An eczematous cutaneous condition known as contact dermatitis causes inflammation. Contact irritants such as metal or chemical ions, as well as tiny reactive compounds that alter proteins & trigger adaptive and innate immune reactions (contact allergens), are the main culprits. Both allergic and irritating contact dermatitis fall under the category of contact dermatitis.
While allergic contact dermatitis is a prolonged (type 4) hypersensitivity reaction to external encounter antigens, irritant contact dermatitis is a generic skin reaction to direct chemical injury that releases transmitters of inflammation primarily from epidermal cells. Cytokines & T cells work together to cause immunological reactions. Even when the allergen is in contact with covered parts when there is photo exposure, allergic dermatitis lesions are restricted to sun-exposed regions.
Unfortunately, data show that allergic contact dermatitis, which affects about 20% of youngsters, is much more common than previously thought. The good news is that most contact dermatitis cases self-limit and may be treated with straightforward supportive treatments. The disease can, however, be chronic in certain people and have a major impact on quality of life.
Epidemiology
United States statistics
Irritant contact dermatitis (ICD) is frequent in professions requiring frequent hand washing or repetitive skin exposure to irritants such as food, water, and other substances. Cleaning, hospital services, preparing food, & hairdressers are among the high-risk professions. The prevalence of workplace hand dermatitis was reported to be 55.6 percent in two acute care units and 69.7 percent in the most heavily exposed personnel. Occupational hand dermatitis was found to be strongly linked with washing hands frequency of more than 40 times each shift.
The prevalence of sexual distinctions
Women experience irritant contact dermatitis much more frequently than males do. Women are more likely than men to develop hand eczema, and environmental rather than hereditary factors are to blame. Contrary to other industrial disorders that primarily affect men, occupational irritant contact dermatitis affects women almost two to one. Due to their customarily proportionally bigger part in household maintenance and the maintenance of young children, women are more exposed to dermal irritants.
In particular, women work in a large number of occupations that are very susceptible to ICD (e.g., nursing, hairdressing).
Variations in occurrence due to age
At any age, ICD can develop. Numerous cases of diaper dermatitis are irritating contact dermatitis brought on by substances in urine & particularly feces, that directly irritate the skin. Older people’s skin is thinner, drier, and less tolerant of soaps & solvents than that of younger people. When combined with occupational ICD, atopic dermatitis, & age more than 50, occupational hand eczema is frequently accompanied by chronic dermatitis & extended sick leave.
Anatomy
Pathophysiology
The clinical manifestation of proinflammatory cytokine production from cutaneous cells (mostly keratinocytes), typically in reaction to chemical stimuli, is ICD. In contrast to allergic contact dermatitis, irritant dermatitis results from innate immunity that has been activated without previous sensitization. Various clinical forms might develop.
Disruption of the skin barrier, cellular alterations in the epidermis, & cytokine production is the three major pathophysiological alterations. A wide variety of substances can cause cutaneous irritation when present in high enough concentrations or for long enough periods of time. Solvents, mechanical, & microtrauma irritants are typical skin irritants.
In order to increase transepidermal water evaporation & make the skin more vulnerable to the increased direct harmful effects of many other formerly well-tolerated dermal exposures, solvents strip the skin of vital lipids and oils, which causes dermal irritation. Propanol, an alcohol, doesn’t irritate the skin as much as sodium lauryl sulphate, a detergent.
Skin irritation could result from microtrauma. Fiberglass is a typical example, which in susceptible people may cause pruritus with just slight apparent irritation. Numerous plant stems and leaves have tiny spicules and thorns that cause immediate skin damage. Combining physical irritants like friction, abrasive grit, and occlusion with detergents like sodium lauryl sulphate increases the likelihood of developing irritating contact dermatitis.
Skin sensitization to topical treatments is more likely to occur when there is skin irritation—both allergic and non-allergenic substances that irritate the skin cause the migration & maturation of Langerhans cells. An increase in irritating contact dermatitis may signal the emergence of an allergy to skin creams, drugs, and rubber gloves.
Regional epidermal cells, endothelial cells, epidermal fibroblasts & different leukocytes interact with one another throughout the pathogenesis of irritating contact dermatitis under the direction of a network of lipid & cytokines mediators. Through the secretion of cytokines & their reactions to them, keratinocytes have a significant impact on the beginning and continuation of inflammatory skin reactions. Certain cytokines are produced constitutively by sleeping keratinocytes.
The following cytokines can be released by epidermal keratinocytes in response to a wide range of environmental stimuli, such as ultraviolet light and chemical substances.
Stimulating cytokines for growth (IL-6, IL-7, IL-15, Colony-stimulating factor for granulocytes and macrophages, transforming growth factor–alpha)
Cytokines controlling cellular vs humoral immunity (IL-10, IL-12, IL-18)
In epidermal inflammatory responses, such as irritating contact dermatitis, adhesion molecules molecule 1 encourages leukocyte infiltration into the epidermis.
