Contact Dermatitis in Skin of Color

Contact dermatitis, also known as contact eczema, is an adverse skin reaction after contact exposure to a foreign agent, caused either by its irritant (irritant contact dermatitis, ICD) or its allergenic property (allergic contact dermatitis, ACD). The clinical appearance of the lesions depends on the skin region involved and the duration of the exposure; it may be papular, urticaria-like, vesicular, or bullous, presented on an erythematous background. In dark pigmented or black skin, erythema is less recognizable, and the lesions are often hypo- or hyperpigmented; after repeated or persisting exposure, eczematization occurs, and chronic pruritus often results in lichenification. In specific areas of the body such as the eyelids, penis, and scrotum, contact dermatitis can be presented as erythematous edema rather than papules or vesicles. Lesions can be provoked or aggravated by exposure to sun or UV light, resulting in a phototoxic or photoallergic reaction. The skin response also depends on the particular properties of the agent, the nature and duration of the contact, and the individual susceptibility of the patient.