eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Dermatitis, Contact: Differential Diagnoses & Workup

Author: R Scott Lowery, MD, Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Center, Arkansas Children's Hospital
Contributor Information and Disclosures

Updated: Oct 30, 2009

Differential Diagnoses

Cellulitis, Preseptal
Keratitis, Bacterial
Conjunctivitis, Allergic
Keratitis, Fungal
Conjunctivitis, Bacterial
Keratitis, Interstitial
Conjunctivitis, Giant Papillary
Keratoconjunctivitis, Atopic
Conjunctivitis, Viral
Keratoconjunctivitis, Sicca
Dermatitis, Atopic
Red Eye Evaluation

Workup

Other Tests

Patch testing is the criterion standard for diagnosing contact dermatitis. A small portion of the suspected offending agent is placed on the skin and patched for 48 hours. A low dose of the test substance is used to avoid irritation as much as possible. Allergic responses may take longer than 72 hours to become evident. Irritants will show a response in a few hours. If irritation occurs, the substance may be falsely identified, which is the major weakness of this test.

Histologic Findings

Histologically, appearance varies with the clinical spectrum of the disease. With mild contact dermatitis, simple parakeratosis and hyperkeratosis with intracellular edema and small infiltrates are seen. Early in the disease, neutrophils commonly are seen (more often in irritant contact dermatitis than in allergic dermatitis). With chronic disease, ballooning degeneration and frank necrosis may be appreciated. Hyperpigmented lesions show melanin-laden macrophages in the upper dermis with basal pigmentation.

More on Dermatitis, Contact

Overview: Dermatitis, Contact
Differential Diagnoses & Workup: Dermatitis, Contact
Treatment & Medication: Dermatitis, Contact
Follow-up: Dermatitis, Contact
References
Further Reading
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References

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  14. Kulkarni PS, Meredith TA. Steroids in ocular therapy, antiallergic therapies. In: Zimmerman TJ, ed. Textbook of Ocular Pharmacology. Lippincott Williams & Wilkins; 1997:61-74, 363-85, 609-33, 683-701, 801-4.

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  18. Marks JG, Martini MC. Contact dermatitis and contact urticaria. In: Principle and Practice of Dermatology. 2nd ed. Churchill Livingstone; 1996:419-427.

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Keywords

contact dermatitis, contact allergy, contact sensitivity, dermatitis venenata

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Contributor Information and Disclosures

Author

R Scott Lowery, MD, Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Center, Arkansas Children's Hospital
R Scott Lowery, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Jack L Wilson, PhD, Distinguished Professor, Department of Anatomy and Neurobiology, University of Tennessee at Memphis
Jack L Wilson, PhD is a member of the following medical societies: American Association of Anatomists, American Association of Clinical Anatomists, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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