Contact dermatitis

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Contact dermatitis
Contact dermatitis around wound.jpg
Contact dermatitis rash.
Specialty Dermatology

Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. [1] Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.

Contents

Contact dermatitis results from either exposure to allergens (allergic contact dermatitis), or irritants (irritant contact dermatitis). Allergic contact dermatitis involves a delayed type of hypersensitivity and previous exposure to an allergen to produce a reaction. [2] Irritant contact dermatitis is the most common type and represents 80% of all cases. [1] It is caused by prolonged exposure to irritants, leading to direct injury of the epidermal cells of the skin, which activates an immune response, resulting in an inflammatory cutaneous reaction. [1] Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight. Diagnosis of allergic contact dermatitis can often be supported by patch testing. [3]

Epidemiology

Contact dermatitis constitutes 95% of all occupational skin disorders. [4] There are few accurate statistics on the incidence and prevalence of contact dermatitis. [5] The results of the few studies that have been undertaken cannot be compared because of methodological differences. [5]

Signs and symptoms

Contact dermatitis is a localized rash or irritation of the skin caused by contact with a foreign substance. Only the superficial regions of the skin are affected in contact dermatitis. Inflammation of the affected tissue is present in the epidermis (the outermost layer of skin) and the outer dermis (the layer beneath the epidermis). [6]

Contact dermatitis results in large, burning, and itchy rashes. These can take anywhere from several days to weeks to heal. This differentiates it from contact urticaria (hives), in which a rash appears within minutes of exposure and then fades away within minutes to hours. Even after days, contact dermatitis fades only if the skin no longer comes in contact with the allergen or irritant. [7] Chronic contact dermatitis can develop when the removal of the offending agent no longer provides expected relief.

Irritant dermatitis is usually confined to the area where the irritating substance actually touched the skin, whereas allergic dermatitis may be more widespread on the skin. Irritant dermatitis is usually found on hands whereas exposed areas of skin. Symptoms of both forms include the following:

While either form of contact dermatitis can affect any part of the body, irritant contact dermatitis often affects the hands, which have been exposed by resting in or dipping into a container (sink, pail, tub, swimming pools with high chlorine) containing the irritant.

Causes

The percentage of cases attributable to occupational contact dermatitis varies substantially depending on the industries that predominate, the employment that people have, the risks to which they are exposed, the centers that record cases, and variances in defining and confirming diagnoses. [9]

Common causes of allergic contact dermatitis include: nickel allergy, 14K or 18K gold, Balsam of Peru (Myroxylon pereirae), and chromium. In the Americas they include the oily coating from plants of the genus Toxicodendron : poison ivy, poison oak, and poison sumac. Millions of cases occur each year in North America alone. [10] The alkyl resorcinols in Grevillea banksii and Grevillea 'Robyn Gordon' are responsible for contact dermatitis. [11] Bilobol, another alkyl resorcinol found in Ginkgo biloba fruits, is also a strong skin irritant. [12]

Common causes of irritant contact dermatitis include solvents, metalworking fluids, latex, kerosene, ethylene oxide, paper, especially papers coated with chemicals and printing inks, certain foods and drink, [13] food flavorings and spices, [14] perfume, [13] surfactants in topical medications and cosmetics, alkalis, low humidity from air conditioning, and many plants. Other common causes of irritant contact dermatitis are harsh alkaline soaps, detergents, and cleaning products. [15]

There are three types of contact dermatitis: irritant contact dermatitis; allergic contact dermatitis; and photocontact dermatitis. Photocontact dermatitis is divided into two categories: phototoxic and photoallergic.

Irritant contact dermatitis

The irritant's direct cytotoxic impact on epidermal keratinocytes causes Irritant contact dermatitis. [1] This disrupts the skin barrier and activates the innate immune system. Keratinocytes in the epidermis can be actually affected by irritants. [1] It is a complicated reaction that is influenced by genetic and environmental elements, both of which have a role in the pathogenesis of the disease. [1] It can be seen in both occupational and non-occupational environments but it's more common in the occupations dealing in low humidity conditions. [1]

Contact dermatitis caused by unprotected handling of damp, impregnated wooden construction debris. Contact dermatitis.jpg
Contact dermatitis caused by unprotected handling of damp, impregnated wooden construction debris.

Irritant contact dermatitis (ICD) can be divided into forms caused by chemical irritants, and those caused by physical irritants. Common chemical irritants implicated include: solvents (alcohol, xylene, turpentine, esters, acetone, ketones, and others); metalworking fluids (neat oils, water-based metalworking fluids with surfactants); latex; kerosene; ethylene oxide; surfactants in topical medications and cosmetics (sodium lauryl sulfate); and alkalis (drain cleaners, strong soap with lye residues).

Physical irritant contact dermatitis may most commonly be caused by low humidity from air conditioning. [16] Also, many plants directly irritate the skin.

Allergic contact dermatitis

3-year-old girl with contact dermatitis, one day after contact with poison ivy Poision Ivy 2012.jpg
3-year-old girl with contact dermatitis, one day after contact with poison ivy

Allergic contact dermatitis (ACD) is accepted to be the most prevalent form of immunotoxicity found in humans, and is a common occupational and environmental health problem. [17] By its allergic nature, this form of contact dermatitis is a hypersensitive reaction that is atypical within the population. The development of the disease occurs in two phases, which are induction and elicitation. [17] The process of skin sensitization begins when a susceptible subject is exposed to the allergen in sufficient concentration to elicit the required cutaneous immune response. This causes sensitization and when exposure to the same allergen at a later time at the same or different skin site leads to a secondary immune response at the point of contact. [17] The mechanisms by which this reaction occurs are complex, with many levels of fine control. Their immunology centres on the interaction of immunoregulatory cytokines and discrete subpopulations of T lymphocytes.