Hand irritant contact dermatitis is more likely to occur in people with a history of atopic dermatitis. The lack of filaggrin due to polymorphisms in the filaggrin (FLG) gene may change the skin barrier and be a risk factor for atopic dermatitis. Increased vulnerability to chronic, irritating contact dermatitis is linked to FLG null genotypes.
Etiology
The duration, potency, and concentration of the drug all affect how likely it is that irritating contact dermatitis may manifest. Irritant contact dermatitis can be brought on by skin rashes brought on by chemical, physical, or microtrauma factors. When physical allergens like abrasion, friction, and occlusion are combined with detergents like sodium lauryl sulphate, irritant contact dermatitis is more likely to develop than when they are used alone.
The concentration & quantity of the irritant, the frequency, and the duration of exposure are the elements that affect how severe the ICD is. It also depends on the skin’s characteristics, such as whether it is thin, thick, greasy, very fair, dry, previously injured, or has an atopic propensity. The severity is also affected by environmental variables, including extremes in temperature & humidity.
Genetics
Prognostic Factors
The cause and way of life of people with contact dermatitis affect their prognosis. If the offending chemical exposure is stopped, isolated cases usually end. People who don’t comply, wear metal jewelry, or are exposed to plants due to their lifestyles typically have a severe form. Relapses happen frequently.
Clinical work may be affected by latex allergy, a highly prevalent type of contact dermatitis in the medical field. Anaphylaxis cases are frequently recorded.
Clinical History
Clinical History
Because the identification of irritant contact dermatitis (ICD) depends on the history of contact of the infected body site to the skin irritant, a thorough medical history is necessary. In severe or chronic cases, patch testing is also performed to rule out allergic contact dermatitis as a contributing factor to the person’s cutaneous symptoms.
In cases of uncomplicated acute ICD, symptoms begin to appear within a few hours after exposure. Some irritants, like benzalkonium chloride (e.g., zephiran, a disinfectant, and preservative), which induces a delayed (8–24 h post-exposure) inflammatory process, is known to cause acute, delayed ICD.
In cumulative chronic ICD, the start of symptoms and signs may be weeks away. Multiple instances of below-threshold skin injury that occur frequently enough for the skin’s barrier function to not fully recover between exposures result in cumulative ICD. Individuals with skin problems, such as those who are atopic, have lower irritant thresholds or slower restoration times, which increases their susceptibility to clinical ICD.
Exposure to weak irritants, as opposed to strong ones, is more likely to result in cumulative ICD. The exposure (for instance, to water) frequently occurs both at work and at home. These patients describe fissuring of the chapping (hyperkeratotic epidermis) as causing both itching & pain. Early on in the clinical phase, discomfort, stinging, burning, or pain beyond pruritus develop.
Occupational history
A significant occupational disease is irritant contact dermatitis; up to 40 percent of occupational diseases are skin illnesses. Adults with suspected irritating contact dermatitis must provide the doctor with their job history. Employees who are fresh to a job, who are fundamentally more prone to irritant contact dermatitis, or who have not learned how to defend their skin from epidermal irritants are most likely to develop occupational ICD.
According to a Danish study, the majority of affected workers experience less permanent damage than those who contract other workplace accidents, although skin disorders pay out more in compensation than respiratory illnesses and musculoskeletal ailments.
Physical Examination
Physical examination
The following were suggested by Rietschel & Fowler as the key diagnostic standards for ICD:
Macular erythema, ensuring dominance over vesiculation, and hyperkeratosis.
The epidermis has a scalded look, parched or glazed.
The process of healing starts right away after ceasing exposure to the harmful agent.
Negative outcomes from patch testing with all potential allergens.
The following are some minor objective criteria for ICD:
Dermatitis’ precise boundaries
A dripping effect or another gravitational influence indicator
Compared to allergic contact dermatitis, there is less of a chance for dermatitis to spread.
Morphological changes imply that modest variations in concentration or contact time result in significant variations in damage to the skin.
People may form the habit of repeatedly rubbing an area that has irritating contact dermatitis, which can lead to secondary neurodermatitis and lichenification (lichen simplex chronicus). This could be considered a result of occupational harm.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Seborrheic Dermatitis
Scabies
Psoriasis
Phytophotodermatitis
Perioral Dermatitis
Pediatric Atopic Dermatitis
Lichen Simplex Chronicus
Erysipelas
Drug Eruptions
Cutaneous Manifestations of Kidney Disease
Atopic Dermatitis
Allergic Contact Dermatitis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Finding and eliminating any suspected causative factors is the only effective treatment for ICD. Rarely does an inflammatory process from acute prolonged irritating contact dermatitis to a substance like a benzalkonium chloride (e.g., zephiran) require treatment; instead, it typically goes away as exposure is stopped. The extent of involvement and the existence or absence of secondary infection will determine whether or not symptomatic treatment is continued.
