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Allergic contact dermatitis M004

Document
Last amended 
11 January 2021
Current RMA Instruments

Reasonable Hypothesis SOP

1 of 2021

Balance of Probabilities SOP

2 of 2021

Changes from previous Instruments

SOP Bulletin 218

ICD Coding
  • ICD-9-CM Codes: 692.0-692.6, 692.81, 692.83
  • ICD-10-AM Codes: L23
Brief description

A contact dermatitis occurs when an agent comes into direct contact with the skin and the skin responds at that site of contact with local inflammation.

In allergic contact dermatitis, the inflammation is an allergic response to an agent to which the individual has previously been sensitised. 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.

Confirming the diagnosis

The diagnosis of allergic contact dermatitis is based upon:

  • Clinical features
  • History of exposure to a putative allergen
  • Patch testing results
  • Laboratory tests and/or histopathologic examination (not essential)
  • Lack of recurrence after empirical treatment of the dermatitis and avoidance of the suspected allergen

The relevant medical specialist is a dermatologist.

Additional diagnoses covered by SOP

  • Allergic contact chelitis 
  • Allergic contact dermatitis due to cutaneous exposure from airborne allergens 
Conditions excluded from SOP
  • Atopic dermatitis (eczema)#
  • Dermatitis due to substances taken internally#
  • Irritant contact dermatitis*
  • Local skin hypersensitivity associated with metal implants#
  • Photocontact dermatitis*
  • Systemic allergic dermatitis#
  • Urticaria#

* another SOP applies

# non-SOP condition

Clinical onset

Clinical onset will be when the localised skin inflammation, subsequently confirmed to be due to allergic contact dermatitis, first manifest.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  If untreated the condition can evolve from an acute form to a subacute and then chronic eczematous dermatitis.  The mainstays of treatment are avoidance of the allergen and topical corticosteroids to the affected site.

Comments

For this condition, on cessation of service, there will still be a potential residual link to service for ongoing or recurrent allergic contact dermatitis, if clinical onset occurred during service, for the same allergen as is causative for the post service condition.