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What’s the Difference Between Atopic Dermatitis and Contact Dermatitis?

Posted on April 20, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Sarah Winfrey

When your skin is itchy, discolored, or dry, it’s easy to feel frustrated and overwhelmed — not to mention uncomfortable. Key to resolving the issue is determining what is causing the skin problem. Though a dermatologist should ultimately determine what is causing your symptoms, it can be helpful to understand which conditions may be responsible.

Atopic dermatitis (AD) and contact dermatitis (CD) are two common causes of skin rashes, itching, and discomfort. These skin conditions share many similar symptoms and may even occur alongside one another in some people. Here is what you need to know about the key similarities — and differences — between atopic dermatitis and contact dermatitis.

What Are Atopic Dermatitis and Contact Dermatitis?

The word “dermatitis” refers to skin inflammation. As such, both atopic dermatitis and contact dermatitis are characterized by inflammation of the dermis, or skin.

Atopic dermatitis is the clinical term for one type of eczema. This is a chronic skin condition that can cause itching, scaly patches of skin, red or gray patches on the skin, small bumps on the skin, and swollen skin (especially after scratching). AD develops when a person’s immune system becomes sensitized to proteins from a source inside or outside the body. The immune system becomes overactive and sets off inflammatory processes that attack the skin.

This type of eczema is not curable, but there are ways to alleviate symptoms and feel better. If you are diagnosed with eczema, your doctor will help you come up with a treatment plan that is specific to your eczema and your needs.

Contact dermatitis is also characterized by an itchy rash that can be very uncomfortable. It’s a skin reaction that occurs after coming into direct contact with something that causes allergy or irritation. Although treating the rash itself can make you feel better, symptoms may not go away until you figure out what’s triggering them and how to avoid it.

Types of CD include:

  • Allergic contact dermatitis, caused by allergens, such as metals like nickel and plants including poison ivy and mango
  • Irritant contact dermatitis, caused by irritants, such as bleach, solvents, or shampoos

How Are Atopic Dermatitis and Contact Dermatitis Similar?

There are several similarities between atopic dermatitis and contact dermatitis.

Symptoms

Both atopic dermatitis and contact dermatitis cause a skin rash that can cause intense itching.

Causes

Both AD and CD can be brought on by exposure to certain substances or situations (known as triggers). These specific triggers are typically different between the two different conditions.

Learn four ways to discover your eczema triggers.

Diagnosis

A family doctor or general practitioner can usually diagnose atopic dermatitis and contact dermatitis. However, you also may be referred to a dermatologist, who specializes in diagnosing and treating skin conditions like these.

To diagnose your condition, your doctor will likely need to take your medical history and conduct a physical exam. They may also need to perform a biopsy to support the diagnosis. If the doctor suspects you have allergic contact dermatitis, they may have you undergo a patch test. This test can help identify the particular substances that are contributing to your symptoms.

Treatment

While many of the treatments for atopic dermatitis and contact dermatitis are different, they overlap in the following areas.

  • Corticosteroid creams — Applying hydrocortisone creams can reduce itching and inflammation. Itch relief can prevent you from scratching, giving the skin a chance to heal. Topical steroids also limit the allergic response experienced in contact dermatitis.
  • Antibiotics — If your skin is infected due to excessive scratching, a topical or oral antibiotic can help fight off the infection and allow your skin to heal. Certain bacteria can trigger atopic dermatitis also.
  • Oral steroids — A short course of oral steroids can be used to treat severe itching and inflammation in both types of dermatitis. Because of the potential side effects of systemic steroids, these must be taken infrequently.
  • Cool, wet dressings — Applying a towel or cloth soaked in cool water can lower inflammation and help reduce the itch response for people with both conditions.

How Are Atopic Dermatitis and Contact Dermatitis Different?

There are some distinct differences between atopic dermatitis and contact dermatitis.

Symptoms

While the rashes seen in AD and CD often feel very similar, they may differ slightly. Atopic dermatitis can produce thickening of the skin over time, which is not usually seen in contact dermatitis. On the other hand, blisters often occur in contact dermatitis, but not in atopic dermatitis.

Causes

Atopic dermatitis is believed to be caused by a genetic variation that leads to an overactivation of the immune system that affects the skin. People with this type of eczema don’t retain moisture as well, due to missing or malfunctioning proteins of the skin barrier. The poor moisture retention causes dry skin that is more susceptible to bacterial infection and other irritation.

AD flare-ups (periods of worsened symptoms) can be triggered by certain situations or substances, such as stress or certain foods, but these triggers are not the root cause of the condition.

Contact dermatitis results from a delayed immune system reaction to a specific allergen or caustic substance that causes the skin to have an inflammatory response.

For allergic contact dermatitis, common allergens include:

  • Poison ivy
  • Detergent or soap
  • Shampoo
  • Hair dye
  • Fragrances or perfumes
  • Lotions or emollients

For irritant contact dermatitis, common triggers include:

  • Certain solvents
  • Bleaches and detergents
  • Airborne substances including sawdust
  • Fertilizers and pesticides

Diagnosis

The diagnostic process may proceed differently if your health care provider or dermatologist suspects contact dermatitis rather than atopic dermatitis. The history of your condition is important, given that exposure to allergens can cause allergic contact dermatitis. In a doctor suspects allergic CD, they’ll try to determine exactly what substances you are having an allergic reaction to. Determining these irritants will allow you to avoid known triggers and, as a result, avoid the contact dermatitis response in the future.

Determining what particular substances trigger your CD can involve extensive allergy and irritant testing. Although this testing may sometimes be time-consuming or frustrating, it’s often worthwhile as you’ll come away knowing what to avoid.

Treatment

As noted, atopic dermatitis and contact dermatitis share many similar treatments. However, treatment for AD can be much more extensive and chronic than treatment for CD.

In addition to the aforementioned treatment options, atopic dermatitis may also be treated with the following.

Injectable Biologics

These medications help control the immune system response that causes atopic dermatitis, rather than just controlling the rash from outside the body. The U.S. Food and Drug Administration (FDA) has approved Dupinext and Adbry — injectable forms of dupilumab and tralokinumab-ldrm, respectively — for treating atopic dermatitis.

Phototherapy

Also known as light therapy, phototherapy involves exposing affected skin to controlled doses of UV light. This treatment is often used to help control skin responses in people who struggle with repeated flare-ups that don’t respond to other treatments. Although phototherapy may be helpful in treating atopic dermatitis, it increases a person’s risk of skin cancer in the future.

Cognitive Behavioral Therapy and Biofeedback

Cognitive behavioral therapy is a type of talk therapy that can help those with atopic dermatitis manage the interconnected physical and psychological impacts of the condition. Biofeedback may similarly help people become aware of and reduce sensations like itchiness caused by eczema.

Is It Possible to Have Both Atopic Dermatitis and Contact Dermatitis?

People can experience both atopic dermatitis and contact dermatitis at the same time. However, it’s easy to mistake CD for AD, especially in people who’ve already been diagnosed with the latter. The two conditions may be related, but researchers have had difficulty determining just how often the connections occur together and why. More research is necessary to verify a connection between them and understand how, when, and where they are connected.

Find Your Team Today

MyEczemaTeam is the social network for people with eczema and their loved ones. More than 42,000 members come together to ask questions, give advice, and share their experience with others who understand life with eczema.

Do you have contact dermatitis in addition to atopic dermatitis? How do you manage both conditions? Share your thoughts in the comments below or by posting on MyEczemaTeam.

All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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