Use ceramide-containing lotions or unflavored emollients after washing your hands with soap and right before bed, you should advise them. Cleansers can be rated based on how irritating they are. Recommend using minor skin washes in place of soap on the affected regions, such as Cetaphil cleanser, Aquanil, Oilatum AD, & Neutrogena cleanser. People should be warned against washing their hands with abrasives or improper solvents like gasoline, which can damage or dehydrate the skin.
The Danish Contact Dermatitis Group’s recommendation for treating hand eczema summarises the fundamental principles of treatment in a flowchart and emphasizes that moisturizing cream should be used along with all other therapies. According to the guidelines, doctors should refer patients with hand eczema to a dermatologist if the condition doesn’t clear up in a month because longer wait times are linked to worse outcomes.
Emergency Department Care
Treatment at an emergency room could involve the following:
Burow solution (1:40 dilution), Topical soak with cool tap water, saline (1 tsp/pint)
Baths in lukewarm water
Aveeno lukewarm baths
Emollients (such as white petrolatum and Eucerin) may help chronic instances.
Therapeutic draining may be beneficial for large vesicles (but retaining the vesicle tops in place). The next step is to apply an antibiotic treatment, or a dressing drenched in Burow liquid to these lesions. Only serious cutaneous ICD, such as burn injuries from hydrofluoric acid or, rarely, fresh concrete Portland cement, necessitate hospital hospitalization.
Barrier Creams
Ceramide-containing creams, such as Cerave, Impruv, and Cetaphil RESTORADERM, may be especially beneficial in helping people with ICD & atopic dermatitis restore the cutaneous barrier. People who have moist work-related irritating contact dermatitis may find it beneficial to restore the epidermal barrier with the aid of creams having dimethicone (such as Cetaphil creams).
Cleansers
The majority of detergents and soaps are alkaline and raise cutaneous pH, which impairs the skin’s physiologic protective acid mantle by lowering the fat content. The essential components in the induction of ICD & itching by soaps include disruption of the stratum corneum and pH alterations. In people with dry, sensitive skin, these issues are even worse in the winter.
Due to regular hand washing, ICD is a frequent issue among healthcare professionals. Ethanol (60 to 85 percent), isopropanol (60 to 80 percent), and N-propanol (60 to 80 percent have the highest antibacterial effectiveness. Chlorhexidine (2-4%) & triclosan (1-2%) have lower & slower antibacterial activity and may increase the likelihood of resistant bacteria.
One method to lessen skin damage, dryness, and irritation among healthcare workers is to use alcohol-based hand lotions containing different emollients instead of harsh detergents and soaps. The preparations containing 4 percent chlorhexidine gluconate cause irritant contact dermatitis the most frequently, followed by nonantimicrobial detergents & preparations with lower doses of chlorhexidine gluconate and very well alcohol-based hand rubs with emollients as well as other skin conditioners.
Steroids & Immunomodulators
The effectiveness of topical corticosteroids & immunomodulators in the management of ICD is unknown. Comparing corticosteroids to the vehicle and to the untreated control, it was discovered that they were unsuccessful in treating surfactant-induced irritating dermatitis. Topical corticosteroids, however, might be advantageous for eczematous symptoms that are overlaid.
Steroid use has potential side effects, especially when applied near the eye. Long-term corticosteroid use must be avoided since it increases the risk of developing cataracts, glaucoma, corneal thinning or perforation, losing one eye, and other issues.
Topical tacrolimus can be used as a substitute for topical steroids, but it can also be irritating, which can make people with irritant contact dermatitis experience even more stinging and irritation.
An eczematous cutaneous condition known as contact dermatitis causes inflammation. Contact irritants such as metal or chemical ions, as well as tiny reactive compounds that alter proteins & trigger adaptive and innate immune reactions (contact allergens), are the main culprits. Both allergic and irritating contact dermatitis fall under the category of contact dermatitis.
While allergic contact dermatitis is a prolonged (type 4) hypersensitivity reaction to external encounter antigens, irritant contact dermatitis is a generic skin reaction to direct chemical injury that releases transmitters of inflammation primarily from epidermal cells. Cytokines & T cells work together to cause immunological reactions. Even when the allergen is in contact with covered parts when there is photo exposure, allergic dermatitis lesions are restricted to sun-exposed regions.
Unfortunately, data show that allergic contact dermatitis, which affects about 20% of youngsters, is much more common than previously thought. The good news is that most contact dermatitis cases self-limit and may be treated with straightforward supportive treatments. The disease can, however, be chronic in certain people and have a major impact on quality of life.
United States statistics
Irritant contact dermatitis (ICD) is frequent in professions requiring frequent hand washing or repetitive skin exposure to irritants such as food, water, and other substances. Cleaning, hospital services, preparing food, & hairdressers are among the high-risk professions. The prevalence of workplace hand dermatitis was reported to be 55.6 percent in two acute care units and 69.7 percent in the most heavily exposed personnel. Occupational hand dermatitis was found to be strongly linked with washing hands frequency of more than 40 times each shift.
