Severe Contact Dermatitis with Progressive Symptoms: A Case of Occupational Exposure

Case at a Glance

A 41-year-old male landscaper presented with progressively worsening contact dermatitis following repeated exposure to Toxicodendron species (poison ivy/oak) during occupational yard work activities.

Patient's Story

The patient, a 41-year-old male (height 5'11", weight 305 lbs), works in landscaping and regularly maintains large properties with abundant poison ivy and oak vegetation. He reported a 10-day history of contact dermatitis that began following several consecutive days of yard work. Unlike his typical mild reactions consisting of small red spots on his arms, this episode presented with significantly more severe and widespread symptoms. The patient noted progressive worsening with new lesions appearing daily, which concerned him as this differed from his usual self-limiting reactions.

Initial Assessment

Physical examination revealed multiple areas of contact dermatitis with varying degrees of severity. The patient presented with a large, inflamed lesion on his wrist that was notably larger and more intense than his typical reactions. Most concerning was significant swelling and erythema of the right ear, described by the patient as feeling 'hot and heavy' - a symptom he had never experienced before. Additional lesions were noted on the face near the beard area, suggesting widespread exposure.

The Diagnostic Journey

The patient's history of repeated occupational exposure to Toxicodendron species, combined with the clinical presentation and progressive nature of symptoms, strongly suggested allergic contact dermatitis. The escalating severity despite previous mild reactions indicated possible sensitization from chronic exposure. Differential diagnosis included bacterial superinfection, given the progressive nature and systemic symptoms.

Final Diagnosis

Severe allergic contact dermatitis secondary to Toxicodendron species exposure with possible secondary bacterial infection and systemic inflammatory response.

Treatment Plan

Given the severity and progressive nature, systemic corticosteroids were indicated rather than topical treatments alone. Oral prednisone was prescribed with a tapering schedule. Topical corticosteroids were recommended for localized lesions. Patient education included proper decontamination techniques, protective equipment use during occupational exposure, and recognition of warning signs requiring immediate medical attention. Antihistamines were recommended for symptomatic relief of pruritus.

Outcome and Follow-up

Patient was advised to return if symptoms worsened or failed to improve within 48-72 hours of treatment initiation. Follow-up was scheduled to monitor treatment response and discuss long-term prevention strategies for occupational exposure. Patient counseled on the importance of seeking prompt medical attention for future severe reactions, as repeated sensitization can lead to increasingly severe responses.