Online Dermatologist > Atopic Dermatitis vs. Contact Dermatitis

Atopic Dermatitis vs. Contact Dermatitis: What’s the Difference?

by | Jun 11, 2024 | Blog, Eczema, Rash

Atopic dermatitis (left) and contact dermatitis (right): Side-by-side comparison showing atopic dermatitis with red, inflamed patches and small bumps, and contact dermatitis with a red, inflamed patch featuring crusting and defined borders

Atopic dermatitis (left) and contact dermatitis (right) display different symptoms. Atopic dermatitis features red, inflamed patches with small bumps, while contact dermatitis shows a red, inflamed area with crusting and defined borders

Key Takeaways

 

  • Atopic Dermatitis: Chronic, genetic condition with symptoms like redness, itchiness, and scaly patches.
  • Contact Dermatitis: Triggered by external irritants or allergens, causing localized redness, blisters, and itching.
  • Similarities: Both conditions result in red, itchy, inflamed skin that can appear scaly and crusty.
  • Diagnosis: Requires medical history, skin examination, and sometimes allergy patch testing.
  • Treatment: Includes emollients, topical steroids, and specific treatments like biologics for atopic dermatitis.
Dermatitis, also known as eczema is a jumbled area in dermatology. There are several classifications to describe dermatitis because it is not a single disease entity but a desperate group of diseases. Dermatitis makes up 20% of all new patients referred to dermatology clinics.[1]

In this article we will focus on two subtypes: Atopic dermatitis and contact dermatitis. We will discuss what each type is, their similarities and differences, causes and triggers,  diagnosis and treatment, prevention and monitoring. Understanding these aspects is crucial for proper management of both conditions.

 

What is Dermatitis

Dermatitis refers to a group of conditions that causes inflamed, irritated, and often itchy skin.[1] The word eczema originates from the Greek word of ‘boiling’, reflecting the early appearance in the disease.[2] Dermatitis is broadly classified into three main groups,

  1. Atopic dermatitis
  2. Contact dermatitis
  3. Stasis dermatitis

Atopic dermatitis is the most common type.[1] Its prevalence is around 2% in parts of the developing world and 20% in children in western Europe, Australia, and the United States. Atopy is a state where some individuals produce a special group of antibodies called IgE , against common environmental allergens. Atopic individuals may or may not develop one or more atopic diseases such as asthma, hay fever, food allergies and atopic dermatitis.[2]

There are two types of contact dermatitis,

  • Irritant contact dermatitis – accounts for 80% of contact dermatitis and results from injuries caused by various irritants
  • Allergic contact dermatitis – Triggers an allergic reaction[3]

 

Similarities between atopic dermatitis and contact dermatitis

An inflammatory response is a hallmark of all eczemas.[2] Despite subtle differences in involvement of immune cells, the ultimate result is similar for both atopic and contact dermatitis. Though the classifications give differentiating features for the two conditions, the similar clinical symptoms make it difficult to  identify atopic dermatitis from contact dermatitis. Both types cause a red , itchy, and inflamed skin leading to discomfort and a poor quality of life.

 

Differences between atopic dermatitis and contact dermatitis

Here are the key differences between atopic dermatitis and contact dermatitis.

 

Nature of the condition

Atopic dermatitis is chronic and long-lasting, often starting
in childhood. Contact dermatitis is usually acute and triggered by direct contact with specific substances.

 

Common age of onset

Atopic dermatitis typically begins between 2 months to 5 years or during puberty or later, Contact dermatitis can occur at any age.[4]

 

Typical Locations

The distribution of atopic dermatitis varies with age but a general skin dryness persists throughout life. In infants (under the age of 1) vesicular and weeping type of eczema starts on the face with a non specific distribution commonly sparing the diaper area. In children atopic dermatitis affects mainly the elbow and knee flexures, wrist and ankles, extensor aspect of the limbs. In adults the distribution is similar to childhood with a tendency of licenification (skin becoming thickened and dry) with trunk, face and hands less involved.
Contact dermatitis usually appears at the site of contact with the allergen or irritant such as the hands and forearms.[2]

 

Symptoms

Atopic dermatitis-  cardinal feature is itching. There will be red, scratching dry patches. Affected child may sleep poorly and be hyperactive.

Contact dermatitis – can cause a red rash, blisters, and itchiness on the exposed skin.[2]

 

Response to Triggers

Atopic dermatitis is influenced by environmental and genetic factors. Some environmental factors like, having many older siblings, growing up on a farm, having childhood measles and gut infections can reduce the risk.

whereas contact dermatitis is triggered by direct contact with specific allergens or irritants continuously.[2]

 

Triggers for atopic dermatitis and contact dermatitis

Anything that causes dermatitis to flare is known as a trigger. Triggers can vary from individuals. Knowing the triggering factors will help you to avoid them, which eventually helpful in reducing flare-ups.

 

Common triggers for atopic dermatitis are,

  • skin care products
  • weather(cold or hot)
  • wool clothing
  • dust mites
  • stress
  • allergens like perfumes and laundry detergents
  • Infections[4]

 

Common triggers for contact dermatitis are,

Irritant contact dermatitis Allergic contact dermatitis
  • Detergents and bleach
  • Plants
  • Fruit juice
  • Hand sanitizer
  • Soaps
  • Gasoline and diesel oil
  • Disinfectants
  • Fertilizers and pesticides
  • Chemicals used to remove grease, oils, and cutting fluids
  • Nickel – in jewellery, cell phones, foods, cigarette
  • Fragrance – in perfumes and skin care products
  • Latex – in medical supplies like gloves
  • Urushiol – found in the sap of poison ivy, poison oak, sumac

 

Some people develop the rash after exposing the allergen contacted skin to UV light in the sun.[2]

 

What Causes Atopic Dermatitis and Contact Dermatitis?