The prevalence of sexual distinctions
Women experience irritant contact dermatitis much more frequently than males do. Women are more likely than men to develop hand eczema, and environmental rather than hereditary factors are to blame. Contrary to other industrial disorders that primarily affect men, occupational irritant contact dermatitis affects women almost two to one. Due to their customarily proportionally bigger part in household maintenance and the maintenance of young children, women are more exposed to dermal irritants.
In particular, women work in a large number of occupations that are very susceptible to ICD (e.g., nursing, hairdressing).
Variations in occurrence due to age
At any age, ICD can develop. Numerous cases of diaper dermatitis are irritating contact dermatitis brought on by substances in urine & particularly feces, that directly irritate the skin. Older people’s skin is thinner, drier, and less tolerant of soaps & solvents than that of younger people. When combined with occupational ICD, atopic dermatitis, & age more than 50, occupational hand eczema is frequently accompanied by chronic dermatitis & extended sick leave.
The clinical manifestation of proinflammatory cytokine production from cutaneous cells (mostly keratinocytes), typically in reaction to chemical stimuli, is ICD. In contrast to allergic contact dermatitis, irritant dermatitis results from innate immunity that has been activated without previous sensitization. Various clinical forms might develop.
Disruption of the skin barrier, cellular alterations in the epidermis, & cytokine production is the three major pathophysiological alterations. A wide variety of substances can cause cutaneous irritation when present in high enough concentrations or for long enough periods of time. Solvents, mechanical, & microtrauma irritants are typical skin irritants.
In order to increase transepidermal water evaporation & make the skin more vulnerable to the increased direct harmful effects of many other formerly well-tolerated dermal exposures, solvents strip the skin of vital lipids and oils, which causes dermal irritation. Propanol, an alcohol, doesn’t irritate the skin as much as sodium lauryl sulphate, a detergent.
Skin irritation could result from microtrauma. Fiberglass is a typical example, which in susceptible people may cause pruritus with just slight apparent irritation. Numerous plant stems and leaves have tiny spicules and thorns that cause immediate skin damage. Combining physical irritants like friction, abrasive grit, and occlusion with detergents like sodium lauryl sulphate increases the likelihood of developing irritating contact dermatitis.
Skin sensitization to topical treatments is more likely to occur when there is skin irritation—both allergic and non-allergenic substances that irritate the skin cause the migration & maturation of Langerhans cells. An increase in irritating contact dermatitis may signal the emergence of an allergy to skin creams, drugs, and rubber gloves.
Regional epidermal cells, endothelial cells, epidermal fibroblasts & different leukocytes interact with one another throughout the pathogenesis of irritating contact dermatitis under the direction of a network of lipid & cytokines mediators. Through the secretion of cytokines & their reactions to them, keratinocytes have a significant impact on the beginning and continuation of inflammatory skin reactions. Certain cytokines are produced constitutively by sleeping keratinocytes.
The following cytokines can be released by epidermal keratinocytes in response to a wide range of environmental stimuli, such as ultraviolet light and chemical substances.
Stimulating cytokines for growth (IL-6, IL-7, IL-15, Colony-stimulating factor for granulocytes and macrophages, transforming growth factor–alpha)
Cytokines controlling cellular vs humoral immunity (IL-10, IL-12, IL-18)
In epidermal inflammatory responses, such as irritating contact dermatitis, adhesion molecules molecule 1 encourages leukocyte infiltration into the epidermis.
Hand irritant contact dermatitis is more likely to occur in people with a history of atopic dermatitis. The lack of filaggrin due to polymorphisms in the filaggrin (FLG) gene may change the skin barrier and be a risk factor for atopic dermatitis. Increased vulnerability to chronic, irritating contact dermatitis is linked to FLG null genotypes.
The duration, potency, and concentration of the drug all affect how likely it is that irritating contact dermatitis may manifest. Irritant contact dermatitis can be brought on by skin rashes brought on by chemical, physical, or microtrauma factors. When physical allergens like abrasion, friction, and occlusion are combined with detergents like sodium lauryl sulphate, irritant contact dermatitis is more likely to develop than when they are used alone.
The concentration & quantity of the irritant, the frequency, and the duration of exposure are the elements that affect how severe the ICD is. It also depends on the skin’s characteristics, such as whether it is thin, thick, greasy, very fair, dry, previously injured, or has an atopic propensity. The severity is also affected by environmental variables, including extremes in temperature & humidity.
The cause and way of life of people with contact dermatitis affect their prognosis. If the offending chemical exposure is stopped, isolated cases usually end. People who don’t comply, wear metal jewelry, or are exposed to plants due to their lifestyles typically have a severe form. Relapses happen frequently.
Clinical work may be affected by latex allergy, a highly prevalent type of contact dermatitis in the medical field. Anaphylaxis cases are frequently recorded.
Clinical History
Because the identification of irritant contact dermatitis (ICD) depends on the history of contact of the infected body site to the skin irritant, a thorough medical history is necessary. In severe or chronic cases, patch testing is also performed to rule out allergic contact dermatitis as a contributing factor to the person’s cutaneous symptoms.
