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Therapeutic Approach

Contact dermatitis (CD) is a common eczematous disorder caused by chemical contact with the skin and, rarely, a systemic reaction to an ingested contact allergen. Depending on the nature of the causative chemical, CD is either allergic (ACD) or irritant (ICD). Due to immune involvement, ACD has an incubation period of several hours to days, whereas ICD manifests almost immediately after exposure to the culprit chemical except in cases of cumulative irritant CD where exposure to the culprit chemical gradually and additively over months to years will manifest itself (eg, water). Effective treatment of CD depends on identifying and avoiding relevant chemicals. Patch testing may help diagnose ACD but is limited by the scope of allergens tested and the expertise and experience of the provider. Importantly, in the initial evaluation, contact urticaria should be excluded. Regardless of type of dermatitis, patients benefit from knowing the sources of the offending chemicals, alternative products they can substitute, and protective equipment they may use. While the treatments listed below may be used to help clear eruptions, it must be emphasized that continued exposure to offending chemicals can perpetuate the dermatitis. See Table 4-1.

Table 4-1Contact Dermatitis Treatment Table

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