t know it. 

Allergic contact dermatitis causes include:

• Poison ivy, poison oak, and poison sumac

• Hair dyes or straighteners

• Nickel, a metal found in jewelry and belt buckles

• Leather (specifically, chemicals used in tanning leather)

• Latex rubber

• Citrus fruit, especially the peel

• Fragrances in soaps, shampoos, lotions, perfumes, and cosmetics

• Some medications you put on your skin

Continued

Some rashes look like an allergic reaction but really aren’t because your immune system wasn’t involved.

Instead, you touched something that took away the surface oils shielding your skin. The longer that thing stayed on your skin, the worse the reaction. It’s called irritant contact dermatitis.

Things that can cause irritant contact dermatitis include:

• Acids

• Some drain cleaners

• Urine, saliva, or other body fluids

• Certain plants, such as poinsettias and peppers

• Hair dyes

• Nail polish remover 

• Paints and varnishes

• Harsh soaps or detergents

• Resins, plastics, and epoxies

If you have eczema, you’re more likely to get this kind of rash.

Another less common form of contact dermatitis is photocontact dermatitis. This is a rash that can form when you use certain products, such as sunscreen, on your skin and then spend time in the sun. The combination of the sun and the allergen or irritant on your skin causes a reaction.

Contact Dermatitis Treatment and Home Remedies

Depending on how bad your symptoms are, you may be able to treat your contact dermatitis at home, or you may need to see your doctor.

Continued

To help soothe your skin, you can try these home remedies:

• Wash your skin with mild soap and cool water right away.

• Remove or avoid the allergen or irritant that caused the rash.

• Apply hydrocortisone cream over small areas.

• For blisters, use a cold moist compress for 30 minutes, three times a day.

• Put moisturizers on damaged skin several times a day to help restore the protective layer.

• Take an oral histamine for itching.

Don’t use an antihistamine lotion unless your doctor suggests it, because it could cause skin irritation or an allergic reaction, too.

When to Contact Your Doctor About Contact Dermatitis

Call your doctor if your rash is:

• Painful 

• Keeps you from sleeping or distracts you during the day

• Sudden 

• Spreads over a large part of your body

• On your face or genitals

• Not better after a couple of days

• Oozing or infected

• Affecting your eyes, nose, or lungs

Your doctor will take a look and ask you questions to help figure out what’s going on.

Continued

Depending on how severe it is, they may prescribe:

•  Steroid pills, creams,  or ointment

• Antihistamines 

• Immunosuppressive medications for severe cases

Your doctor can do skin tests to determine what you are allergic to.

If you can’t avoid what’s bothering your skin, talk to your doctor about wearing gloves or using creams to keep it safe.

Contact Dermatitis Prevention

The best way to avoid getting contact dermatitis is to know what makes you break out and stay away from it. If you do come into contact with an allergen or irritant, wash it off as soon as possible to reduce your reaction.

If you’re not sure what’s causing your rashes, take these steps:

• Use only fragrance-free, dye-free lotions, detergents, and soaps.

• Wear protective gear if you might come into contact with an irritant or allergen, such as long sleeves and pants near plants or in the sun, or goggles and gloves when using cleaning products.

• Use a barrier cream to keep your skin’s outer layer strong and moisturized.

• Test any new product on a small patch of your skin before using it.

Contact dermatitis: MedlinePlus Medical Encyclopedia

There are 2 types of contact dermatitis.

Irritant dermatitis: This is the most common type. It is not caused by an allergy, but rather the skin’s reaction to irritating substances or friction. Irritating substances may include acids, alkaline materials such as soaps and detergents, fabric softeners, solvents, or other chemicals. Very irritating chemicals may cause a reaction after just a short period of contact. Milder chemicals can also cause a reaction after repeated contact.

People who have atopic dermatitis are at increased risk of developing irritant contact dermatitis.

Common materials that may irritate your skin include:

• Cement
• Hair dyes
• Long-term exposure to wet diapers
• Pesticides or weed killers
• Rubber gloves
• Shampoos

Allergic contact dermatitis: This form of the condition occurs when your skin comes in contact with a substance that causes you to have an allergic reaction.

Common allergens include:

• Adhesives, including those used for false eyelashes or toupees.
• Antibiotics, such as neomycin rubbed on the surface of the skin.
• Balsam of Peru (used in many personal products and cosmetics, as well as in many foods and drinks).
• Fabrics and clothing, including both materials and dyes.
• Fragrances in perfumes, cosmetics, soaps, and moisturizers.
• Nail polish, hair dyes, and permanent wave solutions.
• Nickel or other metals (found in jewelry, watch straps, metal zips, bra hooks, buttons, pocketknives, lipstick holders, and powder compacts).
• Poison ivy, poison oak, poison sumac, and other plants.
• Rubber or latex gloves or shoes.
• Preservatives commonly used in prescription and over-the-counter topical medicines.
• Formaldehyde, which is used in a broad number of manufactured items.

You will not have a reaction to a substance when you are first exposed to the substance. However, you will form a reaction after future exposures. You may become more sensitive and develop a reaction if you use it regularly. It is possible to tolerate the substance for years or even decades before developing allergy. Once you develop an allergy you will be allergic for life.

The reaction most often occurs 24 to 48 hours after the exposure. The rash may persist for weeks after the exposure stops.

Some products cause a reaction only when the skin is also exposed to sunlight (photosensitivity). These include:

• Shaving lotions
• Sunscreens
• Sulfa ointments
• Some perfumes
• Coal tar products
• Oil from the skin of a lime

A few airborne allergens, such as ragweed, perfumes, vapor from nail lacquer, or insecticide spray, can also cause contact dermatitis.

Is It Hives or Something Else?

Itching, swelling, and red and white welts are all signs you may have hives — or chronic idiopathic hives, if the welts appear consistently for six weeks or more and have no known cause. While any skin rash might seem to you to be an allergic reaction or hives, the reality is there are numerous skin disorders that can be mistaken for chronic hives.

How to Tell if It’s Chronic Hives

If you notice a persistent, itchy skin rash, seeing a dermatologist is a good first step toward confirming a diagnosis and finding relief. “Giving a complete medical history and undergoing a physical exam are the best ways to determine what’s causing the rash or hives, and if there is a more serious skin disorder behind it,” explains Joseph L. Jorizzo, MD, a professor of dermatology at Weill Cornell Medical College in New York City and Wake Forest Baptist Health University School of Medicine in Winston-Salem, North Carolina.

Hives can appear anywhere on the body, and they can change shape, travel, and disappear and reappear within short periods of time. Hives can also appear as bumps or swollen red or skin-colored welts or “wheals” with clear edges and a red center that when pressed turns white. While the cause of chronic hives is typically unknown, some common triggers include certain foods, medications, insect bites, pet dander, viral or bacterial infections, and reactions to physical stimuli like temperature and sun exposure.

5 Skin Disorders Often Confused With Hives

Hives can be mistaken for other skin disorders, such as:

Heat rash. This skin condition occurs in hot, humid weather and can be aggravated by clothing that causes friction or blocks sweat ducts. The rash of fluid-filled blisters and bumps can be itchy and sensitive. Cases of heat rash can range from mild to severe, where the bumps contain pus or affect the deeper layer of the skin. Unlike chronic hives, heat rash typically clears on its own and can be treated by cooling the skin and reducing sweating. 

Contact dermatitis. This is a common condition in which something that touches the skin causes a red rash. The reaction may be caused by an allergy to an ingredient in makeup or a particular metal in jewelry, or by continuous contact with an irritant such as soap or bleach. But whereas hives cause an itchy reaction, most people who experience contact dermatitis feel more of a stinging or burning sensation, and the reaction appears only where the skin has come in contact with the trigger. 

Rosacea. Unlike hives, which can occur anywhere on the body, rosacea is limited to the face and is characterized by redness on the cheeks, nose, chin, or forehead. Small, visible blood vessels and pimple-like bumps on the face, as well as watery or irritated eyes, are other common symptoms. Rosacea cannot be cured, but it can be controlled with the use of certain medications.

Eczema. The symptoms of eczema generally vary from person to person and can be found all over the body. Causing red, inflamed, dry, scaly, and intensely itchy skin, eczema can be difficult to distinguish from hives. As with chronic hives, the exact cause of eczema is unknown, but it’s thought to be linked with dry, irritated skin and an overactive immune system. The treatment is different from that for hives, which is why it’s important to have a doctor diagnose the skin disorder you have and recommend proper treatment.

