Contact Dermatitis

Inflammatory ICD: L25

Also known as: Allergic Contact Dermatitis, Irritant Contact Dermatitis

Description

Contact dermatitis is an inflammatory skin reaction caused by direct contact with an external substance. Irritant contact dermatitis (ICD) is more common and results from direct chemical damage, while allergic contact dermatitis (ACD) involves a delayed type IV hypersensitivity reaction. It is one of the most common occupational skin diseases.

Symptoms

  • Erythema and oedema at contact site
  • Vesicles and bullae (acute phase)
  • Pruritus (often intense in ACD)
  • Dryness, fissuring, and scaling (chronic phase)
  • Well-demarcated borders corresponding to contact area
  • Lichenification with chronic exposure

Causes & Triggers

  • Irritants: soaps, detergents, solvents, water (ICD)
  • Allergens: nickel, fragrances, preservatives, rubber (ACD)
  • Cosmetic ingredients (parabens, formaldehyde releasers)
  • Topical medications (neomycin, bacitracin)
  • Occupational exposure (healthcare workers, hairdressers)

Severity Classification

Mild Localised erythema and dryness, minimal vesiculation
Moderate Spreading erythema, vesicles, significant pruritus
Severe Widespread bullous reaction, secondary infection, inability to work

Treatment Ladder

  1. 1 Identification and avoidance of causative agent (most important step)
  2. 2 Mild: Emollients and low-potency topical corticosteroids
  3. 3 Moderate: Medium-to-high-potency topical corticosteroids
  4. 4 Severe / Extensive: Short course of oral prednisolone
  5. 5 Chronic: Steroid-sparing agents (tacrolimus, pimecrolimus)

Relevant Compounds

Allantoin

Skin protectant and soothing agent

Allantoin is a naturally occurring nitrogenous compound found in botanical extracts (particularly co…

Aloe Vera

Anti-inflammatory soothing agent

Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…

Ceramides

Barrier repair — restores disrupted lipid barrier

Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…

Cholesterol

Barrier restoration — replenishes lipid matrix disrupted by irritant or allergic insult

Cholesterol is an essential component of the stratum corneum lipid matrix, constituting approximatel…

Dimethicone

Barrier protection — shields skin from contact allergens and irritants

Dimethicone is an FDA-approved skin protectant and the most commonly used silicone in dermatological…

Glycerin

Hydration support — maintains skin moisture during barrier recovery

Glycerin is the most widely used humectant in skincare and cosmetic formulations. A naturally occurr…

Hyaluronic Acid

Hydration support for damaged skin

Hyaluronic acid is a naturally occurring glycosaminoglycan found abundantly in the dermis and epider…

Hydrocortisone

First-line low-potency topical steroid for mild cases

Hydrocortisone is a low-potency topical corticosteroid identical to endogenous cortisol. It is the m…

Palmitamide MEA

Anti-inflammatory lipid — downregulates pro-inflammatory cytokine cascade and reduces irritant/allergic contact dermatitis symptoms

Palmitamide MEA (palmitoylethanolamide / N-palmitoylethanolamine) is an endogenous fatty acid amide …

Panthenol

Promotes wound healing and barrier recovery

Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…

Petrolatum

Protective barrier — shields damaged skin from further irritant/allergen exposure and aids healing

Petrolatum is the gold standard occlusive agent in dermatology, reducing transepidermal water loss (…

Shea Butter

Barrier-protective emollient — provides occlusive moisture seal and anti-inflammatory support during skin barrier recovery

Shea butter is a fat extracted from the nuts of the African shea tree (Vitellaria paradoxa). It is u…

Squalane

Emollient — non-irritating lipid replacement

Squalane is the hydrogenated (saturated) form of squalene, a naturally occurring lipid produced by h…

Recommended Drugs

Cortaid OTC hydrocortisone for acute flares

Suggested Cosmetics

Advantan Cream (Methylprednisolone Aceponate 0.1%) Potent steroid for allergic contact dermatitis Bioderma Sensibio Light Cream Hypoallergenic moisturiser for irritated skin CeraVe Moisturising Cream Ceramide cream for compromised barrier Cetaphil Gentle Skin Cleanser Minimalist formula safe for irritated skin Cetaphil Moisturising Cream Barrier repair cream for damaged skin Desonate Gel (Desonide 0.05%) Mild steroid for sensitive-area contact dermatitis Diprovate Cream (Betamethasone Dipropionate 0.05%) Potent steroid for moderate-to-severe contact dermatitis Dot & Key Ceramide & Hyaluronic Acid Moisturiser Gentle ceramide-based moisturiser for damaged barrier Earth Rhythm Phyto Ceramide Deep Moisture Cream Gentle ceramide cream for irritated skin Elidel Cream (Pimecrolimus 1%) Steroid-sparing agent for chronic contact dermatitis Elocon Cream (Mometasone Furoate 0.1%) Potent steroid for acute contact dermatitis Eumovate Cream (Clobetasone Butyrate 0.05%) Moderate steroid for mild contact dermatitis on sensitive areas Flutivate Cream (Fluticasone Propionate 0.05%) Moderate steroid for contact dermatitis Fusiderm B Cream (Fusidic Acid 2% + Betamethasone 0.1%) Antibiotic-steroid combination for infected contact dermatitis Locoid Cream (Hydrocortisone Butyrate 0.1%) Mild-moderate steroid for mild contact dermatitis Physiogel AI Calming Relief Cream Barrier repair for irritant-damaged skin Re'equil Ceramide & Hyaluronic Acid Moisturiser Ceramide-based barrier repair for damaged skin Tacroz Ointment (Tacrolimus 0.03% / 0.1%) Steroid-sparing option for chronic contact dermatitis Tenovate Cream (Clobetasol Propionate 0.05%) Superpotent steroid for severe acute contact dermatitis Venusia Max Intensive Moisturising Cream Barrier-repair emollient for damaged skin

Lifestyle Tips

  • Patch testing is essential for identifying allergens in ACD
  • Use fragrance-free, hypoallergenic skincare products
  • Wear protective gloves for occupational or household chemical exposure
  • Apply emollients frequently to restore and maintain barrier function
  • Keep a contact diary to identify triggering substances

When to Refer

  • Need for patch testing (allergic contact dermatitis suspected)
  • Occupational contact dermatitis (medicolegal implications)
  • Widespread or severe reaction not responding to topicals
  • Secondary infection requiring systemic antibiotics