Contact dermatitis is a common occupational disease and occurs at home to cosmetics, skin care products and to other chemicals. Outdoors plants are common causes of contact dermatitis; poison ivy is prototype of a skin irritant that produces dramatic inflammation on contact.  Textile dyes in clothing are a common source of skin problems. Contact dermatitis has been divided into two categories:

1. allergic contact dermatitis  2. and irritant contact dermatitis

Both allergic contact dermatitis and irritant contact dermatitis have similar presentations. Acute skin lesions may be red, swollen and weeping; crusting lesions may appear after a few days. In chronic cases skin reddening, scaling and fissuring are common. The distribution of the lesions may provide clues to the irritant or allergen trigger. Identifying and removing the contact solves the problem.

Our strategy of managing skin diseases is to treat them as ecological problems. You get better results if you assume that several factors interact to produce skin disease than if you assume that each disease has a single cause and single cure. The skin is a meeting place for disease- causing agents coming from the outside and the inside at the same time. Skin irritants and allergens combine forces to produce skin chronic skin disease. Food allergy and contact allergy may be two expressions of the same or similar antigens. Food allergy may start eczema, and the inflamed skin, in turn, becomes more vulnerable to irritants, allergens and infections.

Allergic Contact Dermatitis

Allergic contact dermatitis is a delayed, type IV allergic reaction. Latex rubber is a well recognized source of contact reactions. Healthcare personnel. now wear latex gloves routinely in all patient encounters and sensitization estimates go as high as 40%.  Patients who have been sensitized to skin-contact allergens may develop generalized eczematous inflammation if these allergens or chemically related substances are ingested. For example, a patient with a history of nickel allergy may get a widespread involvement after eating foods rich in nickel. Patients sensitized to latex may cross-react to bananas and kiwifruit. Patients sensitized to topical ethylenediamine may develop generalized inflammation following treatment with aminophylline. 

Contact urticaria is a local immediate or delayed hive-like reaction reaction at the site of contact . The skin contact may also cause a generalized allergic reaction with rhinitis, asthma, or anaphylaxis.  Natural rubber latex, for example can cause contact urticaria. Symptoms vary from mild itching to asthma and anaphylaxis. Ethylene oxide, isocyanates, chloramine-T, epoxy resins and nickel sulphate have caused IgE-mediated skin reactions.

Ahmed and Richardson described patients with hand dermatitis; their occupations were in healthcare, followed by laborers, service workers, and machinists/mechanics. The most commonly positive patch tests were: formaldehyde & releasers, other preservatives, fragrances, rubber, nickel, and neomycin/bacitracin. [i]

Bacitracin is an antibiotic that is used in several types of consumer products, including cosmetics and ophthalmic and skin ointments. Bacitracin is often combined with two other antibiotics, polymyxin and neomycin, in first aid antibiotic products (Polysporin). Increasing reports of allergic contact dermatitis reactions and near fatal anaphylaxis  concerns the  North American Contact Dermatitis Group.

Allergic contact dermatitis of the feet may be caused by rubber and leather components of shoes; substances identified by patch testing included  chromated leather,  p-tert butylphenol formaldehyde resin, dithiodimorpholine, 2- mercaptobenthiazole, thiurams and isocyanates.

Textile contact dermatitis often presents itching and red patches with or without fine skin peeling. Huntley suggests: “Usually these lesions develop at sites where the garments fit tightly, such as inner and posterior thighs, back of knees, buttocks, waistband area, and anterior and posterior axillary folds.”

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