Pityriasis rosea. This common skin disease causes a splotchy red rash that appears on the body and typically lasts around six to eight weeks, although sometimes much longer. Unlike chronic hives, pityriasis rosea usually disappears on its own without treatment.

More Serious Skin Problems

The main feature distinguishing chronic hives from more serious skin disorders is whether the welts are filled with fluid. If the red bumps are itchy, inflamed, and filled with fluid, the condition is most likely hives. If they’re hard and filled with other material besides fluid, and if after a skin test the lesions have a brownish color, there’s most likely an underlying problem.

“A lesion that looks like a hive can be circled,” says Dr. Jorizzo. “If the individual lesion lasts longer  than 24 hours, more serious urticarial lesions such as urticarial vasculitis or an urticarial lesion of bullous pemphigoid must be excluded by biopsy.”

So if you experience hives or hivelike symptoms, it’s important to see your doctor to determine the source, if possible, and discuss the appropriate treatment.

Atopic and Contact Dermatitis: How They Differ

Atopic dermatitis and contact dermatitis are both very common types of eczema—a skin condition that can cause itchy, scaly, inflammatory rashes.

While their symptoms are similar, the two have very different causes. Atopic dermatitis is a chronic skin condition characterized by inflammation of the skin (dermatitis). Most cases of atopic dermatitis are thought to occur due to a combination of genetic and environmental factors. Contact dermatitis develops when the skin comes in contact with something that triggers a reaction. Properly identifying the type of eczema is key to getting the correct treatment.

In some cases, the difference between the two is quite obvious; in other cases, it is not. Some patients can even have both atopic and contact dermatitis at the same time, making assessment more difficult.

Verywell / JR Bee

Symptoms

Both atopic and contact dermatitis can go through eczema’s three different phases.

During the acute phase, the first of the three, both types of dermatitis cause a red, itchy rash that may ooze or weep clear fluid. With contact dermatitis, small, fluid-filled blisters (called vesicles) are likely to develop, while weeping plaques (broad, raised areas of skin) are more common with atopic dermatitis. And while both conditions are extremely itchy during this phase, contact dermatitis is more likely to also cause pain and burning. If a case shows some distinction, it usually occurs in this phase.

It’s during the next phase, the sub-acute phase, that atopic dermatitis and contact dermatitis are particularly hard to tell apart. In both cases, the rashes are rough, dry, and scaly, often with superficial papules (small, red bumps).

In both cases, the chronic stage is characterized by lichenification, a scaly, leathery thickening of the skin that occurs as a result of chronic scratching.

Given that these phases are not concrete and any contrasts may or may not be pronounced, telling contact dermatitis from atopic dermatitis based on the look of the rash alone can be a challenge. That’s where some additional considerations come into play.

Location

The location of the eczema rash is an extremely important clue when differentiating between atopic and contact dermatitis.

Atopic dermatitis most classically involves the flexural locations of the skin, such as the folds of the elbows (antecubital fossa), behind the knees (popliteal fossa), the front of the neck, folds of the wrists, ankles, and behind the ears.

Since atopic dermatitis begins as an itch that, when scratched, results in a rash, it makes sense that the locations easiest to scratch are those that are affected. The flexural areas are most often involved in older children and adults, but less so in babies, simply because they have trouble scratching these particular spots. In contrast, very young children tend to get atopic dermatitis on the face, the outside elbow joints, and the feet.

On the other hand, contact dermatitis occurs at the site of an allergen exposure, and therefore can be virtually anywhere on the body. These are often areas that aren’t typically affected by atopic dermatitis; for example, on the stomach (due to nickel snaps on pants), under the arms (from antiperspirants), and on the hands (from wearing latex gloves).

Age

The age of a person experiencing an eczematous rash can be an important distinction between the two conditions as well. Most people who develop atopic dermatitis are 5 years of age or younger, while contact dermatitis is less common in young children.

While atopic dermatitis can appear for the first time in adulthood, contact dermatitis is much more common in adults.

While not a symptom itself, age can help put symptoms in context.

Atopic Dermatitis Symptoms

Contact Dermatitis Symptoms

Causes

Perhaps the most significant difference between atopic and contact dermatitis is a person’s susceptibility.

Atopic Dermatitis Mechanism

A person with atopic dermatitis often has a genetic mutation in a protein in their skin called filaggrin. A mutation in filaggrin results in a breakdown of the barriers between epidermal skin cells.

This leads to dehydration of the skin as well as the ability for aeroallergens, like pet dander and dust mites, to penetrate the skin. Such aeroallergens result in allergic inflammation and a strong itching sensation. Scratching further disrupts the skin and causes more inflammation and more itching.

An underlying propensity for allergy can also cause eczema to develop as a result of eating a food to which a person is allergic, causing T-lymphocytes (a type of white blood cell) to migrate to the skin and result in allergic inflammation. Without these underlying propensities, a person is unlikely to develop atopic dermatitis.

Contact Dermatitis Mechanism

Contact dermatitis, on the other hand, is due to a reaction to a chemical exposure directly on the skin. It occurs among a majority of the population from interaction with poison oak, poison ivy, or poison sumac (approximately 80% to 90% of people react to contact with these plants). Contact dermatitis is also common when exposed to nickel, cosmetic agents, and hair dye.

Contact dermatitis isn’t caused by an allergic process, but as a result of T-lymphocyte-mediated delayed-type hypersensitivity.

Atopic Dermatitis Causes

• Genetic susceptibility

• Common in those with allergies and asthma

• Triggers include stress, skin irritation, and dry skin

Contact Dermatitis Causes

• Topical exposure to offending substance

• Delayed hypersensitivity response

• Triggers include nickel, poison ivy/poison oak, and latex

Diagnosis

Despite similarities between the rashes, both atopic dermatitis and contact dermatitis are primarily diagnosed by visual inspection and review of a thorough medical history. Age of the person affected and the location of the rash, along with your doctor’s trained eye, are used to help differentiate between the two conditions.

In some instances, testing may be necessary.

The diagnosis of atopic dermatitis involves the presence of eczema rash, the presence of itching (pruritus), and the presence of allergies. Allergies are common in those with atopic dermatitis and can be diagnosed using skin testing or blood testing. There is no specific test to diagnose atopic dermatitis, however.

The diagnosis of contact dermatitis involves the presence of eczema rash, which is usually itchy, and the ability to determine the trigger with the use of patch testing.

A skin biopsy of both atopic and contact dermatitis will show similar features—namely, spongiotic changes in the epidermis, a swelling of the epidermal skin cells that appear like a sponge under a microscope. Therefore, a skin biopsy will not differentiate between these two conditions.

Diagnosing Atopic Dermatitis

Diagnosing Contact Dermatitis

Treatment

Treatment for both atopic and contact dermatitis is similar, with the goal of reducing inflammation and itching and preventing future breakouts.

Keeping the skin well-moisturized is recommended for both conditions, but it’s critical for atopic dermatitis. Regular application of creams or ointments helps reduce and prevent flares. Moisturizing can help soothe the skin during an active contact dermatitis flare-up, but it will not prevent contact dermatitis.

Regardless of whether the eczema rash is from atopic dermatitis or contact dermatitis, identifying and ​avoiding the cause is the main treatment modality.

Medications used to treat the conditions are similar as well, but there are differences in when and how they’re used.

• Topical steroids: A mainstay of treatment for both atopic dermatitis and contact dermatitis, these medications reduce inflammation, irritation, and itching. Over-the-counter hydrocortisone is helpful for mild cases, while prescription steroids may be needed in others.
• Oral steroids: These drugs may be used in cases of contact dermatitis where the rash is severe or widespread. Oral steroids are rarely used for atopic dermatitis.
• Antihistamines: Although they don’t clear up the rash in either condition, oral antihistamines can help relieve itching for some people.
• Phototherapy: Sometimes light therapy is used for adults with difficult-to-treat dermatitis.
• Topical calcineurin inhibitors: Elidel (pimecrolimus) and Protopic (tacrolimus) are nonsteroidal topical medications often used to treat atopic dermatitis in those ages 2 and older. They aren’t often used for contact dermatitis, except in severe cases or in those who haven’t responded to other treatments.
• Dilute bleach baths: These are recommended in certain cases to help reduce Staphylococcus aureus bacteria on the skin. Dilute bleach baths may help improve atopic dermatitis but are generally not recommended for contact dermatitis. Evidence of their effectiveness is mixed; a 2018 review study found that bleach baths improved symptoms of atopic dermatitis. A 2017 review found bleach baths did decrease the severity of atopic dermatitis, but that plain water baths were just as effective.