The causes of the both have overlaps

Atopic dermatitis : There is a strong genetic factor causing atopic dermatitis. The genes that predispose you to atopy tend to run in the families. The likelihood of inheriting atopic dermatitis is particularly high if the mother has it. If both parents have atopic eczema the child has a 75% chance of developing it. Impaired skin barrier function and recurrent exposure to the triggers also contribute to the development of atopic dermatitis.

Contact dermatitis: The cause of contact dermatitis often linked to lifestyle factors.

In irritant contact dermatitis , strong irritants can elicit an acute reaction after a brief contact while prolonged exposure to weak irritants can lead to lesions on exposed area. Those who have  a dry skin are especially susceptible.

Allergic contact dermatitis occurs as a delayed type hypersensitivity reaction. It has the pervious contact which induces the allergy, is specific to one chemical and its close relatives, after the allergy has been established all areas of skin will react to the allergen in subsequent encounters.

Certain professions like health care workers, food service workers, construction workers, cosmetologists, florists, mechanics, agricultural workers, natural resource and mining workers, manufacturing workers have a higher risk of developing contact dermatitis according to some studies.[3]

How are Atopic and Contact Dermatitis Diagnosed?

 

Diagnostic criteria for atopic dermatitis

You dermatologist will take a history and examine you to come to a diagnosis. The must have feature is itchy skin. With that three or more of the following,

  1. History of itchiness over skin creases
  2. History of asthma or hay fever
  3. General dry skin in the past year
  4. Visible flexural dermatitis
  5. Onset in the first two years of life[3]

 

Before your dermatology visit, consider

  1. Do you have any blood relatives with atopic dermatitis, asthma or hay fever?
  2. What are the exact symptoms and the location?
  3. When did the symptoms begin?[4]

In rare occasions your dermatologist will request a skin biopsy to come to a diagnosis.

 

Diagnostic criteria for contact dermatitis

For irritant and allergic contact dermatitis a detailed history will help in diagnosis. Mindful to tell about,

  1. All the skin, hair, and nail care products you use
  2. Whether you apply skin, hair, nail care product to someone else(child, elderly people)
  3. When the rash appear

To identify the allergen in allergic contact dermatitis, you may need to undergo a medical testing called patch test. During this test, small amounts of different suspected allergens are applied in aluminium cups held in position on your skin for 2- 3 days.[5]  This test usually identifies up to 80% of reactions correctly.[2]

 

What are the Treatment Options for Atopic and Contact Dermatitis?

The treatment for both the conditions aims to,

  • Reduce flare-ups
  • Relieve symptoms
  • Maintain the skin barrier to keep it normal, hydrated, and free from infections

Your treatment plan will be tailored to the severity of your condition.

 

Atopic dermatitis treatment

Skin care is essential for managing atopic dermatitis. Your doctor will provide you a skin care plan including how to bathe, apply moisturizer correctly, and be gentle with your skin. Wet wrap therapy, which involves wrapping the treated skin in a layer of wet bandage, can help the skin absorb medications and stay hydrated. Avoiding triggers is also important. The treatment options may include corticosteroid cream or ointment, pimecrolimus cream or tacrolimus ointment, crisaborole ointment and ruxolitinib cream. But the treatment of choice will depend on your condition.[4]

 

Contact dermatitis treatment

The crucial step is avoidance of identified triggers. In severe cases you may need to avoid the causative agent completely, but this doesn’t always mean you have to quit your job! Simple lifestyle modifications, such as wearing protective gloves, clothing can be helpful. Since maintaining the barrier function is important to prevent flare-ups, you doctor will prescribe barrier creams and topical steroids for temporary symptom relief. Cool compression will help in relieving itchiness.[3]

 

How to Prevent and Monitor the Progression?

For both the conditions it is important to

  1. Avoid triggers
  2. Maintain skin health trough proper skin care
  3. Adhere to the advices given by your dermatologist

 

Here are some tips for you to keep you skin healthy

  • Don’t let your skin get dry. Use a moisturizer after bathing
  • Choose fragrance free skin care products
  • Test all new skin care products before using them
  • Take short baths or showers multiple times a day
  • Choose dermatitis friendly clothing and detergents, loose fitting, cotton cloths.
  • Protect your skin from extreme temperature[4]
References

First Derm ensures the highest quality and accuracy in our articles by using reliable sources. We draw from peer-reviewed studies, academic research institutions, and reputable medical journals. We strictly avoid tertiary references, linking to primary sources such as scientific studies and statistics. All sources are listed in the resources section at the bottom of our articles, providing transparency and credibility to our content.

 

  1. American Academy of Dermatology. Eczema Resource Center. Available at: https://www.aad.org/public/diseases/eczema
  2. Weller RB, Hunter HJA, Mann MW. Clinical Dermatology. 5th ed. Hoboken, NJ: John Wiley & Sons; 2015.
  3. Ludmann P. Eczema Types: Contact Dermatitis Overview. American Academy of Dermatology. Last updated December 14, 2020. Available at: https://www.aad.org/public/diseases/eczema/types/contact-dermatitis.
  4. Ludmann P. Eczema Types: Atopic Dermatitis Skin Care. American Academy of Dermatology. Last updated October 10, 2023. Available at: https://www.aad.org/public/diseases/eczema/types/atopic-dermatitis/atopic-dermatitis-coping.
  5. Ludmann P. Patch Testing Can Find What’s Causing Your Rash. American Academy of Dermatology. Last updated March 15, 2021. Available at: https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/patch-testing-rash.

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