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Medicine (MD/DO)
First Aid
First Aid for the USMLE Step 1 (2023)
Page 111 -
Allergic Contact Dermatitis

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Allergic Contact Dermatitis

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Hypersensitivity Type III
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Hypersensitivity Type IV

Allergic Contact Dermatitis

Allergy-alligator Contact-sports Dermatologist-examining-rash
Type IV Hypersensitivity
(4) Fork Hiker-sensitive-crying

Allergic contact dermatitis is a part of type IV hypersensitivity, which is a T-cell mediated reaction that occurs 48-72 hours after exposure to the allergen. It is described as a delayed reaction mediated by a cellular response.

Physical Contact with Allergen
Physical Contact-sports Allergy-alligator

Allergic contact dermatitis is characterized by an inflammatory skin condition that occurs after contact with an allergen, resulting in erythematous, pruritic skin.


Nickel is one of the most common substances found as an allergen for allergic contact dermatitis. It can be found as a component of scissors, crochet hooks, and cell phones.


Neomycin is the most common cause of medicine-related contact dermatitis and is usually used to treat otitis externa, superficial eye infections, and bacterial skin infections. Patients with allergic contact dermatitis from neomycin may also have an allergy to aminoglycosides.

Poison Ivy
Posion Ivy

Poison ivy can cause allergic contact dermatitis due to its oily coating. The resinous coating, called urushiol, should be removed as soon as possible in a 2-hour window by washing the area.


Contact allergic dermatitis patients can experience urticaria, a raised red area on the skin that occurs with itchiness.


Pruritus, or itchiness, is the most common symptom that presents in patients with allergic contact dermatitis.

Erythematous, Vesicular
Earth-red In-a-vest

Allergic contact dermatitis is typically erythematous and vesicular.

Patch Testing

If the diagnosis of the specific allergen is still unknown and treatment fails to cure the patient, patch testing should be considered.

Avoid Cause
Avoid-sign Cause-sign

The best management of allergic contact dermatitis is to avoid and remove any allergen causes.

Topical Hydrocortisone
Topical Hydrant-court

Topical hydrocortisone is a topical steroid used to reduce inflammation.


Antihistamines are used to treat pruritus in patients.

Cool Water Soaks
Cool Water

Soak the lesion in soothing cool water for around 20 minutes to help reduce pruritus in patients. The patient can also sprinkle the water with an oatmeal-based bath product.


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