Airborne contact dermatitis

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


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 [1].

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 more commonly in occupations associated with exposure to known allergens (see occupational skin disease).

Workers in the following industries are more commonly affected:

A personal history of atopy (particularly atopic dermatitis) is also a risk factor for airborne allergic and irritant contact dermatitis [5].

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 [3,6–8].

Airborne allergic contact dermatitis

Allergens that can induce allergic contact dermatitis include:

Airborne irritant contact dermatitis

Airborne irritants that induce airborne contact dermatitis include:

  • Fibreglass
  • Chlorothalonil
  • Continuous positive airway pressure (CPAP) filtered air; this can cause airborne irritant contact blepharitis [3].

Photoallergic reactions

Photoallergic reactions that can induce airborne contact dermatitis include:

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

Contact urticaria

Potential 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 dermatitis is common and can be the only affected site [1,6]. Occasionally, covered areas can also be affected due to the accumulation of airborne particles under the garments [3].

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 [14].

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 on finding the characteristic distribution and morphology of the rash on physical examination [15].

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 [13].

Other measures include:

For severe cases, treatment can include:

What is the outcome for airborne contact dermatitis?

Airborne contact dermatitis can result in 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 [13]. Some patients may progress to chronic actinic dermatitis [16].

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Related information

 

References

  1. Pongpairoj K, Ale I, Andersen KE, et al. Proposed ICDRG Classification of the Clinical Presentation of Contact Allergy. Dermatitis 2016; 27: 248–58. PubMed
  2. Lotti T, Menchini G, Teofoli P. The Challenge of Airborne Dermatitis. Clin Dermatol 1998; 16: 27–31. PubMed
  3. Lachapelle JM. Environmental airborne contact dermatoses. Rev Environ Health 2014; 29: 221–31. PubMed
  4. Goossens A. Airborne dermatosis. Acta Dermatovenerol Croat 2006; 14: 153–5. PubMed
  5. Cashman MW, Reutemann PA, Ehrlich A. Contact dermatitis in the United States: epidemiology, economic impact and workplace prevention. Dermatol Clin 2012; 30: 87–98. PubMed
  6. Swinnen I, Goossens A. An update on airborne contact dermatitis: 2007–2011. Contact Dermatitis 2013; 68: 232–8. PubMed
  7. Santos R, Goossens A. An update on airborne contact dermatitis: 2001–2006. Contact Dermatitis 2007; 57: 353–60. PubMed
  8. Huygens S, Goossens A. An update on airborne contact dermatitis. Contact Dermatitis 2001; 44: 1–6. PubMed
  9. Wright AM, Cahill JL. Airborne exposure to methylisothiazolinone in paint causing allergic contact dermatitis: an Australian perspective. Australas J Dermatol 2016; 57: 294–5. PubMed
  10. Lundov MD, Zachariae C, Menné T, Johansen JD. Airborne exposure to preservative methylisothiazolinone causes severe allergic reactions. BMJ 2012; 345: e8221. PubMed
  11. Lundov MD, Mosbech H, Thyssen JP, Menné T, Zachariae C. Two cases of airborne contact dermatitis caused by methylisothiazolinone in wall paint. Contact Dermatitis 2011: 65: 176–9. PubMed
  12. Alwan W, White IR, Banerjee P. Presumed airborne contact allergy to methylisothiazolinone causing acute severe facial dermatitis and respiratory difficulty. Contact Dermatitis 2014: 70: 316–28. PubMed
  13. Sanjeev H, Dipankar D, Mahajan R. Airborne contact dermatitis — current perspectives in etiopathogenesis and management. Indian J Dermatol 2011; 56: 700–6. PubMed
  14. Lachapelle JM. Industrial airborne irritant or allergic contact dermatitis. Contact Dermatitis 1986; 14: 137–45. PubMed
  15. Schloemer JA, Zirwas MJ, Burkhart CG. Airborne contact dermatitis: common causes in the USA. Int J Dermatol 2015; 54: 271–4. PubMed
  16. Sharma VK, Sethuraman G. Parthenium dermatitis. Dermatitis 2007; 18: 183–90. PubMed

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