In cases of uncomplicated acute ICD, symptoms begin to appear within a few hours after exposure. Some irritants, like benzalkonium chloride (e.g., zephiran, a disinfectant, and preservative), which induces a delayed (8–24 h post-exposure) inflammatory process, is known to cause acute, delayed ICD.
In cumulative chronic ICD, the start of symptoms and signs may be weeks away. Multiple instances of below-threshold skin injury that occur frequently enough for the skin’s barrier function to not fully recover between exposures result in cumulative ICD. Individuals with skin problems, such as those who are atopic, have lower irritant thresholds or slower restoration times, which increases their susceptibility to clinical ICD.
Exposure to weak irritants, as opposed to strong ones, is more likely to result in cumulative ICD. The exposure (for instance, to water) frequently occurs both at work and at home. These patients describe fissuring of the chapping (hyperkeratotic epidermis) as causing both itching & pain. Early on in the clinical phase, discomfort, stinging, burning, or pain beyond pruritus develop.
Occupational history
A significant occupational disease is irritant contact dermatitis; up to 40 percent of occupational diseases are skin illnesses. Adults with suspected irritating contact dermatitis must provide the doctor with their job history. Employees who are fresh to a job, who are fundamentally more prone to irritant contact dermatitis, or who have not learned how to defend their skin from epidermal irritants are most likely to develop occupational ICD.
According to a Danish study, the majority of affected workers experience less permanent damage than those who contract other workplace accidents, although skin disorders pay out more in compensation than respiratory illnesses and musculoskeletal ailments.
Physical examination
The following were suggested by Rietschel & Fowler as the key diagnostic standards for ICD:
Macular erythema, ensuring dominance over vesiculation, and hyperkeratosis.
The epidermis has a scalded look, parched or glazed.
The process of healing starts right away after ceasing exposure to the harmful agent.
Negative outcomes from patch testing with all potential allergens.
The following are some minor objective criteria for ICD:
Dermatitis’ precise boundaries
A dripping effect or another gravitational influence indicator
Compared to allergic contact dermatitis, there is less of a chance for dermatitis to spread.
Morphological changes imply that modest variations in concentration or contact time result in significant variations in damage to the skin.
People may form the habit of repeatedly rubbing an area that has irritating contact dermatitis, which can lead to secondary neurodermatitis and lichenification (lichen simplex chronicus). This could be considered a result of occupational harm.
Differential Diagnoses
Seborrheic Dermatitis
Scabies
Psoriasis
Phytophotodermatitis
Perioral Dermatitis
Pediatric Atopic Dermatitis
Lichen Simplex Chronicus
Erysipelas
Drug Eruptions
Cutaneous Manifestations of Kidney Disease
Atopic Dermatitis
Allergic Contact Dermatitis
Finding and eliminating any suspected causative factors is the only effective treatment for ICD. Rarely does an inflammatory process from acute prolonged irritating contact dermatitis to a substance like a benzalkonium chloride (e.g., zephiran) require treatment; instead, it typically goes away as exposure is stopped. The extent of involvement and the existence or absence of secondary infection will determine whether or not symptomatic treatment is continued.
Use ceramide-containing lotions or unflavored emollients after washing your hands with soap and right before bed, you should advise them. Cleansers can be rated based on how irritating they are. Recommend using minor skin washes in place of soap on the affected regions, such as Cetaphil cleanser, Aquanil, Oilatum AD, & Neutrogena cleanser. People should be warned against washing their hands with abrasives or improper solvents like gasoline, which can damage or dehydrate the skin.
The Danish Contact Dermatitis Group’s recommendation for treating hand eczema summarises the fundamental principles of treatment in a flowchart and emphasizes that moisturizing cream should be used along with all other therapies. According to the guidelines, doctors should refer patients with hand eczema to a dermatologist if the condition doesn’t clear up in a month because longer wait times are linked to worse outcomes.
Emergency Department Care
Treatment at an emergency room could involve the following:
Burow solution (1:40 dilution), Topical soak with cool tap water, saline (1 tsp/pint)
Baths in lukewarm water
Aveeno lukewarm baths
Emollients (such as white petrolatum and Eucerin) may help chronic instances.
Therapeutic draining may be beneficial for large vesicles (but retaining the vesicle tops in place). The next step is to apply an antibiotic treatment, or a dressing drenched in Burow liquid to these lesions. Only serious cutaneous ICD, such as burn injuries from hydrofluoric acid or, rarely, fresh concrete Portland cement, necessitate hospital hospitalization.
Barrier Creams
Ceramide-containing creams, such as Cerave, Impruv, and Cetaphil RESTORADERM, may be especially beneficial in helping people with ICD & atopic dermatitis restore the cutaneous barrier. People who have moist work-related irritating contact dermatitis may find it beneficial to restore the epidermal barrier with the aid of creams having dimethicone (such as Cetaphil creams).
