Allergic Contact Eczema
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Allergic contact eczema is a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions. For some reason, more women than men suffer from allergic contact eczema. A rash may take a week or more appear after the first contact with whatever is acting as the allergen.
Not all individuals are predisposed to suffering from allergies. In the case of allergic contact eczema, only those predisposed to certain allergens (i.e. chemicals, nickel, rubber, plastics, glue, adhesive tapes, certain medications, or plants) will be affected.
To be diagnosed with allergic contact eczema, one must have to have come in contact with the offending allergen previously. The rash first appears only at the site of skin contact with the allergen. Later it often spreads and may involve skin well away from the contact site. This is because the immune cells become activated and migrate out through the bloodstream to other areas of the body. If allergic contact eczema is suspected, it is to remember where it first started when taking the medical history behind the development of a rash.
The cells of the immune system work in various ways in skin disease. The rash that occurs after being stung by nettles happens within minutes of contact. It is due to the release of chemicals such as histamines by immunity cells within the skin layers. This is known as immediate hypersensitivity. This is what happens in irritant contact eczema.
Slower-acting forms of response by the immune system occur because the population of cells that react against the invading substance or organism (allergen) needs to be built up from a small number of 'memory' cells that recognize the allergen. Over two or three days these cells give rise to others that in turn switch on other defense mechanisms such as the release of chemicals that attract the scavenger cells of the immune system. Because of the lag between initial contact and subsequent reaction, this is called delayed hypersensitivity. The skin reactions underlying allergic contact eczema are of this type.
It is not known why some substances are particularly prone to causing contact allergies, but some of the common culprits include:
- Nickel: a white metal often used in jewelry, belt buckles, jean studs, metal watch straps, and bra fasteners. Many other metals can also cause reactions.
- Perfumes: Balsam of Peru is a component of fragrances which can cause contact allergies
- Rubber and Related Chemicals: used in shoes, tires and clothing
- Potassium Dichromate: used in cement, leather and matches
- Hairdressing Chemicals (paraphenylenediamine)
- Medications: used in lanolin, neomycin (antibiotic), fusidic acid (antibiotic), steroid creams and cetearyl alcohol (used in emollient creams)
- Epoxy Resins: found in glues used in hobbies, woodworking, and glass fiber construction
- Colophony: a resin from spruce trees, used in sticking plaster adhesive
- Plants: both by direct contact and by contact with airborne particles
In the food industry a wide variety of foods are known to potentially cause skin reactions. These include**:
- Citrus fruits and their peels
- Other fruits and vegetables
- Spices, herbs, seasonings (e.g. horseradish, mustard, garlic)
- Fish and seafood
- Meat and poultry
**This is by no means a comprehensive list of all possible allergens which can cause allergic contact eczema.
Some of the materials known to potentially cause skin reactions are themselves components of common treatments for eczema (e.g. lanolin in moisturizers and hydrocortisone in steroid creams). Therefore, if the condition is worsening or proving resistant to treatment, it may be that the treatment itself is contributing to the skin problem.
Sometimes the cause and effect relationship is obvious, with a red scaly reaction around an earring or under a watchstrap. At other times, especially if a long time has passed since the initial exposure and sensitization, it may be impossible to distinguish contact allergic from other types of eczema.