The first affiliated hospital of zhengzhou

university
subject Dermatology and venerology grade Oversea student

Dept. of Dermatolog Teaching way multimedia class hour 2

The First Affiliated Hospital of
Zhengzhou University

content Contact Dermatitis,, Atopic Dermatitis

Objective
 To master the clinical features, diagnosis of contact dermatitis and atopic dermatitis

Key cocept
Contact Dermatitis
Clinical Features and Diagnosis
History: contacting irritating and allergic agents
Signs
–Patches or plaques with angular corners, geometric outlines, and sharp margins
–The skin lesions are usually restricted to contact sites
Atopic dermatitis (AD)
Etiology: Genetics of atopic dermatitis, Allergens, Immunological aspects
Clinical Features and Diagnosis
Course of dermatology

Contact Dermatitis
Miao Qing

Dept. Of dermatology
the first teaching hospital , zhengzhou university
 Contact Dermatitis

 Definition

– there are two types of dermatitis caused by

substances coming contact with the skin: irritant

dermatitis and allergic contact dermatitis.

 Contact Dermatitis

– irritant contact dermatitis is an inflammatory

reaction in the skin resulting from exposure to

a substance that causes an eruption in most

people who come in contact with it.

 Contact Dermatitis

– Allergic contact dermatitis is an acquired sensitivity to various

substances that produce inflammatory reaction in those ,and only

those , who have been previously exposed to the allergen.

 Irritant contact dermatitis

 Definition

– dermatitis caused by exposure to a substance which

has a damaging effect on the normal barrier function

of the epidermis.
 Irritant contact dermatitis

 Etiology

– alkalis (soaps , detergents, ammonia preparations,

lye, drain pipe cleaners, toilet bowl cleaners )
– acids ( hydrochloric acids, sulfuric acids and nitric
acids, phenol, acetic acid )
– other irritants ( metal salts----calcium, copper,
nickel, silver and zinc)
 clinical features

 irritant contact dermatitis may be:

 acute
 subacute
 chronic
 Irritant contact dermatitis

– acute irritant contact dermatitis is seen after one single ,

usually accidental, exposure to a strong skin irritants such

as acid, alkali, phenol. The onset is rapid and lesions

appears exactly at the sites of contact.

 Irritant contact dermatitis

 Subacute irritant contact dermatitis : there is ongoing

irritation as in infantile napkin dermatitis.
 Chronic irritant contact dermatitis: a classic
example of cumulative exposure to a mild cutaneous
irritant is “washer woman,s hands” due to continual
contact with detergents and alkalis. Chronic skin
damage then develops.
 Clinical features
 Acute irritant contact dermatitis
– after exposure to a strong irritant the affected skin
becomes reddish--brown and vesicles develop. The
lesions appear rapidly , usually within 6~12 hours of
contact, and are painful and itchy.
 Clinical features

 Subacute irritant contact dermatitis: there is erythema

with crusting and sometimes blistering. There may

also be early acanthosis and skin thickening.

 Irritant contact dermatitis

 Chronic irritant contact dermatitis tends , initially, to

present as dry, fissured areas of skin which are

susceptible to secondary infections. This is seen

typically in housewives and young mothers whose

hands are repeatedly exposed to soap, detergents, and

water.
 Treatment
 Identification of the irritant and its subsequent
avoidance is the cornerstone of successful therapy.
 The cause is identified on the patients history.
 For the active phase, a topical steroid cream or ointment
is usually the most appropriate treatment. If the lesions
are acute with vesicles and weeping , wet dressing
applied as lotions may be needed until the subacute
phase is reached, when topical steroids can be
substituted.
 The choice of topical steroid for the subacute phase is
wide , relatively strong steroid is justified.
 Treatment
 Children with napkin dermatitis should have all napkins
removed and be nursed in a warm dry environment with
the skin exposed. Lesions will rapidly resolve if this is
done and improvement will be accelerated by the use of
a mild steroid antifungal combination .
 The management of chronic is protection of the area
involved , mostly commonly the hands, from exposure to
the cause and the liberal use of emollients to replace the
lipid barrier.
 Allergic contact dermatitis
Definition

– dermatitis caused by prior exposure to an allergen

leading to specific cell-mediated sensitization.