Cleansers
The majority of detergents and soaps are alkaline and raise cutaneous pH, which impairs the skin’s physiologic protective acid mantle by lowering the fat content. The essential components in the induction of ICD & itching by soaps include disruption of the stratum corneum and pH alterations. In people with dry, sensitive skin, these issues are even worse in the winter.
Due to regular hand washing, ICD is a frequent issue among healthcare professionals. Ethanol (60 to 85 percent), isopropanol (60 to 80 percent), and N-propanol (60 to 80 percent have the highest antibacterial effectiveness. Chlorhexidine (2-4%) & triclosan (1-2%) have lower & slower antibacterial activity and may increase the likelihood of resistant bacteria.
One method to lessen skin damage, dryness, and irritation among healthcare workers is to use alcohol-based hand lotions containing different emollients instead of harsh detergents and soaps. The preparations containing 4 percent chlorhexidine gluconate cause irritant contact dermatitis the most frequently, followed by nonantimicrobial detergents & preparations with lower doses of chlorhexidine gluconate and very well alcohol-based hand rubs with emollients as well as other skin conditioners.
Steroids & Immunomodulators
The effectiveness of topical corticosteroids & immunomodulators in the management of ICD is unknown. Comparing corticosteroids to the vehicle and to the untreated control, it was discovered that they were unsuccessful in treating surfactant-induced irritating dermatitis. Topical corticosteroids, however, might be advantageous for eczematous symptoms that are overlaid.
Steroid use has potential side effects, especially when applied near the eye. Long-term corticosteroid use must be avoided since it increases the risk of developing cataracts, glaucoma, corneal thinning or perforation, losing one eye, and other issues.
Topical tacrolimus can be used as a substitute for topical steroids, but it can also be irritating, which can make people with irritant contact dermatitis experience even more stinging and irritation.
An eczematous cutaneous condition known as contact dermatitis causes inflammation. Contact irritants such as metal or chemical ions, as well as tiny reactive compounds that alter proteins & trigger adaptive and innate immune reactions (contact allergens), are the main culprits. Both allergic and irritating contact dermatitis fall under the category of contact dermatitis.
While allergic contact dermatitis is a prolonged (type 4) hypersensitivity reaction to external encounter antigens, irritant contact dermatitis is a generic skin reaction to direct chemical injury that releases transmitters of inflammation primarily from epidermal cells. Cytokines & T cells work together to cause immunological reactions. Even when the allergen is in contact with covered parts when there is photo exposure, allergic dermatitis lesions are restricted to sun-exposed regions.
Unfortunately, data show that allergic contact dermatitis, which affects about 20% of youngsters, is much more common than previously thought. The good news is that most contact dermatitis cases self-limit and may be treated with straightforward supportive treatments. The disease can, however, be chronic in certain people and have a major impact on quality of life.
United States statistics
Irritant contact dermatitis (ICD) is frequent in professions requiring frequent hand washing or repetitive skin exposure to irritants such as food, water, and other substances. Cleaning, hospital services, preparing food, & hairdressers are among the high-risk professions. The prevalence of workplace hand dermatitis was reported to be 55.6 percent in two acute care units and 69.7 percent in the most heavily exposed personnel. Occupational hand dermatitis was found to be strongly linked with washing hands frequency of more than 40 times each shift.
The prevalence of sexual distinctions
Women experience irritant contact dermatitis much more frequently than males do. Women are more likely than men to develop hand eczema, and environmental rather than hereditary factors are to blame. Contrary to other industrial disorders that primarily affect men, occupational irritant contact dermatitis affects women almost two to one. Due to their customarily proportionally bigger part in household maintenance and the maintenance of young children, women are more exposed to dermal irritants.
In particular, women work in a large number of occupations that are very susceptible to ICD (e.g., nursing, hairdressing).
Variations in occurrence due to age
At any age, ICD can develop. Numerous cases of diaper dermatitis are irritating contact dermatitis brought on by substances in urine & particularly feces, that directly irritate the skin. Older people’s skin is thinner, drier, and less tolerant of soaps & solvents than that of younger people. When combined with occupational ICD, atopic dermatitis, & age more than 50, occupational hand eczema is frequently accompanied by chronic dermatitis & extended sick leave.
The clinical manifestation of proinflammatory cytokine production from cutaneous cells (mostly keratinocytes), typically in reaction to chemical stimuli, is ICD. In contrast to allergic contact dermatitis, irritant dermatitis results from innate immunity that has been activated without previous sensitization. Various clinical forms might develop.
Disruption of the skin barrier, cellular alterations in the epidermis, & cytokine production is the three major pathophysiological alterations. A wide variety of substances can cause cutaneous irritation when present in high enough concentrations or for long enough periods of time. Solvents, mechanical, & microtrauma irritants are typical skin irritants.
In order to increase transepidermal water evaporation & make the skin more vulnerable to the increased direct harmful effects of many other formerly well-tolerated dermal exposures, solvents strip the skin of vital lipids and oils, which causes dermal irritation. Propanol, an alcohol, doesn’t irritate the skin as much as sodium lauryl sulphate, a detergent.