Atopic Dermatitis Treatment

• Regular moisturization

• Topical steroids

• Phototherapy

• Topical calcineurin inhibitors

• Dilute bleach baths in some cases

• Oral steroids rarely used

Contact Dermatitis Treatment

• Avoiding triggers

• Topical steroids

• Phototherapy

• Oral steroids in severe cases

• Topical calcineurin inhibitors rarely used

• Dilute bleach baths not used

Systemic contact dermatitis in a patient with contact sensitization to nickel

Contact dermatitis is considered a classic allergic reaction to nickel. However, in a number of cases, the development of a systemic reaction due to excessive intake of nickel into the body with food or as a result of medical manipulations is not excluded. The article discusses a case of a skin systemic reaction, manifested mainly by generalized urticaria, in a patient with previously proven skin sensitization to nickel.

Nickel content in products

Skin manifestations in patient N.

Introduction

Atopic and contact dermatitis, acute and chronic urticaria, polymorphic generalized rashes and itching are quite common in the practice of an allergist-immunologist. It is not always possible to establish the exact cause of the skin lesion.Against the background of prolonged symptomatic therapy, exacerbations periodically occur, the etiology of which remains unclear [1].

Nickel allergy can manifest itself as contact allergic dermatitis, systemic contact dermatitis, baboon syndrome, chronic urticaria, dyshidrotic and vesicular eczema, toxidermia, generalized itching, etc.

In patients with sensitization to nickel, its excessive intake into the body with food can provoke the development of generalized skin processes [2, 3].

One study [1] showed the role of a nickel-free diet in patients with idiopathic skin diseases. The study included patients with skin diseases, no atopic history and negative tests for major allergens. The positive effect of a nickel-free diet (limiting foods high in nickel) on skin has been shown. The subsequent introduction of foods with a high nickel content into the diet (provocative test) promoted the resumption of the skin process.It should be noted that nuts, legumes, tea, coffee, chocolate, cabbage, spinach, and potatoes are rich in nickel (table).

There is evidence of the role of food grade nickel in the development of systemic dermatitis in individuals with allergic contact dermatitis to nickel.

Nickel was first discovered in 1751 as a compound with arsenic. Then he belonged to the number of semi-metals, since he showed the properties of both metal and non-metal. However, it was possible to isolate it in its pure form only in 1804.

Nickel is actively used in modern industry, in particular for winding the strings of musical instruments, in the manufacture of dishes, jewelry (applying nickel to the surface of the alloy gives the product shine), furniture fittings, iron-nickel, nickel-cadmium, nickel-zinc, nickel-hydrogen batteries , ferritic materials, and also as a pigment for glass, glaze and ceramics. Nickel is used as a catalyst in many chemical engineering processes.In the aerospace industry, it is used to improve the thermal stability of alloys [4, 5]. In medicine, nickel is used to make braces (titanium nickelide), prostheses, needles, metal catheters, heart valves, endovascular devices, etc.

This metal is characterized by high heat resistance, high corrosion resistance in aggressive environments. The property of nickel, which is a part of alloys, to increase the chemical resistance of the final product is especially important in medicine: metal elements intended for long-term operation are often exposed to an aggressive environment.

It is believed that nickel enters the body through the respiratory system, is deposited in body tissues, in particular in the lungs, and is excreted by the kidneys, crosses the placenta and is excreted in breast milk. Metal is irritating to skin and mucous membranes. Carbonyl nickel (used to make surfaces shiny) is dangerous because it decomposes into nickel and carbon monoxide in the body, forming carboxyhemoglobin. As a result, a violation of the processes of cellular respiration and the formation of sulfhydryl groups of cellular enzymes.

Individuals whose professional activities are related to nickel production often suffer from nosebleeds, atrophic and subatrophic rhinitis, frequent and difficult to treat sinusitis, gray plaque resistant to removal on the tongue. With a long work experience (at least 5-10 years), chronic headache, dizziness, irritability, chronic diseases of the upper respiratory tract, epigastric pain with the formation of hypo- and anacid gastritis, and decreased appetite may appear.Liver dysfunction, moderate anemia, and a tendency to leukopenia are not excluded [6]. Nickel pneumoconiosis has been described in the literature.

Nickel poisoning can be acute or chronic. To diagnose this condition, it is recommended to determine the level of nickel in blood and urine [7].

Allergic reactions to nickel are not uncommon. Nickel ranks first among the triggers for the development of contact allergic dermatitis. Among all metals, the majority of allergic reactions are associated with nickel [8].Allergy to nickel is registered in 8-10% (in Europe up to 15%) of women and 1-2% of men [9]. Nickel hypersensitivity manifests itself in both local and systemic reactions. Redness, peeling, and vesicular rash are usually noted. More serious manifestations are not excluded – systemic dermatitis, eczema of the hands, urticaria, angioedema. Difficulty breathing, migraine attacks, chest discomfort, and heart pain are associated with systemic manifestations of nickel allergy. Such reactions are recorded in patients after cardiac surgery with implantation of nickel-containing elements.Typically, reactions develop shortly after surgery (from two days to one month) [10].

The mechanism of nickel allergy is based on a delayed allergic reaction with the activation of T-helpers of the 17th type against the background of an increase in the production of interleukin 23.

In orthodontic practice, cases of cross-reaction between nickel and palladium have been described [11].

The role of nickel in the formation of dermatitis in people with tattoos is discussed.It has been shown that the level of ions of nickel, chromium, and aluminum is increased precisely in the places of tattoos.

In cardiology and vascular surgery, endovascular interventions are performed in most patients with peripheral vascular disease. Heart surgery uses valves, staples, and other devices. Some of them are made of nickel-containing alloys. It is not by chance that in a number of situations, after the installation of such metallic biodevices, systemic reactions develop [12, 13].For example, a systemic diffuse rash has been described after placement of a stainless steel stent in a patient with a previously diagnosed nickel allergy [14]. A 56-year-old patient developed anaphylactic reaction and generalized severe urticaria after placing an implant containing nickel (mitral valve). After removal of the valve, the urticaria was completely stopped. In the course of diagnostic measures, a positive application test with nickel was obtained [10].

In patients who have undergone the placement of implants containing nickel for a funnel chest, the concentration of nickel in tissues, blood and urine increases.

Application tests are used to diagnose nickel contact allergy. They reveal the delayed-type hypersensitivity underlying most reactions to nickel.

Clinical case

Patient N. 32 years old was admitted to the allergy department with clinical manifestations of urticaria. Complaints about itchy urticarial rashes on the body with an itching intensity of up to 8-9 points (on a ten-point Visual analogue scale), the number of rashes over 50.

Allergic history: for a long period in the place of contact with jewelry made of base metals, skin rashes, which were accompanied by intense itching and were resolved by peeling. Previous testing using application tests is positive with nickel.

For emergency medical care, the patient consulted about itchy rashes on the body in large quantities during the day.

Prescribed parenteral antihistamines (AGP) of the first generation – no effect, the rash intensified.The patient was admitted to an allergy hospital.

On admission, the condition is moderate, emotionally labile, fixed on her own feelings, whiny. On the skin of the face, upper, lower extremities, torso, there is a profuse small-spotted pink rash (up to 0.5 cm in diameter), prone to fusion. Somatic status was normal.

To relieve itching and rashes, the patient was prescribed parenteral AHP therapy of the first generation, but the rash progressed and spread over the body surface, merging into giant spots.After that, therapy was started with systemic glucocorticosteroids (GCS) parenterally – prednisolone 120 mg. The rash diminished for a short period (about two hours), but then new elements began to appear in large numbers. According to the patient, eating also exacerbated the rash. The use of water, tea, bakery products, drinking yoghurts did not affect the skin process, and the use of pasta, porridge, and cottage cheese aggravated it. In addition, such manipulations as intravenous injections or blood sampling from a vein caused a sharp increase in the rash, spreading from the injection site over the entire surface of the arm (figure).

