eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Contact Dermatitis: Differential Diagnoses & Workup

Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Contributor Information and Disclosures

Updated: Aug 6, 2009

Differential Diagnoses

Angioedema
Dyshidrotic Eczema
Atopic Dermatitis
Herpes Simplex Virus Infection
Burns, Chemical
Impetigo
Burns, Electrical
Scabies
Burns, Thermal
Sunburn
Candidiasis
Systemic Lupus Erythematosus
Child Abuse & Neglect: Physical Abuse
Varicella
Diaper Dermatitis
Zoster

Other Problems to Be Considered

Insect bites
Erysipelas
Erythema multiforme
Nummular eczema
Lichen simplex chronicus
Xerosis
Asteatotic eczema
Bullous disorders (eg, bullous pemphigoid, pemphigus, epidermolysis bullosa)
Tinea
Jellyfish envenomation
Lupus erythematosus in infants and children

Workup

Laboratory Studies

  • Laboratory studies are generally of little value in proving a diagnosis of contact dermatitis. However, they may be of value in eliminating some disorders from the differential diagnosis.

Other Tests

  • Patch testing may suggest or confirm the etiologic agent in allergic contact dermatitis. By placing standard concentrations of common allergens or specific ingredients of an implicated product on the skin and leaving them covered for 2 days, one may identify the allergen. If the patient has been previously sensitized to one of the agents under occlusion, this reexposure produces the elicitation phase of a type IV hypersensitivity reaction resulting in pruritus, erythema, and vesiculation.
  • For patients with nickel allergy, a simple procedure exists to test jewelry for the presence of nickel. Trace amounts of nickel can be detected using the dimethylgloxime (DMG) spot test. Two or 3 drops of 1% DMG and 10% hydroxide solution are placed on a white cotton-tipped applicator. The applicator tip is then rubbed against metallic areas of the jewelry. The appearance of a pink color on the applicator tip is a positive result and proof of the presence of nickel. This test is nondestructive. DMG test kits are inexpensive and available from many medical supply stores.

Procedures

  • Biopsies are of little diagnostic help in contact dermatitis. Most types of contact dermatitis show very similar pathologic changes, and allergic and irritant contact dermatitis may not be distinguished with certainty in all cases. However, skin biopsy findings may serve to eliminate some conditions included in the differential diagnosis.

Histologic Findings

  • Histologic findings in contact dermatitis are not usually helpful in identifying the specific cause of the contact dermatitis.
  • Findings in acute contact dermatitis include intercellular edema in the epidermis and vesiculation or blister formation.
  • Mast cells may be increased in urticarial reactions.
  • Chronic contact dermatitis shows signs of lichenification and varying degrees of nonspecific inflammation.

More on Contact Dermatitis

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

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Further Reading

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Keywords

contact dermatitis, allergic contact dermatitis, ACD, dermatitis venenata, contact eczema, rhus dermatitis, poison ivy, poison oak, poison sumac, irritant contact dermatitis, ICD, primary irritant dermatitis, photo contact dermatitis, photoallergic contact dermatitis, phototoxic contact dermatitis, berloque dermatitis, contact urticaria, hives, whelps, eczematous dermatitis, acute caustic burn, cold urticaria, cholinergic urticaria, dermatographism, pressure urticaria, aquagenic pruritus, aquagenic urticaria, solar urticaria, heat urticaria, papular urticaria, exercise-induced urticaria, latex allergy, sunburn, nickel allergy, hyperpigmentation, folliculitis, melanoderma, Umbelliferae family

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Contributor Information and Disclosures

Author

Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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