eMedicine Specialties > Emergency Medicine > Dermatology

Dermatitis, Contact: Follow-up

Author: Bradley D Shy, MD, Staff Physician, Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center
Coauthor(s): David Todd Schwartz, MD, Associate Professor of Emergency Medicine, New York University School of Medicine; Attending Physician, Department of Emergency Medicine, Bellevue Hospital Center and New York University Medical Center
Contributor Information and Disclosures

Updated: Sep 22, 2009

Follow-up

Inpatient & Outpatient Medications

  • Acute contact dermatitis (mild, moderate)  
    • Astringents with wet compress
    • Topical steroids (ointments are recommended over creams)
    • Systemic antipruritics
  • Acute allergic contact dermatitis (ACD) with marked edema and bullae (severe) - Above treatment with addition of systemic steroids
  • Acute irritant contact dermatitis (ICD) secondary to strong acids and alkalis (severe) - Prolonged irrigation with water; further treatment same as for burns
  • Chronic dermatitis - Topical steroids, emollients, and barrier agents

Deterrence/Prevention

  • Prevention is better than cure.
  • The most important part of treatment is to identify and eliminate further exposure to the causative agent.
  • Use appropriate protective clothing. Rubber-based products protect against water-based products but not solvents.

Complications

  • Treat secondary bacterial infections with systemic antibiotics.

Prognosis

  • Following adequate removal of the offending agent, the prognosis for both irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) tends to be excellent.
  • Most contact dermatitis resolves without intervention in 4-6 weeks if further exposure is prevented.
  • Long-term success in treatment is poor if the physician does not identify the etiology.

Patient Education

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, John A Michael, MD, to the development and writing of this article.



More on Dermatitis, Contact

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

  1. Wolff K, Johnson RA, Suurmond D. Contact dermatitis. In: Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology. 5th ed. New York: McGraw-Hill; 2005.

  2. Engkilde K, Menne T, Johansen JD. Inverse relationship between allergic contact dermatitis and type 1 diabetes mellitus: a retrospective clinic-based study. Diabetologia. Apr 2006;49(4):644-7. [Medline].

  3. Spoo J, Elsner P. Cement burns: a review 1960-2000. Contact Dermatitis. Aug 2001;45(2):68-71. [Medline].

  4. Agin PP, Ruble K, Hermansky SJ, McCarthy TJ. Rates of allergic sensitization and irritation to oxybenzone-containing sunscreen products: a quantitative meta-analysis of 64 exaggerated use studies. Photodermatol Photoimmunol Photomed. Aug 2008;24(4):211-7. [Medline].

  5. [Guideline] SGNA Practice Committee. Guideline for preventing sensitivity and allergic reactions to natural rubber latex in the workplace. Gastroenterol Nurs. May-Jun 2008;31(3):239-46. [Medline].

  6. Modi GM, Doherty CB, Katta R, Orengo IF. Irritant contact dermatitis from plants. Dermatitis. Mar-Apr 2009;20(2):63-78. [Medline].

  7. Edwards L. Acute allergic contact dermatitis. In: Dermatology in Emergency Care. New York: Churchill Livingstone; 1997:53-55.

  8. [Guideline] American Academy of Allergy, Asthma and Immunology, American College of Allergy, Asthma and Immunology. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol. Sep 2006;97(3 Suppl 2):S1-38. [Medline]. [Full Text].

  9. Ong PY, Boguniewicz M. Atopic dermatitis and contact dermatitis. Clin Pediatr Emerg Med. 2007;8(4):81-86.

  10. Arndt KA. Archives of Dermatology. Second century. Arch Dermatol. Jan 1984;120(1):42-3. [Medline].

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Further Reading

See Contact Dermatitis for an excellent review of contact dermatitis with a focus on the pediatric population. 9

An illustrated summary of contact dermatitis with special attention to the presentation in the ED can be found in the chapter on this disease in Dermatology in Emergency Care by Libby Edwards. 7

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Keywords

allergic contact dermatitis, ACD, cell-mediated type IV delayed hypersensitivity reaction, contact allergen, contact urticaria, ICD, irritant contact dermatitis, diaper dermatitis, photodermatitis, photoallergic reactions, phototoxic reactions, photodermatitis, poison ivy, poison oak, poison sumac, rhus dermatitis, Toxicodendron, type I IgE-mediated reaction

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Contributor Information and Disclosures

Author

Bradley D Shy, MD, Staff Physician, Department of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center
Disclosure: Nothing to disclose.

Coauthor(s)

David Todd Schwartz, MD, Associate Professor of Emergency Medicine, New York University School of Medicine; Attending Physician, Department of Emergency Medicine, Bellevue Hospital Center and New York University Medical Center
David Todd Schwartz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Mark Louden, MD, FACEP, Assistant Medical Director, Emergency Department, Duke Raleigh Hospital
Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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