With a detailed history taking, it turned out that on the eve of the onset of urticaria, the patient purchased a coffee machine (with metal nickel-plated parts) and began to actively use it.

Based on a history of contact dermatitis for nickel, the appearance of rashes against the background of massive contact with nickel-plated metal products, a diagnosis of systemic contact dermatitis and nickel allergy was established.

Injection therapy was discontinued, and treatment with oral corticosteroids and second-generation antihistamines was started.Cooking and eating using ceramic and wooden utensils is recommended. Three days later, there was a pronounced positive dynamics of the skin process.

Complete blood count: moderate leukocytosis up to 11 × 10 ⁹ / l, without a shift in the leukocyte formula to the left, with normalization of indicators within seven days.

Most likely, systemic contact dermatitis is a consequence of the ingress of nickel with food, as well as during infusion therapy (nickel is part of the needles).

Conclusion

Given the widespread use of nickel in production and everyday life, it is important to keep in mind the potential systemic reactions to it. Skin reactions can be observed not only at the point of contact with a metal product, but also outside it.

Patients with implants of any location, persons with tattoos require special attention. It should be remembered that metal ions that make up paints and biometallic products persist for a long time in the body and come into contact with the immune system.As a result, the risk of developing an allergic reaction is increased, especially in patients with a previously diagnosed reaction to nickel.

90,000 Acute and chronic urticaria. Quincke’s edema

A classic allergic skin disease associated with impaired vascular permeability and edema, often accompanied by damage to the cardiovascular and other systems.

Etiology

Many medicines, food products; pollen, household, epidermal, bacterial and fungal allergens; alcoholic drinks.Intestinal helminths, insect bites, physical factors (cold, ultraviolet radiation, etc.), sometimes benign and malignant tumors.

Pathogenesis

Allergic disease with humoral, circulating antibodies. The main mediator of an allergic reaction is histamine. Mediators cause dilation of capillaries and increased permeability of blood vessels, which leads to hyperemia, blistering and edema.

Clinical picture

Urticaria is manifested by itching and burning of the skin against the background of the appearance of blisters.The rash can be the size of a penny coin or in the form of merging separate large foci of irregular shape. If the urticaria lasts more than 3 months, it is called chronic. With giant urticaria (Quincke’s edema), deep-lying sections of the skin and subcutaneous tissue are edema. Quincke’s angioedema, arising on the mucous membranes, can cause dysfunction of various organs and systems. With edema of the larynx, breathing difficulties up to asphyxia are possible. When localized on the mucous membranes of other organs – dysuric phenomena, symptoms of acute gastroenteritis, intestinal obstruction.Quincke’s edema lasts from several hours to several days and disappears without a trace. With food allergies, with helminthic invasion, it can take a relapsing course. With contact urticaria, arising from contact with ragweed, primrose, poison ivy (phytodermatitis), glandular contents of caterpillars, cosmetics, other haptens under production conditions, rashes can appear acutely, quickly or many hours later, when combing them, spread beyond the contact is noted of the named substances with the skin.

In childhood urticaria, small blisters appear on the background of exudative diathesis, hypersensitivity to a number of foods.

Treatment

1. Removal from contact with the allergen (see ALLERGIC RHINITIS).

2. Antihistamines (see ALLERGIC DERMATITIS).

3. Hypoallergenic diet and detoxification therapy.

4. Ascorbic acid and calcium gluconate are prescribed to improve microcirculation and reduce the permeability of the vascular wall.

5. In cases of laryngeal edema, abdominal syndrome, adrenaline solution and ephedrine solution, prednisolone or hydrocortisone are injected intravenously or intramuscularly. In case of Quincke’s edema with localization in the larynx, dehydration therapy is additionally recommended. With an increase in asphyxia and the lack of effect from the therapy, tracheostomy is indicated.

In chronic urticaria, the patient should be carefully examined to identify concomitant diseases and their correction.Hyposensitizing therapy may be recommended in the form of intravenous administration of aminocaproic acid solution in isotonic sodium chloride solution No. 5 1 time per day, or sodium thiosulfate solution, or histaglobin according to the scheme.

Antipruritic agents can be recommended topically in aerosols allergodil or histimet, or lubrication with menthol solution, citric acid solution. Antipruritic action is provided by corticosteroid ointments or creams (elokom), radon baths or hypnotherapy.

Allergic contact dermatitis: basic approaches to diagnosis, treatment and prevention | # 10/09

Allergic contact dermatitis is a classic form of delayed-type hypersensitivity reaction mediated by sensitized lymphocytes. According to a number of authors, from 1% to 2% of the population of various regions suffer from this pathology. The prevalence of the disease is higher in industrialized countries.It increases as more and more chemicals are introduced into use, which are part of drugs, cosmetic products, medical implants, household chemicals, and industrial reagents.

Unlike simple contact dermatitis, in which an irritant in all people, when exposed to the skin, causes inflammation, allergic dermatitis occurs only in sensitized individuals, that is, in people who have immune cells specific to this substance – T-lymphocytes.Contact dermatitis is often caused by harmless chemicals that normally do not cause any clinical manifestations in healthy people. But allergic dermatitis is also known in contact with aggressive agents – components of hair dyes, hair growth agents, dyes for fabrics, fur and skin, detergents, medicines, juice of poisonous plants.

A classic example of allergic contact dermatitis is dermatitis caused by plants of the sumac genus (in particular, poisonous sumac – Rhus toxicodendron), in which the rash is often linear and located on open areas of the body.

The pathogenesis of allergic contact dermatitis is based on a tuberculin-like hypersensitivity reaction of a delayed (cellular) type, the inductive phase of which begins with a local effect on the skin of low molecular weight chemicals of organic or inorganic nature. Their sensitizing (allergenic) properties depend on their ability to penetrate the skin and form stable covalent bonds with host proteins. So, dinitrochlorobenzene forms complexes in the epidermis with proteins containing a lot of lysine and cysteine.Skin lipids can also play the role of an adjuvant.

In the formation of hypersensitivity, the leading role is played by professional macrophages of the epidermis – multi-process Langerhans cells. The emerging delayed hypersensitivity is directed not only at the chemical itself, but also at the carrier protein.

Usually, at least 10-14 days pass from the moment of contact of the skin with the allergen until the development of the first clinical manifestations. The duration of the sensitization period is usually shorter for aggressive chemicals.So, according to our observations, drug allergens when applied to the skin can cause manifestations of contact dermatitis as early as 7-8 days. The most common allergenic medications are local forms of antibacterial drugs; contact allergic reactions to local anesthetics, antiseptics and latex are less common.

The location and configuration of the lesion is determined by the causative factor. The most common form of the disease is eczematous dermatitis. The disease is easily diagnosed and, as a rule, is characterized by a favorable course.The rash disappears when the pathogenic factor stops acting. To accelerate the regression of clinical manifestations, topical anti-inflammatory drugs, mainly topical glucocorticosteroids, can be used.

Etiology

According to our observations, the most common cause of allergic contact dermatitis is stainless metal alloys, from which household products are made – kitchen utensils, jewelry, watches, denim rivets, zippers, keys, as well as medical supplies – dental crowns, braces , devices for focal and extrafocal osteosynthesis.So, having analyzed 208 cases of allergic contact dermatitis that we encountered in practice in the period from 1999 to 2009, we came to the conclusion that the metals nickel, cobalt and chromium, which are part of stainless alloys, caused inflammation in 184 (88.5% ) patients.

The list of the most common, according to our data, causes of allergic contact dermatitis is given in table. one.

Pathogenesis

Allergic contact dermatitis is a delayed-type allergic reaction.An allergen that gets on the skin binds to tissue proteins, forming a compound that can cause an allergy – an antigen. Langerhans cells absorb the antigen as part of the membrane molecules of the main histocompatibility complex of the 2nd class by T-lymphocytes. Activated T-lymphocytes and Langerhans cells produce gamma-interferon, interleukins 1 and 2, which enhance the immune response and inflammatory response. Activated T-lymphocytes migrate through the lymphatic vessels to the paracortical zone of regional lymph nodes.In the lymph nodes, they undergo antigen-dependent proliferation and differentiation. Some of the “specialized” T-lymphocytes take part in the immune response, while the rest are converted into memory cells. They cause a rapid, pronounced response after repeated contact with the allergen. After the first contact with the allergen, the accumulation of T-lymphocytes that recognize it occurs, which usually lasts 10-14 days. After that, T-lymphocytes leave the regional lymph nodes in the blood and populate all the peripheral organs of the immune system.Upon repeated contact with the allergen, memory cells are activated and a rapid accumulation of effector cells of a delayed-type allergic reaction – macrophages and lymphocytes – occurs.