Skin irritation could result from microtrauma. Fiberglass is a typical example, which in susceptible people may cause pruritus with just slight apparent irritation. Numerous plant stems and leaves have tiny spicules and thorns that cause immediate skin damage. Combining physical irritants like friction, abrasive grit, and occlusion with detergents like sodium lauryl sulphate increases the likelihood of developing irritating contact dermatitis.
Skin sensitization to topical treatments is more likely to occur when there is skin irritation—both allergic and non-allergenic substances that irritate the skin cause the migration & maturation of Langerhans cells. An increase in irritating contact dermatitis may signal the emergence of an allergy to skin creams, drugs, and rubber gloves.
Regional epidermal cells, endothelial cells, epidermal fibroblasts & different leukocytes interact with one another throughout the pathogenesis of irritating contact dermatitis under the direction of a network of lipid & cytokines mediators. Through the secretion of cytokines & their reactions to them, keratinocytes have a significant impact on the beginning and continuation of inflammatory skin reactions. Certain cytokines are produced constitutively by sleeping keratinocytes.
The following cytokines can be released by epidermal keratinocytes in response to a wide range of environmental stimuli, such as ultraviolet light and chemical substances.
Stimulating cytokines for growth (IL-6, IL-7, IL-15, Colony-stimulating factor for granulocytes and macrophages, transforming growth factor–alpha)
Cytokines controlling cellular vs humoral immunity (IL-10, IL-12, IL-18)
In epidermal inflammatory responses, such as irritating contact dermatitis, adhesion molecules molecule 1 encourages leukocyte infiltration into the epidermis.
Hand irritant contact dermatitis is more likely to occur in people with a history of atopic dermatitis. The lack of filaggrin due to polymorphisms in the filaggrin (FLG) gene may change the skin barrier and be a risk factor for atopic dermatitis. Increased vulnerability to chronic, irritating contact dermatitis is linked to FLG null genotypes.
The duration, potency, and concentration of the drug all affect how likely it is that irritating contact dermatitis may manifest. Irritant contact dermatitis can be brought on by skin rashes brought on by chemical, physical, or microtrauma factors. When physical allergens like abrasion, friction, and occlusion are combined with detergents like sodium lauryl sulphate, irritant contact dermatitis is more likely to develop than when they are used alone.
The concentration & quantity of the irritant, the frequency, and the duration of exposure are the elements that affect how severe the ICD is. It also depends on the skin’s characteristics, such as whether it is thin, thick, greasy, very fair, dry, previously injured, or has an atopic propensity. The severity is also affected by environmental variables, including extremes in temperature & humidity.
The cause and way of life of people with contact dermatitis affect their prognosis. If the offending chemical exposure is stopped, isolated cases usually end. People who don’t comply, wear metal jewelry, or are exposed to plants due to their lifestyles typically have a severe form. Relapses happen frequently.
Clinical work may be affected by latex allergy, a highly prevalent type of contact dermatitis in the medical field. Anaphylaxis cases are frequently recorded.
Clinical History
Because the identification of irritant contact dermatitis (ICD) depends on the history of contact of the infected body site to the skin irritant, a thorough medical history is necessary. In severe or chronic cases, patch testing is also performed to rule out allergic contact dermatitis as a contributing factor to the person’s cutaneous symptoms.
In cases of uncomplicated acute ICD, symptoms begin to appear within a few hours after exposure. Some irritants, like benzalkonium chloride (e.g., zephiran, a disinfectant, and preservative), which induces a delayed (8–24 h post-exposure) inflammatory process, is known to cause acute, delayed ICD.
In cumulative chronic ICD, the start of symptoms and signs may be weeks away. Multiple instances of below-threshold skin injury that occur frequently enough for the skin’s barrier function to not fully recover between exposures result in cumulative ICD. Individuals with skin problems, such as those who are atopic, have lower irritant thresholds or slower restoration times, which increases their susceptibility to clinical ICD.
Exposure to weak irritants, as opposed to strong ones, is more likely to result in cumulative ICD. The exposure (for instance, to water) frequently occurs both at work and at home. These patients describe fissuring of the chapping (hyperkeratotic epidermis) as causing both itching & pain. Early on in the clinical phase, discomfort, stinging, burning, or pain beyond pruritus develop.
Occupational history
A significant occupational disease is irritant contact dermatitis; up to 40 percent of occupational diseases are skin illnesses. Adults with suspected irritating contact dermatitis must provide the doctor with their job history. Employees who are fresh to a job, who are fundamentally more prone to irritant contact dermatitis, or who have not learned how to defend their skin from epidermal irritants are most likely to develop occupational ICD.
According to a Danish study, the majority of affected workers experience less permanent damage than those who contract other workplace accidents, although skin disorders pay out more in compensation than respiratory illnesses and musculoskeletal ailments.
Physical examination
The following were suggested by Rietschel & Fowler as the key diagnostic standards for ICD:
Macular erythema, ensuring dominance over vesiculation, and hyperkeratosis.
