From the Guidelines
Yes, contact dermatitis can present with macular lesions, as evidenced by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1.
Contact Dermatitis Overview
Contact dermatitis is an inflammatory skin reaction that occurs when the skin comes into contact with irritants or allergens.
- In its early stages or milder forms, it may appear as flat, reddened areas (macules) on the skin.
- However, as the condition progresses, it often develops into more pronounced features including papules, vesicles, scaling, and sometimes swelling.
- The appearance depends on several factors including the causative agent, duration of exposure, individual sensitivity, and the body location affected.
Treatment and Management
Treatment typically involves:
- Identifying and avoiding the triggering substance
- Using topical corticosteroids like hydrocortisone 1% cream applied twice daily for 1-2 weeks to reduce inflammation
- Moisturizers to repair the skin barrier
- For severe cases, oral antihistamines like cetirizine 10mg daily may help with itching, and more potent prescription steroids might be necessary
- Cool compresses can provide symptomatic relief during acute flares
Types of Contact Dermatitis
The macular presentation is more common in irritant contact dermatitis than in allergic contact dermatitis, which tends to be more vesicular and edematous, as noted in the clinical practice guideline for acute otitis externa 1.
- Irritant contact dermatitis is inflammation of the skin caused by direct chemical damage usually from acids or alkalis.
- Allergic contact dermatitis occurs only in susceptible individuals with a predisposition to an allergic reaction to antigens such as metals, chemicals, plastics, rubber, leather, or drugs.
From the Research
Contact Dermatitis Characteristics
- Contact dermatitis (CD) is a common inflammatory skin disease caused by exposure to contact allergens and irritants 2, 3.
- It can manifest in different forms, including allergic contact dermatitis and irritant contact dermatitis, as well as other subtypes such as immediate skin reactions, photoinduced contact dermatitis, and non-eczematous contact dermatitis 3.
Clinical Presentation
- The clinical presentation of contact dermatitis can vary widely, and multiple subtypes may occur simultaneously 2.
- Contact dermatitis can mimic many kinds of skin diseases, such as atopic dermatitis, lichen planus, and angioedema 3.
- In some cases, contact dermatitis can present with a maculopapular eruption, as seen in a patient with multiple corticoid orally elicited allergic contact dermatitis 4.
Macular Presentation
- A study reported a patient with contact allergy to multiple topical corticosteroids, who developed a generalized maculopapular eruption after oral provocation tests with certain corticosteroids 4.
- This suggests that contact dermatitis can indeed present with macular lesions in some cases, particularly in patients with specific allergies or sensitivities 4.