Histological picture

The histological picture of allergic contact dermatitis is characterized by the infiltration of the dermis by mononuclear cells, primarily near the blood vessels and sweat glands. The epidermis is hyperplastic and also infiltrated by mononuclear cells.Typically, the formation of bubbles in the epidermis, which are connected to the formation of bullae. The serous fluid filling them contains granulocytes and mononuclear cells.

Clinical manifestations

The disease, according to our data, is more common in young and middle-aged people. However, exceptions are possible. So, of the people we examined, the youngest was a one and a half year old girl with an allergy to cobalt, and the oldest patient was an eighty year old man sensitized to chromium and nickel.

In the clinic of allergic contact dermatitis, there are acute, subacute and chronic forms, as well as mild, moderate and severe.

The interval from the initial exposure to the allergen to the formation of skin hypersensitivity can vary from a relatively short (2-3 days when exposed to a strong sensitizer, for example, urushiol from the juice of plants of the Sumac genus) to a very long (several months or years in the case of a weak sensitizer, for example, salts of chromic acid or chloromethylisothiazolinone).As a rule, in an already sensitized organism, the disease develops acutely 12–72 hours after exposure to the allergen and is manifested by itching, bright hyperemia and swelling of the skin at the site of contact, against which papules, small bubbles or blisters are visible, opening and leaving weeping erosion (oozing) … Sometimes skin necrosis occurs.

The fading inflammation leaves crusts and scales. In a chronic course, peeling and lichenization appear.

For acute allergic contact dermatitis, the following stages of rash development are characteristic: erythema => papules => vesicles => erosion => crusts => peeling.For chronic course: papules => desquamation => lichenization => excoriation.

With severe allergic contact dermatitis (for example, caused by poison sumac), the patient may be disturbed by symptoms of intoxication – headache, chills, weakness and fever.

Localization of dermatitis can be any and depends on the place of contact with the allergen. So, professional allergens more often form foci of inflammation on the palmar and lateral surfaces of the hands and fingers, forearms, and allergenic metals sensitize the skin and mucous membranes in contact with rings, bracelets, zippers, jeans rivets (“jeans rivet disease”) , metal dental crowns.

Different areas of the skin are characterized by unequal susceptibility to allergic dermatitis. Inflamed and infected tissues are sensitized more often. Friction, squeezing, maceration and increased sweating contribute to the formation of allergies. In this regard, the skin of the eyelids, neck, perineum, and the anterior abdominal wall in the area of ​​contact with fasteners and buckles is more often sensitized. Often, patients do not realize that they are allergic, believing that they simply “rubbed” the skin in the area of ​​inflammation.

Allergic contact dermatitis always begins at the site of exposure to the allergen. Therefore, at the beginning of the disease, the lesion is clearly demarcated, although it often goes beyond the area of ​​the skin in contact with the allergen. In sensitized patients, the lesion may spread to other parts of the body or become generalized.

With a single contact, the disease lasts for several days or weeks. With frequent and regular contact – months and years.

Diagnostics

The localization of skin lesions usually suggests possible causal allergens. In the future, their role in the pathological process is determined when applying skin tests. For the application test, the test material is applied to the skin for 48–72 hours, and then the size of the reaction caused by the allergen is estimated.

Since allergy is always a systemic process, the skin and mucous membranes of the whole body are sensitized.Therefore, inflammation develops when an allergen is applied to any part of the skin. Nevertheless, it is technically more convenient to carry out application skin tests in the interscapular region, the outer surface of the shoulder and the inner surface of the forearm, when fixing the material on which the patient feels most comfortable during the study.

The test materials are applied to dry skin treated with alcohol, covering them with pieces of gauze and then affixing with adhesive tape (therefore, the test is called “patch”).It is convenient to use a standard test system with standardized allergens already applied to the adhesive base. Thus, in Russia the Allertest system is registered for the diagnosis of allergic contact dermatitis to 24 reagents. It is sold in a pharmacy and allows diagnostics of contact allergies to nickel sulfate, lanolin, neomycin sulfate, potassium dichromate, a mixture of local anesthetics – derivatives of caines, a mixture of fragrances, rosin, epoxy resin, a mixture of quinolines, Peruvian balsam, ethylenediamine dihydrochloride chloride, p-tert-butylphenol formaldehyde, parabens, a mixture of carbamates, a mixture of black rubbers, chloromethylisothiazolinone, quaternium 15, mercaptobenzothiazole, paraphenylenediamine, formaldehyde, a mixture of mercaptans, thiomersal and a mixture of thiuram derivatives.It is a simple and completely ready-to-use application skin examination system. Allergens are included in the hydrophilic gel, from which, when soaked, the allergen is then released. “Allertest” contains two adhesive plates on the skin, each of which has 12 allergens applied. All 24 antigens can be tested simultaneously, or the desired allergen can be cut from the plate with scissors and applied independently.

After 48–72 hours from the beginning of the setting, the flaps are removed, wait 20–30 minutes for nonspecific mechanical irritation to subside, and the severity of the reaction is taken into account.Changes in the site of contact of the skin with the allergen are quantitatively taken into account. Grading of a positive result is carried out as follows: (+) – erythema; (++) – erythema and papules; (+++) – erythema, papules, vesicles; (++++) – erythema, papules, vesicles and severe edema.

A true allergic reaction persists for 3-7 days, while a reaction caused by skin irritation disappears within a few hours. Therefore, in doubtful cases, you should re-evaluate the severity of the reaction the next day.

H1 blockers do not affect the results of application tests. Topical application of corticosteroids to the skin area selected for the test should be discontinued at least one week before the test. Taking systemic corticosteroids in a daily dose exceeding 15 mg of prednisolone can suppress even sharply positive reactions, therefore, application skin tests are performed no earlier than 7 days after the cancellation of immunosuppressive therapy. In rare cases, patients who are constantly taking corticosteroids, skin tests are performed if the dose of prednisolone does not exceed 15 mg / day.However, it should be borne in mind that in this case there is a risk of receiving false negative test results.

When conducting a patch test, it should be remembered that the procedure itself can cause sensitization in the patient. Among the substances that have the ability to cause sensitization already at the first contact, it is worth noting plant resins, paraphenylenediamine, methyl salicylate. Therefore, the application test must be justified. In addition, when conducting the test, it is necessary to exclude the possibility of nonspecific inflammation – primary skin irritation by the tested substances.For this, the test materials, if they are not included in the standard test system, should be used in concentrations that do not cause irritation in most healthy people (in the control group). The test should not be performed for acute or extensive contact dermatitis, as increased skin reactivity can lead to a false positive result. In addition, testing with a causative allergen can cause a sharp exacerbation of the skin process. Therefore, before conducting a study, the patient must be instructed in detail, drawing his attention to the fact that when severe irritation appears, he must remove the bandage with the allergen and contact the doctor.

When receiving a positive result of an application skin test, it must be remembered that it indicates only sensitization to the test substance, but is not absolute proof that this particular allergen caused dermatitis, because the possibility of prolonged and polyvalent sensitization always remains. In other words, another antigen that you have not studied can also be the cause of allergies. Therefore, when establishing a diagnosis, it is also necessary to take into account the data of anamnesis and physical examination.

Differential Diagnostics

Allergic contact dermatitis has to be differentiated from simple contact dermatitis, seborrheic and atopic dermatitis.

Simple contact dermatitis can develop as a result of damage to the epidermis by irritating chemicals (croton oil, kerosene, phenol, organic solvents, detergents, caustic soda, lime, acids, etc.) or physical impact (overheating, squeezing, compression).There is no primary sensitizing effect. Symptoms of inflammation occur immediately after exposure to an irritant, rather than 12–48 hours later as with allergic contact dermatitis. The presence of papules in acute contact dermatitis means its allergic nature. Occupational simple contact dermatitis is similar in appearance to allergic dermatitis. The patch test differentiates these conditions.

