Allergic contact dermatitis

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997

Allergic contact dermatitis is an itchy skin condition caused by an allergic reaction to material (the allergen) in contact with the skin. It arises some hours after contact with the responsible material, and settles down over some days providing the skin is no longer in contact with it. In severe cases contact allergic dermatitis may be followed by generalised autoeczematisation (id reaction). Ingestion of a contact allergen is usually safe, but rarely may lead to baboon syndrome or generalised systemic contact dermatitis.

Contact dermatitis should be distinguished from contact urticaria, in which a rash appears within minutes of exposure and fades away within minutes to hours. The allergic reaction to latex is the best known example of allergic contact urticaria.

Allergic contact dermatitis is also distinct from irritant contact dermatitis, in which a similar skin condition is caused by excessive contact with irritants. Irritants include water, soaps, detergents, solvents, acids, alkalis, and friction. Irritant contact dermatitis may affect anyone, providing they have had enough exposure to the irritant, but those with atopic dermatitis are particularly sensitive. Most cases of hand dermatitis are due to contact with irritants.

Allergy is the term given to a reaction by a small number of people to a substance (known as the allergen) which is harmless to those who are not allergic to it. Only small quantities of allergen are necessary to induce the reaction. Contact allergy occurs predominantly from the allergen on the skin rather than from internal sources or food. The first contact does not result in allergy; often the person has been able to touch the material for many years without adverse reaction.

Clinical features of contact allergic dermatitis

The dermatitis is generally confined to the site of contact with the allergen, although severe cases may extend outside the contact area or it may become generalised. Sometimes the allergen is transmitted from the fingers so unexpected sites can be affected eg the eyelids and genitals. Dermatitis is unlikely to be due to a specific allergen if the area of skin most in contact with that allergen is unaffected. The affected skin may be red, swollen and blistered or dry and bumpy.

Some typical examples of allergic contact dermatitis include:

More images of allergic contact dermatitis:

Some substances are particularly prone to cause contact allergy. In New Zealand, contact with plants related to the Japanese Wax Tree (Toxicodendron succedanium) results in allergic dermatitis in the majority of people, characteristically resulting in severe blisters and swelling.

Other common allergies are to nickel (jewellery), fragrances, preservatives, rubber (gloves), dye (hair colourants), adhesives of various kinds, and topical medications such as antibiotics. There is a very long list of materials that have caused contact allergy in a small number of individuals.


Sometimes contact allergy arises only after the skin has been exposed to ultraviolet light. The rash is confined to sun exposed areas even though the allergen may have been in contact with covered areas. This is called photocontact dermatitis.

Examples of photoallergy include:

Testing for contact allergy

Sometimes it is easy to recognise contact allergy and no specific tests are necessary. The rash usually (but not always) completely clears up if the allergen is no longer in contact with the skin, but recurs even with slight contact with it again.

The open user test is used to confirm contact allergy to a cosmetic such as a moisturiser. The product under suspicion is applied several times daily for several days to a small area of sensitive skin. The inner aspect of the upper arm is suitable. Contact allergy is likely if dermatitis arises in the treated area.

If you think you may have a contact allergy, consult a dermatologist to have patch tests performed. An open application test to a product may also be recommended.

Treatment of contact allergic dermatitis

It is important to recognise how you are in contact with the responsible substance so that, where possible, you can avoid it.

Active dermatitis is usually treated with the following:

Contact allergy may disappear but often persists indefinitely.

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