What questions should be asked when taking a history for contact dermatitis?

Essential History Questions for Contact Dermatitis

When evaluating a patient for contact dermatitis, you must systematically explore atopic background, temporal patterns, product exposures, occupational factors, and environmental triggers to identify the causative agent and distinguish between irritant and allergic mechanisms. 1

Atopic and Personal Background

• Ask specifically about childhood atopic dermatitis, asthma, hay fever, and family history of atopy – this helps distinguish endogenous/atopic dermatitis from contact dermatitis, though clinical features alone are unreliable for this distinction 1
• Document any previous allergic reactions to medications or products, including the specific type of reaction 2
• Inquire about history of recurrent herpetic infections and respiratory infections 2

Temporal and Distribution Patterns

• Determine where symptoms initially began and how they subsequently spread – the pattern of progression provides crucial diagnostic clues 1
• Ask whether symptoms improve during weekends, holidays, or when away from specific environments, and whether they recur upon return – this temporal relationship strongly suggests occupational or environmental triggers 1
• Establish the timeline: acute onset versus chronic/cumulative exposure 1

Product and Substance Exposures

• Question about relationship to specific products, especially cosmetics, personal-care products, topical medications, clothing, bandages, or protective equipment like gloves – these are common culprits 1
• Obtain a detailed history of all wash products contacting the skin – most contain harsh emulsifiers/surfactants that damage the skin barrier, particularly in predisposed individuals 1
• Document both "wet" irritants (water, detergents, organic solvents, soaps, weak acids/alkalis) and "dry" irritants (low humidity, heat, powders, dusts) 1
• Ask about frequency of hand washing and which specific products are used 1

Activity-Related Triggers

• Inquire whether symptoms relate to particular activities such as hairdressing, holidays, home improvements, painting, decorating, recreation, or sports – these activities often involve allergen or irritant exposure 1
• Ask about subjective symptoms like stinging or smarting that occur within minutes of contact, especially on the face – this suggests subjective irritancy from cosmetics or sunscreens 1

Occupational History

• Take a detailed occupational history including specific tasks performed, products handled at work, and review of health and safety data sheets – occupational dermatitis accounts for approximately 70% of occupational skin disease 1
• Determine whether symptoms are related to work or specific workplace activities 1
• Identify both the theoretical job description and what workers actually do in practice 1

Photosensitivity

• Ask whether symptoms worsen after sunlight exposure – this suggests photoallergic or phototoxic contact dermatitis 1

Common Pitfalls to Avoid

• Do not rely solely on morphology and distribution to predict the cause – clinical features are unreliable in distinguishing atopic/endogenous dermatitis from irritant or allergic contact dermatitis, even in children 1, 2
• Do not overlook occupational exposures that might transfer to other body areas via hands – this can prevent healing despite apparent allergen avoidance 3
• Ensure comprehensive questioning about hygiene practices and all product use – failure to identify the causative agent prevents healing 3, 4
• Remember that irritant and allergic etiologies often coexist, particularly in hand and foot eczema 1