The hallmarks of seborrheic dermatitis include oily skin, as well as other signs of seborrhea and typical localization – the scalp and nasolabial folds.The affected areas are covered with greasy crusts, peel off profusely; itching is usually uncommon.

Atopic dermatitis usually begins in early childhood. The skin is dry. Itching is characteristic, which appears before the rash, and not after them, as with allergic contact dermatitis. The flexion surfaces are most often affected symmetrically. The edges of the affected areas are indistinct; there is no consistent development of elements of rashes: erythema => papule => vesicle.

In our practice, there were combined skin lesions, when allergic contact dermatitis developed on ointments and other topical dosage forms for the treatment of dermatoses. Thus, in a 45-year-old woman suffering from microbial eczema, exacerbated by the use of Zenerit (erythromycin, zinc acetate), we revealed sensitization to erythromycin, an antibiotic from the macrolide group. 3 days after discontinuation of this medication, the symptoms of exacerbation disappeared.

Three of the patients we examined, who had been receiving topically Celestoderm-B with garamycin for a long time, complained of the lack of a therapeutic effect from the use of this medication.That is, despite the use of an anti-inflammatory agent, the itching and intensity of the rash not only did not decrease, but sometimes intensified some time after the application of the medicine. During the allergological examination by the method of application testing, sensitization was established – a drug allergy to the antibiotic gentamicin (Garamicin), which is part of the drug. Replacement of the drug with the topical glucocorticosteroid Elokom after a few days led to a complete regression of the symptoms of dermatitis in all three patients.

Carrying out differential diagnostics, it is also necessary to remember about photocontact, phototoxic and true photoallergic dermatitis.

Photocontact dermatitis is caused by the interaction of a chemical and ultraviolet light in the skin. With it, rashes appear only on open, sun-exposed areas of the body. The sensitizing agent is most often drugs (tetracyclines, sulfo compounds, griseofulfin, hormonal contraceptives) or topically applied resinous extracts.In phototoxic dermatitis, skin damage is caused by the action of substances (for example, hogweed juice) that acquire toxic local irritating properties under the influence of ultraviolet rays. In true photoallergic dermatitis, the sensitizing allergen undergoes chemical changes under the influence of ultraviolet rays. In the absence of insolation, it is harmless to the patient’s body.

One of the rare types of contact allergy is contact urticaria. Depending on the pathogenesis, allergic, non-immune and combined forms of this disease are distinguished.The non-immune form develops as a result of direct exposure to the skin or mucous membranes of an agent, most often nettle, leading to the release of mediators from mast cells. Allergic contact urticaria is caused by the production of specific IgE antibodies and is related, according to the mechanism of development, to type 1 hypersensitivity. Most often it is caused by food (fish, milk, peanuts, etc.), allergens of domestic animals (saliva, wool, epithelium) and antibiotics of the penicillin series. Little is known about the combined form of contact urticaria due to the effects of both immune and nonspecific factors.This type of reaction is often thought to be triggered by ammonium persulfate, an oxidizing agent found in hair bleach.

Treatment

The treatment of allergic contact dermatitis is based on the exclusion of contact of the body with the allergen that caused the disease. In the acute stage, with edema and weeping, wet-drying dressings are shown, followed by topically applied glucocorticoids. If the rash is represented by large blisters, then they are pierced, allowing the liquid to drain; the bubble cap is not removed; dressings moistened with Burov’s liquid are changed every 2-3 hours.In severe cases, systemic corticosteroids are prescribed.

Prevention and treatment of staphylococcal and streptococcal skin infections play an important role.

Allergic contact dermatitis usually has a good prognosis. With the timely identification of the causative allergen and the elimination of contact with it, the symptoms of the disease completely regress after 1–3 weeks, and sufficient awareness of the patient about the nature and causative factors of the disease significantly reduces the possibility of chronicity and recurrence of dermatitis.

Prevention

To prevent the formation of allergic contact dermatitis, the local use of medications with a high sensitizing ability should be avoided, first of all, beta-lactam antibiotics, furacilin, antihistamines, sulfonamides and local anesthetics.

With frequent and professional contacts with low molecular weight compounds, it is necessary to use personal protective equipment for the skin, mucous membranes and respiratory tract – special protective clothing, gloves, and protective creams.

After identifying the cause of allergic contact dermatitis, carefully instruct the patient and discuss with him all possible sources of the allergen, drawing his attention to the need to stop contact with this reagent and cross-reacting substances (the most common allergens, their sources and cross-reacting substances are shown in Table 2) … For example, people who are allergic to nickel are advised not to wear stainless steel jewelry or use nickel-plated cookware.Such patients are contraindicated for implants containing nickel, including dental crowns and braces made of white metal, steel structures for osteosynthesis. Steel rivets and fasteners on jeans or other underwear are also recommended to be sealed from the inside with adhesive tape or cloth to avoid their contact with the skin.

If the dermatitis is caused by rubber gloves, they can be replaced with vinyl ones. It should also be remembered that rubber drains and other medical supplies should not be used in such patients.The use of latex condoms is contraindicated for them.

If you are allergic to formaldehyde, the patient should not use some medicines and cosmetics containing this preservative. The patient should be explained that before using medicines and cosmetics, it is necessary to familiarize himself with their composition indicated on the package.

In the case of occupational dermatitis, it is required to recommend suitable types of work to the person.

Literature

1. Harrison T.R. Internal diseases. Ed. E. Fauci, J. Braunwald and others. In two volumes. Per. from English M., Practice – McGraw-Hill (joint edition), 2002.

2. Patterson R., Grammer L. K., Greenberger P. A. Allergic diseases: diagnosis and treatment. Per. from English ed. A.G. Chuchalin. M., GEOTAR MEDICINE, 2000.

3. Popov N.N., Lavrov V.F., Soloshenko E.N. Clinical immunology and allergology.M., REINFOR, 2004.

4. Luss L. V., Erokhina S. M., Uspenskaya K. S. New possibilities for the diagnosis of allergic contact dermatitis // Russian Allergological Journal. 2008. No. 2.

5. Fitzpatrick T., Johnson R., Wolfe K. et al. Dermatology. Atlas-reference. Per. from English ed. E.R. Timofeeva. M., Practice, 1999.

E.V. Stepanova , Candidate of Medical Sciences
Research Institute of Vaccines and Serums named after V.I. I. I. Mechnikov RAMS, Moscow

Key words: allergic contact dermatitis, application skin tests, prophylactic dermatitis, allergic dermatitis, drug allergens, occupational allergens, contact allergens, metal allergy, contact dermatitis, metal dermatitis, contact urticaria.

The most common causes of allergic contact dermatitis

Major contact allergens, their sources, and the most common cross-reagents

Allergic dermatitis – prices for treatment, symptoms and diagnosis of allergic dermatitis in the “CM-Clinic”

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About the disease

Allergic dermatitis is a disease of the epidermis, characterized by skin inflammation due to contact with external irritants (allergens). The disease is not infectious and therefore cannot be transmitted from person to person.

Dermatitis is the most common skin pathology that occurs in people regardless of gender and age. According to statistics, every fifth person has at least once encountered unpleasant manifestations of allergic dermatitis.In some cases, the disease becomes a serious cosmetic and medical problem due to large areas of skin lesions and the occurrence of unpleasant symptoms – itching, burning, cracks in the skin, etc.

There are two main factors that provoke the development of the disease: the ingress of an allergen into the human blood or contact with an external stimulus. In accordance with this, doctors distinguish several forms of dermatitis, with their inherent symptoms and causes of occurrence – atopic, seborrheic, contact.

Symptoms

The severity of the clinical picture of the disease directly depends on the form of dermatitis, the cause of its occurrence, as well as on how often and how closely a person comes into contact with allergens.

When in contact with an unfavorable factor, skin inflammation occurs in the place where there was contact with the irritant. With the spread of allergenic substances through the blood, dermatitis can occur on any part of the human skin.

Symptoms of the disease, according to the type of allergic dermatitis:

With atopic dermatitis:

• red skin rash, localized in the area of ​​skin folds, face (especially on the cheeks), neck;
• Crusting when inflammation is damaged;
• dry skin;
• itchy skin.

Atopic dermatitis is characterized by frequent relapses – symptoms can periodically disappear and recur. There is also a different intensity of itching – it can be pronounced or, conversely, become almost invisible.

