eMedicine Specialties > Ophthalmology > Dermatologic Disorders

Dermatitis, Contact

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

Introduction

Background

Contact dermatitis is probably the most commonly encountered immunologic disease by dermatologists. In 1895, Jadassohn described contact allergy to mercury and is regarded as the father of contact dermatitis. Prior to this described observation, few physicians recognized the concept of contact hypersensitivity.

The field began to grow in the 1920s with further studies describing the phenomenon and has culminated in the modern era, present day, when volumes of information on the topic are available. Entire books are available listing compounds that have been noted to cause the disease process. An example is Fisher's Contact Dermatitis, a 1,117 page text that breaks down the subject by occupation, plants, and every other conceivable classification.1

Pathophysiology

Contact dermatitis is due to either allergic reaction or, more commonly, irritant exposure. Irritants usually are acids, alkalis, resins, or other chemicals and frequently are found in drugs, dyes, plants, preservatives, cosmetics, and metals. Excessive moisture also may act as an irritant.

Irritants (as small molecular weight haptens) form a complete antigen by binding to dermal proteins and causing a sensitization (of T lymphocytes) on first contact and an inflammatory response on subsequent exposure. Allergic contact dermatitis occurs in sensitized individuals through the mechanism of type IV, cell-mediated immunity. Reexposure to sensitized antigens causes delayed hypersensitivity.

Frequency

United States

Incidence is extremely common; estimates vary.

Race

No racial predisposition seems to exist.

Sex

Men and women appear to be affected equally.

Age

With regard to irritant contact dermatitis, all age groups appear to be affected in similar proportions. Allergic contact dermatitis generally does not occur in children younger than 5 years or in elderly individuals because their immune systems do not respond to antigens in this manner.

Clinical

History

Patients will have a history of exposure to an offending substance; in ophthalmology, it is most commonly topical ocular medications, such as neomycin, atropine, and preservatives (frequently benzalkonium chloride), and glaucoma medications. Of course, many common household items can be the culprit. In general, patients often have a history of exposure, through work or recreation, to a different environment than usual.

Physical

  • Early contact dermatitis is characterized by erythema, edema, chemosis, eyelid induration, and exudative vesicular lesions. Chronic scaling, crusting, eczema, and lichenification occur.
  • Areas of exposure to the offending substance are frequently the hands, face, arms, legs, and neck, and may give clues to the origin of the irritant or allergen.
  • Irritant lesions usually occur 1-2 hours after exposure. Allergic lesions do not usually appear until 48 hours after exposure.
  • In the eye, conjunctivitis with a papillary or cobblestone appearance, chemosis, injection, and tearing frequently occur.
  • Blepharitis also may occur and may be accompanied by a keratitis. This keratitis frequently is appreciated as small yellow opacities near the limbus, often described as a fine punctate keratitis.
  • Patients whose rash occurs in an elongated or linear pattern often will have had exposure to a plant, such as poison ivy or oak.

Causes

Irritant and/or allergen exposure causes contact dermatitis. Frequently encountered agents that may be responsible include drugs, soaps, lotions, cosmetics, metals, foods, dyes, preservatives, and plants. The list is almost endless, but the offending agent will have been encountered within 72 hours (if an allergic reaction) and within a few hours (if an irritant).2,3,4,5

Recent studies have shown an increase in positive patch test reactions to carbamates, balsam of Peru, thimerosal, formaldehyde, imidazolidinyl urea, and methyldibromoglutaronitrile.6 The rates of positive reactions to Dimethylol dimethyl (DMDM) hydantoin, diazolidinyl urea, and methylchloroisothiazolone/methylisothiazolone remained unchanged. All other antigens were noted to decrease during the studied time period.

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

  1. Rietschel RL, Fowler JF. Fisher's Contact Dermatitis. 4th ed. Lippincott Williams & Wilkins; 1995.

  2. Geraut C, Tripodi D, Brunet-Courtois B, Leray F, Geraut L. Occupational dermatitis to epoxydic and phenolic resins. Eur J Dermatol. Apr 7 2009;[Medline].

  3. Pontén A, Dubnika I. Delayed reactions to reusable protective gloves. Contact Dermatitis. Apr 2009;60(4):227-9. [Medline].

  4. Helaskoski E, Kuuliala O, Aalto-Korte K. Occupational contact urticaria caused by cyclic acid anhydrides. Contact Dermatitis. Apr 2009;60(4):214-21. [Medline].

  5. Glick ZR, Saedi N, Ehrlich A. Allergic contact dermatitis from cigarettes. Dermatitis. Jan-Feb 2009;20(1):6-13. [Medline].

  6. Tudela E, MacPherson C, Maibach HI. Long-term trend in patch test reactions: a 32-year statistical overview (1970-2002), part II. Cutan Ocul Toxicol. 2008;27(3):187-202.

  7. Bourke J, Coulson I, English J. Guidelines for the management of contact dermatitis: an update. Br J Dermatol. Mar 19 2009;[Medline].

  8. Ayala F, Fabbrocini G, Bacchilega R. Eyelid dermatitis: an evaluation of 447 patients. Am J Contact Dermat. Jun 2003;14(2):69-74. [Medline].

  9. Cohen DE. Contact dermatitis: a quarter century perspective. J Am Acad Dermatol. Jul 2004;51(1 Suppl):S60-3. [Medline].

  10. Friedlander MH. Contact dermatitis. In: Current Ocular Therapy. 5th ed. Elsevier Science; 2000:143-146.

  11. Garrott HM, Walland MJ. Glaucoma from topical corticosteroids to the eyelids. Clin Experiment Ophthalmol. Apr 2004;32(2):224-6. [Medline].

  12. Guin JD. Eyelid dermatitis: experience in 203 cases. J Am Acad Dermatol. Nov 2002;47(5):755-65. [Medline].

  13. Kanski JJ. Disorders of the conjunctiva. In: Clinical Ophthalmology: A Systematic Approach. 4th ed. Elsevier Science; 1999:69-75.

  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.

  15. Kutting B, Brehler R, Traupe H. Allergic contact dermatitis in children: strategies of prevention and risk management. Eur J Dermatol. Mar-Apr 2004;14(2):80-5. [Medline].

  16. Kwan TH. Spongiotic dermatitis. In: Textbook of Dermatopathology. McGraw-Hill Co; 1998:17-32.

  17. Manni G, Centofanti M, Sacchetti M. Demographic and clinical factors associated with development of brimonidine tartrate 0.2%-induced ocular allergy. J Glaucoma. Apr 2004;13(2):163-7. [Medline].

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

  19. Roy FH. Ocular Differential Diagnosis. 6th ed. Lippincott Williams & Wilkins; 2000.

  20. Weisbecker CA, Fraunfelder FT, Rhee D. Physicians' Desk Reference for Ophthalmology. 28th ed. Medical Economics Co; 2000.

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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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