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©2013 UpToDate ® Print Email Differential diagnosis of allergic contact dermatitis Atopic dermatitis Flexural areas, face, eyelids, and hands frequently involved Personal or family history of flexural eczema, asthma, allergic rhinitis or hay fever during infancy or childhood Irritant contact dermatitis History of irritant exposure More demarcated and less itchy than allergic contact dermatitis Patch testing usually negative; may coexist with allergic contact dermatitis Seborrheic dermatitis Greasy scaly plaques in the central part of the face Frequent involvement of scalp, eyebrows, and eyelids Central chest and folds sometimes involved Absence of edema and vesiculation Dyshidrotic eczema Recurrent vesicular eczema of the hands and/or feet Deep-seated multilocular vesicles on the sides of the digits and on palmar or plantar skin Dorsal surfaces usually not involved Psoriasis Demarcated, erythematous, and scaly plaques; frequent involvement of elbows and knees; nail pitting may be seen at close inspection Absence of vesiculation, but pustules may be present on palms and soles When limited to palms and soles, may be difficult to distinguish from chronic ACD Stasis dermatitis Medial aspects of lower legs usually involved; skin color changes are frequent Other signs of chronic venous insufficiency usually present Persistent stasis dermatitis suggests secondary contact sensitization Asteatotic eczema (eczema craquelé) Crackled patches of dry skin on the lower legs Lack of inflammation Tinea manuum Typically unilateral and asymmetrical Inflammatory edge Sometimes associated with an autoeczematization reaction Autoeczematization (autosensitization) reaction Diffuse, pruritic papulovesicular eruption May be associated with ACD, stasis dermatitis, and bacterial or fungal infection Mycosis fungoides (patch and plaque stage) Scaly patches or plaques, often pruritic, most frequently located on the trunk History of lesions waxing and waning over years Absence of edema and vesiculation