The epidermis has a scalded look, parched or glazed.
The process of healing starts right away after ceasing exposure to the harmful agent.
Negative outcomes from patch testing with all potential allergens.
The following are some minor objective criteria for ICD:
Dermatitis’ precise boundaries
A dripping effect or another gravitational influence indicator
Compared to allergic contact dermatitis, there is less of a chance for dermatitis to spread.
Morphological changes imply that modest variations in concentration or contact time result in significant variations in damage to the skin.
People may form the habit of repeatedly rubbing an area that has irritating contact dermatitis, which can lead to secondary neurodermatitis and lichenification (lichen simplex chronicus). This could be considered a result of occupational harm.
Differential Diagnoses
Seborrheic Dermatitis
Scabies
Psoriasis
Phytophotodermatitis
Perioral Dermatitis
Pediatric Atopic Dermatitis
Lichen Simplex Chronicus
Erysipelas
Drug Eruptions
Cutaneous Manifestations of Kidney Disease
Atopic Dermatitis
Allergic Contact Dermatitis
Finding and eliminating any suspected causative factors is the only effective treatment for ICD. Rarely does an inflammatory process from acute prolonged irritating contact dermatitis to a substance like a benzalkonium chloride (e.g., zephiran) require treatment; instead, it typically goes away as exposure is stopped. The extent of involvement and the existence or absence of secondary infection will determine whether or not symptomatic treatment is continued.
Use ceramide-containing lotions or unflavored emollients after washing your hands with soap and right before bed, you should advise them. Cleansers can be rated based on how irritating they are. Recommend using minor skin washes in place of soap on the affected regions, such as Cetaphil cleanser, Aquanil, Oilatum AD, & Neutrogena cleanser. People should be warned against washing their hands with abrasives or improper solvents like gasoline, which can damage or dehydrate the skin.
The Danish Contact Dermatitis Group’s recommendation for treating hand eczema summarises the fundamental principles of treatment in a flowchart and emphasizes that moisturizing cream should be used along with all other therapies. According to the guidelines, doctors should refer patients with hand eczema to a dermatologist if the condition doesn’t clear up in a month because longer wait times are linked to worse outcomes.
Emergency Department Care
Treatment at an emergency room could involve the following:
Burow solution (1:40 dilution), Topical soak with cool tap water, saline (1 tsp/pint)
Baths in lukewarm water
Aveeno lukewarm baths
Emollients (such as white petrolatum and Eucerin) may help chronic instances.
Therapeutic draining may be beneficial for large vesicles (but retaining the vesicle tops in place). The next step is to apply an antibiotic treatment, or a dressing drenched in Burow liquid to these lesions. Only serious cutaneous ICD, such as burn injuries from hydrofluoric acid or, rarely, fresh concrete Portland cement, necessitate hospital hospitalization.
Barrier Creams
Ceramide-containing creams, such as Cerave, Impruv, and Cetaphil RESTORADERM, may be especially beneficial in helping people with ICD & atopic dermatitis restore the cutaneous barrier. People who have moist work-related irritating contact dermatitis may find it beneficial to restore the epidermal barrier with the aid of creams having dimethicone (such as Cetaphil creams).
Cleansers
The majority of detergents and soaps are alkaline and raise cutaneous pH, which impairs the skin’s physiologic protective acid mantle by lowering the fat content. The essential components in the induction of ICD & itching by soaps include disruption of the stratum corneum and pH alterations. In people with dry, sensitive skin, these issues are even worse in the winter.
Due to regular hand washing, ICD is a frequent issue among healthcare professionals. Ethanol (60 to 85 percent), isopropanol (60 to 80 percent), and N-propanol (60 to 80 percent have the highest antibacterial effectiveness. Chlorhexidine (2-4%) & triclosan (1-2%) have lower & slower antibacterial activity and may increase the likelihood of resistant bacteria.
One method to lessen skin damage, dryness, and irritation among healthcare workers is to use alcohol-based hand lotions containing different emollients instead of harsh detergents and soaps. The preparations containing 4 percent chlorhexidine gluconate cause irritant contact dermatitis the most frequently, followed by nonantimicrobial detergents & preparations with lower doses of chlorhexidine gluconate and very well alcohol-based hand rubs with emollients as well as other skin conditioners.
Steroids & Immunomodulators
The effectiveness of topical corticosteroids & immunomodulators in the management of ICD is unknown. Comparing corticosteroids to the vehicle and to the untreated control, it was discovered that they were unsuccessful in treating surfactant-induced irritating dermatitis. Topical corticosteroids, however, might be advantageous for eczematous symptoms that are overlaid.
Steroid use has potential side effects, especially when applied near the eye. Long-term corticosteroid use must be avoided since it increases the risk of developing cataracts, glaucoma, corneal thinning or perforation, losing one eye, and other issues.
Topical tacrolimus can be used as a substitute for topical steroids, but it can also be irritating, which can make people with irritant contact dermatitis experience even more stinging and irritation.
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