This summary discusses adult patients. Allergic contact dermatitis in children is addressed separately.

Contact dermatitis presents as either allergic or irritant in etiology. While irritant contact dermatitis represents the direct toxic effect of an offending agent on the skin, allergic contact dermatitis (ACD) represents a delayed-type (type IV) hypersensitivity reaction that occurs when allergens activate antigen-specific T cells in a sensitized individual. Consequently, whereas irritant contact dermatitis can occur after one exposure to the offending agent, ACD typically requires repeat exposures before an allergic response is noted. ACD can occur 24-48 hours after exposure to the offending agent.

Contact dermatitis can demonstrate well-demarcated borders, suggestive of an "outside job" or external contact. The most common contact allergens are urishiol (poison ivy, oak, or sumac), nickel, fragrance, cobalt (a metal; see also cobalt toxicity), chromates (leather products), neomycin, thimerosal (ophthalmic preparations and vaccines), adhesives, and oxybenzone (sunscreens). The distribution and geometry of lesions are important clues to diagnosis. It can also present as a systemic contact reaction with widespread lesions when the offending agent is ingested or present in an implanted device. ACD can occur in reaction to topical agents, ingested agents, implanted biomedical devices, and airborne materials.

Per February 2019, isobornyl acrylate was named the "contact allergen of the year" by the American Contact Dermatitis Society. It is an acrylic monomer often used as an adhesive in medical devices, and there have been multiple case reports of diabetes patients developing contact allergies to their insulin pumps. Acrylic nails are also a potential source. Clinician awareness is important, because testing using routine panels does not identify isobornyl acrylate.

The intense erythema and sharply demarcated plaques of contact dermatitis are easy to confuse with cellulitis or erysipelas, especially when vesiculation and bullae formation take place. Differentiating features include the presence of pruritus (often extreme) in contact dermatitis versus the skin warmth and spreading erythema of a soft tissue infection. A detailed allergen exposure history should be elicited.