For contact dermatitis:

• rash on a specific area of ​​the skin in contact with an external irritant;
• appearance of small blisters on the skin;
• general malaise.

A distinctive feature of contact dermatitis is the delayed onset of symptoms.The disease does not occur immediately after contact with the allergen, but much later. This complicates the diagnosis of pathology and the identification of direct external stimuli.

For seborrheic dermatitis:

• scaly spots localized on those areas of the scalp and trunk, which have a large number of sebaceous glands;
• peeling of the head;
• dandruff;
• areas of focal redness of the skin;
• increased sebum secretion.

In some cases, hair loss occurs with seborrheic dermatitis. This is due to the blockage of the hair follicles, which interferes with their normal nutrition.

In the absence of treatment, infection can join dermatitis, as a result of which skin ulceration, necrosis, general malaise and an increase in body temperature can occur.

Causes

Allergic dermatitis occurs under two circumstances: in the presence of a negative reaction of immunity to certain substances and the effect of these substances on the human body.However, in order for the immune system to develop hypersensitivity to the stimulus, special conditions are necessary.

So, for the appearance of a reaction, preliminary (often repeated) contact with the allergen is necessary. With this effect, the immune system acquires special sensitivity and begins to fight against a foreign substance. From this, manifestations of allergic dermatitis arise.

It should be noted that not every person is susceptible to allergies. The leading role in the formation of an allergic reaction is played by heredity.If both parents have a history of allergies, the probability of an allergic reaction in a child is over 80%.

Factors provoking allergic dermatitis:

• genetic predisposition;
• hormonal disorders;
• autoimmune diseases;
• unbalanced nutrition;
• deficiency of vitamins and minerals;
• long-term antibiotic therapy;
• Frequent contact with reagents, chemicals.

Diagnostics

If a rash, redness or other manifestation of an allergic reaction occurs on the skin, seek the advice of a qualified specialist. At the initial examination, the doctor details the patient’s complaints, examines the damaged skin areas and collects anamnesis (medical history). During the conversation, the specialist determines the presence or absence of factors that provoke the onset of allergies (for example, the presence of allergies in close relatives or work in the workplace with harmful substances).

The main task of a specialist is to confirm the allergic nature of skin inflammation, identify allergens and select the most appropriate treatment for relieving symptoms and preventing relapses. For this, the patient is sent to undergo the following examinations:

• Dermatoscopy – a method of examining the skin using a dermatoscope (magnifying device). The examination allows you to exclude other pathologies manifested by changes in the skin.
• A blood test is a common laboratory test that detects inflammatory processes in the body.In the presence of allergies, an increase in the number of lymphocytes, eosinophils, and mast cells will be detected in the analysis.
• Allergy tests (allergo tests) are the most effective way to diagnose allergies, allowing you to identify allergens that cause dermatitis. The presence of a pathological reaction of immunity to an external stimulus is signaled by redness and the appearance of rashes in the area of ​​application of the allergen.

The research results allow the specialist to confirm or deny the diagnosis of allergic dermatitis, as well as to choose the optimal methods of treating the pathology.

Treatment

At the end of all studies, the patient is issued a conclusion, which indicates all common allergens and the degree of sensitivity to them. To prevent the development of allergic reactions, a person must avoid contact with these substances.

To relieve the symptoms of acute allergic dermatitis, the patient is prescribed:

• taking antihistamines of the latest generation;
• topical application of creams and ointments with anti-inflammatory and antipruritic effect;
• treatment of rashes (vesicles, ulcers) with antiseptic solutions;
• compliance with an anti-allergenic diet (for food allergies).

Doctors of the SM-Clinic medical center diagnose allergic dermatitis using high-tech equipment from renowned manufacturers. All our specialists have many years of experience in allergology and dermatology and regularly improve their professional training at scientific conferences and seminars. All this allows us to achieve high results in the treatment of allergic manifestations on the skin.

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90,000 Allergodermatosis: Causes and Diagnosis | Clinic Family Doctor

The most frequent visits to a dermatologist for medical help are allergic dermatoses (dermatitis).

Allergodermatosis is understood as a large group of skin diseases, the main cause of which is allergic reactions, these are: atopic dermatitis, allergic contact dermatitis, various forms of eczema, urticaria, allergic vasculitis, toxicoderma and others.All these diseases are characterized by the absence of age restrictions, a tendency to relapse and the appearance of additional severe allergy symptoms.

Triggering factors for the development of allergic dermatosis

• The main reason for the development of allergic dermatosis is a single or regularly repeated contact of a patient with an allergen. Such a reaction of the body can develop if a person has already had an increased sensitivity to this allergen.The reason for this sensitivity can be antigens of plants, animals and fungi, microbial agents, drugs and various chemical compounds.

• Quite often, the triggering factors are hereditary predisposition, the presence of other allergic diseases, chronic gastrointestinal diseases, endocrinopathies, etc.
• Unfavorable ecological situation. There is an increase in the population’s predisposition to allergic diseases, especially among residents of megalopolises, which is explained by the high level of environmental pollution.
• Regular contact with animals.
• Inadequate and irregular nutrition, lifestyle, stress factor, uncontrolled use of medicines and cosmetics, active use of household chemicals, etc.

What Happens to the Human Body Before Skin Symptoms Appear

Allergic skin diseases are based on changes in the responses of the immune and nervous systems.After initial contact with an allergen, the immune system remembers information about it, i.e. the body enters a state of high alert for a quick reaction to the repeated intake of the same antigen (sensitization). At this time, the person is not disturbed by any symptoms. And with the repeated introduction of this allergen, a pathological immune process begins with damage to the skin, and sometimes other organs.

Reasons to see a doctor

• Severe itching, which is often the culprit of sleep disturbances and neurosis-like symptoms.
• The appearance of papules, vesicles, blisters.
• Redness and swelling.

Later, scratching marks, scales and crusts can be observed on the skin. With prolonged inflammation caused by allergies, the skin coarsens, thickens, dries out and hyperpigments.

Can the patient independently diagnose and manage the symptoms of allergic dermatitis?

No and no again!

How and how to treat allergic dermatosis should be determined only by a doctor, since an incorrectly diagnosed and incorrectly selected self-treatment can lead not only to the spread and deterioration of the disease with a chronicity of the process, but also to subdepressive and behavioral disorders.

• Treatment is necessary complex, but primarily aimed at eliminating repeated contact of the patient with the allergen. To find out the type of allergen, the presence of cross-allergic reactions and the severity of pathological immune disorders, an immunological examination is prescribed.
• Do not forget that these diseases, as a rule, proceed against the background of deviations from the norm of the gastrointestinal tract, nervous system, mineral and carbohydrate metabolism, endocrinopathies, hereditary disorders, therefore, the symptoms of concomitant disorders are necessarily identified and eliminated.Therapy consists of systemic and external treatment that suppresses allergic inflammation and eliminates the action of triggering factors.
• The complex uses hypoallergenic diet therapy, hyposensitizing treatment, eliminates the harm associated with professional duties, and avoids household contacts with sensitizers. In addition, physiotherapy treatments are prescribed.
• To consolidate the treatment, daily skin care is required.A prerequisite is moisturizing the skin with special products, especially after bathing, and avoiding hot baths with detergents that alkalize the skin.

Thus, a timely visit to a dermatologist will provide a modern rational approach to treatment, without the development of adverse reactions, and will allow you to combat exacerbation at an early stage of the disease, controlling the course of allergic dermatosis for a long time.

Allergic contact dermatitis

Allergic contact dermatitis (ACD) is an inflammation of the skin due to exposure to an allergen.Most often, the disease develops in people who have a tendency to develop allergic reactions. In the general population, the prevalence of AKD ranges from 5 to 10%. The disease can develop in all age groups. Among adults, AKD most often occurs in women, which is explained by more frequent contact with nickel (jewelry, piercings), cosmetics and perfumes. The prevalence of allergic contact dermatitis caused by nickel is 4-5% in the general population, and 1-3% for the ingredients of cosmetic products.

Symptoms

The first symptoms of the disease appear as a result of prolonged skin contact with an allergen, which can be various chemicals (metals, etc.). In a person who has an increased sensitivity to a certain substance (allergen), the symptoms of allergic contact dermatitis appear in several stages:

1. First, redness appears on the skin. Often there is swelling of the inflamed area, as well as itching or burning sensation.
2. Later, at the site of redness, bubbles form, filled with a clear liquid, which can burst over time. This results in wet erosion areas.
3. Over time, redness and blisters spread throughout the body. Intoxication of the body occurs, which is manifested by an increase in temperature, weakness, nausea, headache, etc.

