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Airborne contact dermatitis

Authors: Dr Sarajane Ting, General Practitioner, Wellington, New Zealand; A/Prof Rosemary Nixon, Dermatologist, Melbourne, Australia. Adjunct A/Prof Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell/Maria McGivern. September 2019.


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What is airborne contact dermatitis?

Airborne contact dermatitis refers to acute and chronic dermatitis of exposed parts of the body, especially the face, caused by particles suspended in the air. These particles may include fibres, dust, vapours, sprays, gases, and plant materials.

Contact dermatitis is defined as airborne based on the following factors:

  1. The existence of a volatile or airborne causative agent
  2. The clinical presentation
  3. The history of the patient
  4. Patch testing.

Facial airborne contact dermatitis

How is airborne contact dermatitis classified?

Airborne contact dermatitis includes:

Apart from resulting in dermatitis, airborne skin disease can also present as:

Who gets airborne contact dermatitis?

Airborne contact dermatitis can affect anyone; it is seen commonly in occupations associated with exposure to known allergens (see DermNet's page on occupational skin disease).

Workers in the following industries are commonly affected:

A personal history of atopy, particularly atopic dermatitis, is also a risk factor for airborne allergic and irritant contact dermatitis.

What causes airborne contact dermatitis?

The sources of airborne contact dermatitis may be occupational or non-occupational. Some common causal agents of airborne contact dermatitis are listed below.

Airborne allergic contact dermatitis

Airborne allergens that can induce allergic contact dermatitis include:

Airborne irritant contact dermatitis

Airborne irritants that induce irritant contact dermatitis include:

  • Fibreglass
  • Chlorothalonil
  • Continuous positive airway pressure (CPAP) filtered air; this can cause airborne irritant contact blepharitis.

Photoallergic reactions

Photoallergic reactions that can induce airborne contact dermatitis include:

  • Drug photoallergy — chlorpromazine and carprofen
  • Olaquindox (veterinary use)
  • Pesticides.

Contact urticaria

Airborne allergens that can induce contact urticaria may include:

What are the clinical features of airborne contact dermatitis?

The distribution of airborne contact dermatitis is usually symmetrical. The exposed areas are most commonly affected, including the face, dorsal hands, neck, upper chest, and forearms. Eyelid contact dermatitis is common and can be the only affected site. Occasionally, covered areas can also be affected due to the accumulation of airborne particles under the garments.

Common symptoms of airborne contact dermatitis include itching, burning, and stinging.

Airborne contact dermatitis usually presents with diffuse scaly erythematous macules but plaques may also occur. Sometimes a pustular rash can occur as a result of secondary bacterial infection.

How is airborne contact dermatitis diagnosed?

The diagnosis of airborne contact dermatitis can be difficult. The diagnosis relies on taking a comprehensive clinical history, the timeline of the symptoms, consideration of occupational and non-occupational exposures, and finding the characteristic distribution and morphology of the rash on physical examination.

Tests that can be considered are:

What is the differential diagnosis for airborne contact dermatitis?

Airborne contact dermatitis should be distinguished from the following conditions:

What is the treatment for airborne contact dermatitis?

The treatment for airborne contact dermatitis depends on the specific cause. After identifying the specific substance causing airborne contact dermatitis, every effort should be made to reduce the exposure to it. A change of job or residence is sometimes necessary to reduce exposure.

Other measures include:

For severe cases, treatment can include:

What is the outcome for airborne contact dermatitis?

Airborne contact dermatitis can have a significant impact on patients’ quality of life. Complete recovery can often be achieved with avoidance of further exposure, but in severe cases such as Parthenium dermatitis, immunosuppression is often required. Some patients may progress to chronic actinic dermatitis.

 

References

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  2. Lotti T, Menchini G, Teofoli P. The challenge of airborne dermatitis. Clin Dermatol 1998; 16: 27–31. DOI: 10.1016/s0738-081x(97)00168-5. PubMed
  3. Lachapelle JM. Environmental airborne contact dermatoses. Rev Environ Health 2014; 29: 221–31. DOI: 10.1515/reveh-2014-0054. PubMed
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  16. Sharma VK, Sethuraman G. Parthenium dermatitis. Dermatitis 2007; 18: 183–90. DOI: 10.2310/6620.2007.06003. PubMed

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