 Allergic contact dermatitis
 Prevalence and etiology
– this form of dermatitis affects 1~2% of the
population. Certain groups patients are at greater
risk.
– Allergic contact dermatitis results when an allergen
comes into contact with previously sensitized skin.
– The allergens are extremely varied and may be
nonprotein in nature. Many substances , such as
 Allergic contact dermatitis
 Prevalence and aetiology
– dyes and their intermediates , oils, resins, coal tar
derivatives, chemicals used for fabrics, rubbers,
cosmetics , insecticides, as well as the products or
the substances of bacteria, fungi, and parasites, are
proven allergens.
– These substances do not cause demonstrable skin
changes on first contact but may produce specific
changes in the skin when the patient is reexposed to
the allergen at a subsequent time.
Pathogenesis of allergic contact dermatitis

 Allergic contact dermatitis ( ACD ) results when an

allergen comes into contact with previously sensitized
skin . ACD results from a specific acquired
hypersensitivity of the delayed type, also known as
cell-mediated hypersensitivity or immunity .
 The Langerhans cells might play a major role in the
pathogenesis of contact allergy .
 Clinical features
 ACD usually presents with acute or subacute
dermatitis lesions at sites where the allergen is , or has
been , in contact with the skin and also with milder
involvement of more distant areas where there has been
no obvious direct contact .
 In the early stages the affected area is inflamed and itchy
, with papules and vesicles. Continued exposure to the
allergen will lead to dryness , scaling ,and fissuring. The
lesions frequently spread well beyond the area of contact
with the allergen and also even to distant body sites
which have not been in contact with the allergen.
 Regional predilection

 Head and neck

– the causes may be hair dye, hair spray, shampoo.
– The forehead of a man may be the site of a hat
-band dermatitis.
– Perfume dermatitis may cause redness just under
the ears.
– Nickel sensitivity may be noted at the clasp site of
necklaces or earings.
 Regional predilection
 Arms
 the wrists may be involved because of jewelry or
the backs of watches and clasps, all of which
may contain nickel.
 Hands
 Typically occurs on the backs of the hands
and spares the palms. Poison ivy and other plant

may be the causes.

 Differences between direct irritant and
allergic contact
 Direct irritant Allergic contact
 Prevalence Very common Much less common
 Prior exposure
 to substance Not required Essential
 Affected sites Sites of direct contact Sites of contact
 with little extension and distant sites
 Susceptibility Everyone susceptible Only some patients susceptible
 Timing Rapid onset 4~12 hours Onset generally 24 h
 after contact or longer after exposure
 Lesions develop at first No lesions on first
 exposure exposure
Allergic contact dermatitis

Erythema at contact sites

Allergic contact dermatitis

erythema 、 edema
Allergic contact dermatitis
Erythema 、 papules at contact sites
Allergic contact dermatitis

Erythema and papules

at contact site
Allergic contact dermatitis

Erythema and edema

at contact site
Allergic contact dermatitis

Erythema and papules at contact site

Allergic contact dermatitis

Red patch and scales

at contact sites
Allergic contact dermatitis

Red patch

at contact sites
 Allergic contact dermatitis
Erythema and edema 、 blister and oozing

at contact sites
Allergic contact dermatitis

Erythema and edema at contact sites

 Allergic contact dermatitis

erythema 、 blister and bulla at contact sites

 Irritant contact dermatitis

Erythema and erosion ， strange shape

 Diagnosis
 history of contact substances.
 Clinical features : inflammatory reaction at the sites
that contact with the substances.
 pruritus or itching or pain.
 Self-limited course, when the allergens removed.
 Assistant examination : patch test positive.
 Treatment
 The management of ACD is divided logically into four
stages.
1. Detection of the likely sensitizing agent by taking a careful occupational ,recreational ,and medicament history.
2. Preparation for valid patch testing to identify the allergen.
3.Patch testing to the suspected substances .
4.Counselling on avoidance of responsible allergens following patch testing results.
 Treatment
 Systemic therapy
– corticosteroids : the acute stage of severe contact dermatitis
characterized by blistering, swelling and oozing is best
managed with adequate doses of systemic corticosteroids.
Eg: Prednisone 60~100 mg initially .
– antihistamines
 topical therapy
– corticosteroids are the only rational medicaments for
therapy of contact dermatitis. Eg: cream pevisone, cream
Eloson.
 Differential diagnosis
 Acute eczema  Contact dermatitis
Etiology  simple
complex

Affected sites widely affected ,  restricted to contact sites
usually symmetric, unclear  Clear boundary
boundary

Shapes of lesions multiforms  Simply shape , erythema and

,erythema\blister\papules\oozin bulla
g  Short , when elimination of
 Duration usually relapse contact
Differential diagnosis