Allergic contact dermatitis (ACD) is one of the forms of contact dermatitis, in which there occur an allergic reaction on the part of skin on contact with a substance and the other type of contact dermatitis is irritant contact dermatitis (ICD).
Allergic contact dermatitis is less common than irritant contact dermatitis, allergic contact dermatitis is the most prevalent form of immunotoxicity which in found in human beings. In this form of contact dermatitis there occurs a hypersensitive reaction.
There are two essential stages as a result of which allergic contact dermatitis arises:-
Induction phase: In this phase there occurs sensitization of the immune system for an allergic response.
Elicitation phase: In this phase this allergic response is triggered.
In allergic dermatitis there are around 300 substances that can cause allergic contact dermatitis. The molecules of these substances when come in contact with the skin of the individual, they must bind to the carrier proteins on langerhans cells as these cells are present within the suprabasilar layer of the epidermis.
These langerhans cells are the cells within the skin which act as antigen-presenting cells. Then these langerhens cells come in contact with CD4+T cells (helper T cells).
Cytokines also play an important role in allergic contact dermatitis because they help in regulation of accessory-adhesion molecules.
In this disease the langerhans cells migrate from epidermis to the regional draining lymph nodes.
Interleukin 8 is cytokine that is indicating allergic contact dermatitis but not the irritant contact dermatitis.
In allergic contact dermatitis sensitization to a chemical requires lymphatic pathway.
Initially the sensitization takes 10-14 days from the initial or first exposure to a strong contact allergen such as poison ivy.Allergic Contact Dermatitis Commonly Seen In
Allergic contact dermatitis is more common in women than in men.
Allergic contact dermatitis predominantly is a result of allergy to nickel, which is more common in women than in men.
Allergic contact dermatitis occurs in neonates.
Allergic contact dermatitis is more common in persons older than 70 years.
Allergens that leads to allergic contact dermatitis are as follows-
•Balsam of Peru.
•Chromium- used in the tanning of leather.
•Poison ivy, poison oak and poison sumac.
•Neomycin is a kind of topical antibiotic used in local antiseptics, soaps, cosmetics.
•Thimersol used in topical antiseptics.
•Fragrance allergens found in foods.
•Formaldehyde-kind of preservative with multiple uses e.g. in paper products, paints, medications, household cleansers, cosmetic products.
•There are some metals found in medical products such as cobalt chloride as in hair dyes, antiperspirants, metal plated objects.
•Bacitracin- a topical antibiotic.
•First sign appearing on skin is rash or skin lesions at the site of exposure.
•Skin lesions include papules, blisters, vesicles or even a simple red area.
•These vesicles can ooze, drain or crusts are form on them and they become raw, scalded or thickened.
•Other symptoms appearing are itching at the part of exposure, skin redness, inflammation; localized swelling and the area may become tender and warm.
•If left untreated then the skin become dark, leathery and cracked.
•Pain can also be present with other symptoms.
Diagnosis of allergic contact dermatitis is done by following steps-
•Firstly physical examination of the eruptions is done.
•Medical history of the patient is needed.
•Drug-Induced bullous disorders.
•Transient acantholytic dermatosis.
•Urticaria, contact syndrome.
•Emollients in chronic cases.
•Sedating oral antihistamines.
•Calamine lotion, cool oatmeat baths.
•Phototherapy is also helpful.
•Avoidance of allergic metals or accessories.
• Intense itching, burning when scratches till it become raw.
• Burning stops itching returns.
• Skin dry as paper, flaking, small vesicles.
• Eczema worst on uncovered parts or areas.
• Chilly, weakness, sips cold water.
• Restless, anxious, worried about health, death, security, miserly.
• Worse after midnight, getting wet, cold air or bathing.
• Better by hot bathing, warm room.
• In allergic contact dermatitis due to repeated contact of metal there occur red itching pimples, honey like sticky liquid oozing with crust over it.
• Infects and scars easily, heels slowly
• Overweight, sweaty, constipated
• Scalp, hairline, behind ears, genitals, back of hands, palms, skin folds.
• Thickened skin, deep cracks in fingers, heels etc, nail thick, grooved.
• Worse at night
• Better by cold applications.
• Small itchy blisters with corrosive fluid.
• Skin becomes red, raw and inflamed.
• Eczema on margins of hair bends of joints, behind ears.
• Craves for salt, thirsty.
• Greasy oily hair.
• Skin dry generally.
• Eczema from suppressed emotion, inner grief.
• Worse in warmth, salt, seashore and after menses.
• Better in cool weather or bathing.
• Red, raw moist surface, burning itching and oozing after scratching.
• Deep cracks in folds, fingers. Bleed easily, become infected, ulcerations.
• Eruptions of the palms, fingers, bend of joints, behind ears, genitals.
• Itching, scratches until it bleeds, the part become cold after scratching
• Worse in winters, cold air, moving vehicles and at night
• Better in warm air and dryness.
• Intense itching that must be scratched till it bleeds.
• Dirty appearance of skin.
• Eczema behind ears, despair and depression with eczema.
• Infected eczema, offensiveness of all discharges especially of eczema.
• Person anxious and despair of the future, chilly, fear of poverty and anguished at night.
• Worse at night, warmth of bed.
• Better from warmth.
• Eczema with blister like eruptions, redness, swelling and intense itching.
• Restless from discomfort and often very irritable and anxious.
• Muscle stiffness which is relieved by warmth and motion.
• Craving for cold milk.
• Better by hot applications.
• Moist, weeping eruptions, foul odor.
• Intense itching, scratches till it bleeds causing burning.
• Dry scaly cracked areas, unhealthy skin pimples easily infected
• Burning hot feet at night.
• Hair margins, face, area of perspiration, feet bends of elbow, knee affected.
• Worse at night, warmth of bed, heat, bathing and wool.
• Better by dry, cool bathing.
Why not ask your query directly to Dr. Thind’s team? Get an expert opinion FOR FREE!