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Allergic contact dermatitis M004

Document
Last amended 
28 June 2015

Current RMA Instruments:

Reasonable Hypothesis SOP
112 of 2011
Balance of Probabilities SOP
113 of 2011
Changes from previous Instruments:

SOP Bulletin 153

ICD Coding:
  • ICD-9-CM Codes: 692.0-692.6, 692.81, 692.83
  •  ICD-10-AM Codes: L23
Is specific diagnostic evidence required to apply the SOP? - No.
Are there sub-factors that require specific diagnostic information? - No.
Additional Diagnoses covered by SOP
  • Nil
Conditions excluded from SOP
  • Irritant contact dermatitis, use ICD code 692.89
  • Photocontact dermatitis, ICD codes 717.7
  • Systemic contact dermatitis, ICD code
  • Dermatitis due a substance taken internally, ICD codes 693.0-9
Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then:

  1. seek medical officer advice about further investigation, or;
  2. generate a diagnostic report, or;
  3. re-encode the condition, if appropriate.

The following may be useful in establishing the diagnosis:

  • Report from treating doctor.

Comment:

Dermatitis is a non-specific diagnostic label meaning inflammation of the skin.

A contact dermatitis is where the aetiological agent comes into direct contact with the skin and the skin responds at that site of contact with local inflammation.

Classification of contact dermatitis:
  • Topical skin agent => local skin normal inflammatory response = Irritant contact dermatitis
  • Topical skin agent => local skin allergic inflammatory response = Allergic contact dermatitis
  • Topical skin agent + topical light exposure => allergic or normal inflammatory response = Photocontact dermatitis
  • Topical skin agent + local skin allergic inflammatory response; then, systemically absorbed agent => skin allergic inflammatory response = Systemic (Allergic) contact dermatitis

(Topical means local.)

In allergic contact dermatitis, there is an abnormal inflammatory skin response. This abnormal inflammatory skin response is an allergic response which is instigated by an earlier exposure. The earlier exposure does not need to be topical. Subsequent topical exposures to the same allergen will produce an allergic response at the site of skin contact.

For allergic contact dermatitis that is contracted during military service, there will be a residual disability post service. Even though the contact allergen exposure triggering the current dermatitis may be post service, the local skin response is abnormal (allergic), due to the past military exposure to the contact allergen.

Irritant contact dermatitis is a normal inflammatory skin response to a toxic agent and this will occur to some degree in all normal persons. An example would be detergent contact irritant dermatitis.

Persistence of the dermatitis in this case is not contributed to by past exposure. As such, on leaving military service, ongoing dermatitis will cease to be related to military service, being maintained instead by ongoing exposure to civilian contact irritants.