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Allergic Contact Eczema

Allergic contact eczema (dermatitis) is caused by an external substance - the allergen ­ coming into contact with the skin of someone who is allergic to this particular Substance. The allergen itself is not usually harmful, but the skin's immune system gets confused, and 'attacks' the allergen as if it were fighting an infection. The allergen does not have any effect on someone who is not allergic or sensitized to it, and it is possible to develop an allergy after many years of trouble-free contact with the allergen. In fact, someone rarely becomes allergic to an allergen if they have only been in contact with it a few times. Most everyday allergens only trigger allergies after repeated exposure.

Allergic contact eczema is a delayed type of allergy. This is a slow process, and symptoms do not start until several hours or days after skin contact with the allergen. This is a completely different process from an immediate allergy reaction like hay fever. Because of this time lag, people can easily overlook a delayed allergy, and it can be very difficult to work out what is causing the problem, even if an allergy is suspected. For example, if someone develops a rash on their neck on a Tuesday morning, they may not realize it has been caused by an allergy to the aftershave they wore on Saturday night.

What are the commonest causes of allergic contact eczema?

Thousands of substances have been reported to cause allergic contact eczema, but most reactions, are caused by a limited number of allergens. The following are the most common culprits:

  • Nickel in metal jewellery, belt buckles and eyeglass frames
  • Perfumes in fine fragrances, cosmetics and toiletries
  • Rubber chemicals in household gloves and footwear
  • Chemical hair dye
  • Preservative chemicals in cosmetics and toiletries
  • Chromate which is used in the tanning of leather and in cement
  • Plants in the house and garden, and plant extracts in cosmetics
  • Ingredients in topical medicaments and moisturizers.

What does allergic contact eczema look like?

Skin affected with allergic contact eczema is red, swollen, flaky and itchy, just like other kinds of eczema. As a result of this similarity, the diagnosis may not be suspected, especially if someone already has a constitutional or endogenous type of eczema. It is therefore important to consider the possibility of contact allergy if eczema occurs in an unusual pattern or fails to improve with appropriate treatment. Allergic contact eczema can affect people of all ages, but is very uncommon in babies and young children, because their skin has only had limited exposure to contact allergens. Allergic contact eczema affects the area of skin that has been in contact with the allergen. The rash is usually localized, but if there is a strong allergy it may spread to the surrounding skin. Allergic contact eczema mainly affects body areas that have most contact with allergens. These include the following:

  • Hands and feet
  • Face
  • Axillae (underarms)
  • Lower legs with venous eczema.

How is allergic contact eczema treated?

The treatment of allergic contact eczema involves three important steps:

  1. Treat the eczema with topical steroids and emollients.
  2. Identify the allergen(s) by patch testing.
  3. Avoid future exposure to these allergens.

Allergic contact eczema can be extremely itchy and uncomfortable, and it needs active treatment with topical steroids and simple emollients. The ingredients of moisturizers and medicaments can cause allergies, and so it is best to choose products that contain the fewest possible allergens, for example 50:50 liquid paraffin/ white soft paraffin and a steroid ointment rather than cream, because creams contain preservatives.

Patch testing is usually needed to find or confirm which allergen(s) could be causing the eczema. Once the culprit has been identified, it is important to try and avoid future skin contact with this allergen. If this is achieved, and someone does not have any underlying eczema, there is an excellent chance that the eczema will clear completely. Once a contact allergy has developed, it tends to be life-long, so continued care is needed to avoid the allergen (s). People who are allergic to ingredients of cosmetics and toiletries need to read the ingredient labels carefully in order to avoid using a product that contains these allergens. Unfortunately, for some other allergies such as household and industrial chemicals or shoe components, it is much more difficult to find out what can be used safely. The main things to remember are:

  • Allergic contact eczema is caused by skin contact with an allergen in someone who is allergic to this substance.
  • An allergy may develop after many years of trouble-free contact with the allergen.
  • Allergic contact eczema is a slow (delayed type) allergy process, which takes several hours or days to appear and many days to clear.
  • Allergic contact eczema is not caused by anything you have eaten.

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