Contact Dermatitis

Contact dermatitis (CD) is an inflammatory skin disorder caused by exposure to external substances. CD is broadly classified into irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). ICD results from direct chemical injury to the skin followed by the release of inflammatory mediators from epidermal cells. ACD is a type IV delayed hypersensitivity reaction mediated by T cells. Overall, CD is more frequently reported in women, likely due to higher exposure to jewelry, cosmetics, and fragrances, although occupational exposure remains a significant risk factor across all populations.

In a retrospective contact dermatitis study, 1,400 positive patch test reactions were evaluated, 207 of which occurred in patients with darker Fitzpatrick skin types. Distinct patterns of allergen sensitization emerged across racial and ethnic groups. Among Asian patients, nickel and methylisothiazolinone (MI) were the most frequently identified allergens. In Black patients, MI and nickel were again common, with additional sensitization to p-phenylenediamine (PPD), a widely used component of hair dye. Additionally, Black patients had a higher prevalence of allergens to acrylates, a component of artificial nails, and propylene glycol, a common thickener for cosmetic products, when compared to the White patient population. Hispanic patients most commonly reacted to MI, nickel, and formaldehyde.  

Clinical presentation is variable. ICD commonly presents with burning, stinging, soreness, and pain, whereas ACD is typically pruritic. Often times, both subtypes manifest either acutely, subacutely, or chronically. Acute contact dermatitis presents with erythema, edema, oozing, crusting, and tenderness. Subacute CD presents with scale, crusting, and hyperpigmentation. Chronic CD presents with lichenification. When diagnosing CD and interpreting patch test results, clinicians should rely heavily on palpation, especially with their patients who have Fitzpatrick IV-VI. Patients with darker skin tone tend to have more aggressive CD, and the presentation tends to primarily be a papular response. Since erythema is less appreciated in darker Fitzpatrick types and the presence of a papular response in this patient cohort, palpation is essential.  

Patients with darker Fitzpatrick types are more prone to post-inflammatory dyspigmentation and lichenification. Early recognition and treatment is critical in these patients in order to reduce the risk of complications. First-line therapy typically includes mid- to high-potency topical corticosteroids, with systemic corticosteroids reserved for severe disease. Topical calcineurin inhibitors are preferred steroid-sparing options, particularly for sensitive areas or prolonged use. Antihistamines may provide symptomatic relief for pruritus. Refractory or severe ACD may require phototherapy or systemic immunosuppressive agents, including cyclosporine, mycophenolate mofetil, or azathioprine. 

Resources for patients include skinSAFE and Contact Allergen Management Program (CAMP), both of which help patients identify safe products and cross-reactive allergens.  

1. Litchman G, Nair PA, Atwater AR, et al. Contact Dermatitis. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459230/

2. Arora P, Brumley C, Arrington K, Hylwa S. Allergic Contact Dermatitis in Skin of Color: A Retrospective Study from a Comprehensive Patch Testing Center. Dermatitis. 2025;36(2):141-146. doi:10.1089/derm.2024.0175

3. Alchorne MMA, Conceição KDC, Barraza LL, Milanez Morgado de Abreu MA. Dermatology in black skin. An Bras Dermatol. 2024;99(3):327-341. doi:10.1016/j.abd.2023.10.001

4. Okeke C, Malik A, Atwater A. Contactderm. American Contact Dermatitis Society Position Statement: Dermatitis and Skin of Color. 2022. Accessed February 8, 2026. https://www.contactderm.org/UserFiles/ACDSPositionStatement-DermatitisandSkinofColor.pdf. 

5. Tramontana M, Hansel K, Bianchi L, Sensini C, Malatesta N, Stingeni L. Advancing the understanding of allergic contact dermatitis: from pathophysiology to novel therapeutic approaches. Front Med (Lausanne). 2023;10:1184289. Published 2023 May 22. doi:10.3389/fmed.2023.1184289

6. McClain J, Brown AS, Noble CA, Helms SE, Brodell RT. Paraphenylenediamine allergic contact dermatitis in an African American male. JAAD Case Rep. 2023;43:7-8. Published 2023 Nov 3. doi:10.1016/j.jdcr.2023.10.014