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Chapter 4: Contact Dermatitis

INTRODUCTION

KEY POINTS

  • Contact dermatitis can commonly occur in many body areas including periorally, periocularly, periumbilically, and on the extremities with morphology varying from vesicular and bullous to patches and even plaques in chronic disease.

  • In lighter skin, active contact dermatitis is typically pink or red, while in darker skin, it can vary from magenta to violaceous and brown. Often, features of active and chronic disease can be seen simultaneously.

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FIGURE 4-1.

Perioral erythema with yellow crusting at the lateral commisures and under the mid-lower lip. Note several linear fissures on the mucosal lips. The patient had been using Carmex and licking her lips. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 152-21. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows diffuse redness with darker lines in the lips and around the mouth.
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FIGURE 4-2.

Bright-pink edematous mucosal lips extending periorally onto the cutaneous skin with scaling and crusting along the vermillion border. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 2-5.)

A patient with red, swollen lips. Scaling and crusting is found on the margins of the lips.
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FIGURE 4-3.

Light-pink to salmon-colored large, scaly, confluent patch along the forehead, with sparing along the hairline and above the eyebrows. This is secondary to para-pheylenediamine. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 24-2B.)

A photograph shows dermatitis on the forehead where the bangs came in contact with the skin.
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FIGURE 4-4.

Dark-brown confluent vesicular plaque along the hairline and on the forehead, with areas of overlying pink macules and brown crusting. On the central forehead are several scattered skin-colored to brown pinpoint papules. Note the intensity of the black hair dye along the hairline. This is secondary to para-phenylenediamine. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 28-4A.)

A patient with a plaque formed of many hyperpigmented dark brown vesicles with crusting along the anterior hairline and forehead. Hypopigmented Pink to light brown macules are also found along the hairline. Small skin colored and hypopigmented light brown papules are also found on the mid forehead.
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FIGURE 4-5.

Numerous scattered patches and plaques on the right cheek and jawline, ranging from fuchsia on the malar prominence to dusky pink along the jawline and neck in a person with lighter skin of color. This is secondary to contact dermatitis from Balsam of Peru and formaldehyde. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 152-19A. Reproduced with permission from Richard P. Usatine, MD.)

A photo shows erythematous patches in the face of a light-skinned woman.
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FIGURE 4-6.

Bilateral periorbital edema with overlying pink- to salmon-colored lichenified scaly patches. ...

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