Late diagnosis and prevention of allergic contact dermatitis can exacerbate the disease.

Allergic contact dermatitis due to wearing jewelry (www.aaaai.org)

The course of the disease is often complicated by concomitant symptoms such as rhinitis, conjunctivitis, weakness.

Reasons

The main reason for the manifestation of this disease is the effect of allergenic substances on the patient’s skin. The most common allergens are:

• Food products;
• Medicines;
• Household chemicals;
• Cosmetics;
• Plant pollen;
• Wool;
• Chemical compounds.

In childhood, the factors causing this allergic disease include:

• Food products;
• Ecologically unfavorable habitat;
• Infectious diseases;
• Insect bites.

More than 3000 substances are known to cause contact dermatitis. Their number is growing every year. Most of the allergens that cause disease are low molecular weight chemical compounds, metal ions, which can easily penetrate the skin.In the ICD (International Classifier of Diseases), allergic dermatitis is classified based on the causative allergen:

L23.0 – Allergic contact dermatitis caused by metals;

L23.2 – allergic contact dermatitis due to cosmetics;

L23.3 – Allergic contact dermatitis due to drugs in contact with the skin;

L23.4 – allergic contact dermatitis due to dyes;

L23.6 – allergic contact dermatitis caused by food in contact with the skin.

Essential substances liable to cause contact dermatitis and persons at risk:

Symptom relief

Examination of the history of allergic contact dermatitis is carried out by an allergist together with a dermatologist. A suspect test is performed on intact skin to determine the cause of the allergy.

To relieve unpleasant symptoms in contact dermatitis, use local, in severe cases – systemic – glucocorticosteroids, to reduce itching – antihistamines. The use of topical corticosteroids as monotherapy can lead to the development of a fungal or bacterial infection. Due to the so-called “soaking” of the epidermis, the risk of developing a secondary infection increases, which may require additional use of antibiotics, which, in turn, pose a threat of sensitization to the patient.However, these antiallergic agents only alleviate the symptoms of dermatitis, they cannot ensure the patient’s complete recovery.

Treatment

The only effective treatment for allergic contact dermatitis is to avoid contact with the allergen.

Recommendations

To relieve the unpleasant symptoms of allergic contact dermatitis, as well as to prevent sensitization to other substances, certain guidelines must be followed:

• Limit contact with chemicals;
• Provide adequate nutrition;
• Avoid stressful situations;
• Healthy sleep 7-9 hours;
• Use clothes made from natural fabrics
• Use hypoallergenic washing powder;
• Limit the use of makeup;
• Do not take medicines without a doctor’s recommendation;
• Avoid contact with the trigger (allergen).

Allergic contact dermatitis: Causes, Symptoms of acute allergic contact dermatitis, Diagnostics

The wide prevalence of the disease among the population is evidenced by the fact that the share of allergic dermatitis among all groups of occupational diseases is 87 percent.

Causes

As the name of the disease implies, it is based on an allergic reaction caused by various types of allergens. The main thing that distinguishes allergic contact dermatitis is the speed of the reaction.If a person first encounters an allergen, then from the moment of contact until the first signs appear, it takes up to two weeks. With repeated skin contacts with an allergen, three days are enough for the development of a pronounced clinical picture. To date, more than 3000 different allergens have been identified.

By itself, skin allergy is the body’s response to exo- or endogenous contact with sometimes completely harmless particles, which are called allergens. The mechanism of development of a pathological reaction in allergies is that at the first contact of the body with an allergenic particle, human blood cells – leukocytes, perceive it as a foreign element and try to remove it from the body.

During this process, or sensitization (as it is called), a large amount of IgE immunoglobulins is produced by leukocytes, which are nothing more than an antibody to a specific foreign substance (antigen). These substances bind to antigens and activate the release into the vascular bed of inflammatory mediators – histamine and prostaglandin, which cause rash, itching, redness and other manifestations of allergy on the skin. That is, upon repeated contact with an allergen, the body already has previously formed antibodies to it, and therefore the manifestation of an allergy on the skin passes almost immediately.

Symptoms of acute allergic contact dermatitis

At the initial interaction of the skin with an allergen, the disease is considered acute, most often contact dermatitis on the hands. With repeated interactions, it goes into a chronic phase. The intensity of the symptoms depends on the duration of the interaction, the aggressiveness of the reagent, and the susceptibility of the organism.

The main symptoms include:

• local irritation and hyperemia of the skin;
• swelling;
• Intense itching and weeping, with blistering.

Symptoms of chronic allergic contact dermatitis

They are somewhat different from the acute state, in a longer and more intense severity of manifestations. The epidermis in the place of constant contact with the allergen will be thickened, dry with numerous cracks and a pronounced skin pattern.

Diagnostics

The preliminary diagnosis of contact dermatitis is made on the basis of patient complaints and during the initial examination. An accurate diagnosis is made based on tests to detect the allergen.For this purpose, the most informative method is considered to be application tests or (patch-tests). They are very simple, test plates are purchased at the pharmacy, various types of allergens are applied to them, and there can be more than ten of them on one plate.

Methodology for conducting application tests

Test strips are glued onto clean and dry skin of the back for two days. After 48 hours, carefully peel off and carefully study the result. When characteristic symptoms appear at the site of contact, namely, hyperemia, itching, and at a high degree of intensity, blisters may be present, the doctor diagnoses contact dermatitis with high accuracy and identifies the allergen.

Treatment of allergic contact dermatitis

A dermatologist is involved in the treatment of the disease. The basis of treatment is the complete exclusion of contact with the allergen, drug treatment of contact dermatitis will depend on the stage of the disease.

For skin allergies, treatment usually includes antiallergic drugs: allergy ointment and tablets for systemic effects on the body.

Skin allergy ointment can be antipruritic.Also, a skin allergy cream may contain active ingredients that prevent the development of an allergic reaction. Most often, in the treatment of skin allergies, an ointment is used on the skin based on local corticosteroids and their combinations with each other, as well as with antiseptics, wound healing, antibacterial and other components.

Tablets for allergy on the skin have their effect by blocking the influence of mediators of the inflammatory and allergic reactions. A medicine for skin allergy in the form of tablets should be prescribed by a doctor, based on the strength of the reaction, the age of the patient, his activity (since some drugs cause drowsiness, which is dangerous for drivers).

Herbal compresses can be used as a remedy for skin allergies and to treat its consequences. It is important to remember that for skin allergies, treatment with alternative methods should be combined with traditional therapy.

Allergists and dermatologists believe that corticosteroid-type drugs are the best and most effective remedy for the treatment of skin diseases of allergic origin.

If the inflammation has passed into the wet stage, then you can use agents with a drying effect.

Online search for drugs for effective treatment of dermatitis can be done through DOC.ua.

Treatment of acute dermatitis

In the acute phase of dermatitis, the use of local treatment is effective; it is enough to apply lotions in places of particular irritation and wetness. The duration of the course is two weeks, during this period, the ointment should be applied at least 2 times a day to problem areas of the skin.

Treatment of chronic dermatitis

Chronic contact dermatitis is characterized by a longer course, respectively, the treatment will be complex and much more intense and longer than in the acute phase.Corticosteroid medications are administered orally, according to an individually designed scheme by a doctor. Symptomatic treatment consists of taking antihistamines to relieve itching.

Contact dermatitis in children

In children, due to the specificity of the immune system, contact dermatitis is very common, associated with direct damage to the baby’s delicate skin with diapers or diapers. Contact dermatitis is treated quickly, it is enough to remove the irritant.

In no case is it recommended to self-medicate: all these drugs should be prescribed by a pediatrician.Treatment must necessarily be comprehensive: that is why taking medications must necessarily be accompanied by physiotherapy.

Prevention of dermatitis

All preventive measures are aimed at eliminating contact with the allergen, if this is a production factor, then it is necessary to observe precautions and use personal protective equipment as much as possible. In case of transition of allergic contact dermatitis caused by professional activity into the chronic stage, it is necessary to change jobs in order to completely exclude contact with the allergen.