Allergens include nickel, gold, Balsam of Peru (Myroxylon pereirae), chromium, and the oily coating from plants of the genus Toxicodendron , such as poison ivy, poison oak, and poison sumac. Acrylates, rubber chemicals, emulsifiers and dyes, epoxy resin chemicals are just several of the substances that might induce Allergic Contact Dermatitis. [17] Much of the allergic contact dermatitis that arises is caused by occupational exposure. Non-occupational exposure to allergens in medicaments, clothing, cosmetics, and plants are also a significant cause of allergic contact dermatitis. [17]

Photocontact dermatitis

Sometimes termed "photoaggravated", [18] and divided into two categories, phototoxic and photoallergic, PCD is the eczematous condition which is triggered by an interaction between an otherwise unharmful or less harmful substance on the skin and ultraviolet light (320–400 nm UVA) (ESCD 2006), therefore manifesting itself only in regions where the affected person has been exposed to such rays.

Without the presence of these rays, the photosensitiser is not harmful. For this reason, this form of contact dermatitis is usually associated only with areas of skin that are left uncovered by clothing, and it can be soundly defeated by avoiding exposure to sunlight. [19] The mechanism of action varies from toxin to toxin, but is usually due to the production of a photoproduct. Toxins which are associated with PCD include the psoralens. Psoralens are in fact used therapeutically for the treatment of psoriasis, eczema, and vitiligo.

Photocontact dermatitis is another condition in which the distinction between forms of contact dermatitis is not clear-cut. Immunological mechanisms can also play a part, causing a response similar to ACD.

Diagnosis

Patch test Epikutanni-test.jpg
Patch test

Since contact dermatitis relies on an irritant or an allergen to initiate the reaction, it is important for the patient to identify the responsible agent and avoid it. This can be accomplished by having patch tests, one of various methods commonly known as allergy testing. [20] The patch tests were based on the concept of a type IV hypersensitivity reaction where there is exposure of allergens to skin and checking for the development of contact dermatitis in that area. This test involves the application of suspected irritant to a part of the skin and cover it with impermeable material and attached to the skin with the help of adhesive plaster. [21] The top three allergens found in patch tests from 2005 to 2006 were: nickel sulfate (19.0%), Myroxylon pereirae (Balsam of Peru, 11.9%), and fragrance mix I (11.5%). [22]

The patient must know where the irritant or allergen is found to be able to avoid it. It is important to also note that chemicals sometimes have several different names, and do not always appear on labels. [23]

The distinction between the various types of contact dermatitis is based on a number of factors. The morphology of the tissues, the histology, and immunologic findings are all used in diagnosis of the form of the condition. However, as suggested previously, there is some confusion in the distinction of the different forms of contact dermatitis. [24] Using histology on its own is insufficient, as these findings have been acknowledged not to distinguish, [24] and even positive patch testing does not rule out the existence of an irritant form of dermatitis as well as an immunological one.

Prevention

In an industrial setting the employer has a duty of care to its worker to provide the correct level of safety equipment to mitigate exposure to harmful irritants. This can take the form of protective clothing, gloves, or barrier cream, depending on the working environment. It is impossible to eliminate the complete exposure to harmful irritants but can be avoided using the multidimensional approach. The multidimensional approach includes eight basic elements to follow. They are:

Topical antibiotics should not be used to prevent infection in wounds after surgery. [26] [27] When they are used, it is inappropriate, and the person recovering from surgery is at significantly increased risk of developing contact dermatitis. [26]

Treatment

Self-care

Medical care

If the rash does not improve or continues to spread after 2–3 of days of self-care, or if the itching and/or pain is severe, the patient should contact a dermatologist or other physician. Medical treatment usually consists of lotions, creams, or oral medications.

In severe cases, a stronger medicine like halobetasol may be prescribed by a dermatologist.

See also

Related Research Articles

<span class="mw-page-title-main">Allergy</span> Immune system response to a substance that most people tolerate well

Allergies, also known as allergic diseases, refer to a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, coughing, a runny nose, shortness of breath, or swelling. Note that food intolerances and food poisoning are separate conditions.

<span class="mw-page-title-main">Dermatitis</span> Inflammation of the skin

Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is often called eczema, and the difference between those terms is not standardized.

An allergen is a type of antigen that produces an abnormally vigorous immune response in which the immune system fights off a perceived threat that would otherwise be harmless to the body. Such reactions are called allergies.

<span class="mw-page-title-main">Urushiol</span> Oily mixture of organic compounds

Urushiol is an oily mixture of organic compounds with allergenic properties found in plants of the family Anacardiaceae, especially Toxicodendronspp., Comocladia spp. (maidenplums), Metopium spp. (poisonwood), and also in parts of the mango tree as well as the fruit of the cashew tree. In most individuals, urushiol causes an allergic skin rash on contact, known as urushiol-induced contact dermatitis.

<span class="mw-page-title-main">Irritant diaper dermatitis</span> Medical condition

Irritant diaper dermatitis is a generic term applied to skin rash in the diaper area that are caused by various skin disorders and/or irritants.

<span class="mw-page-title-main">Latex allergy</span> Medical condition

Latex allergy is a medical term encompassing a range of allergic reactions to the proteins present in natural rubber latex. It generally develops after repeated exposure to products containing natural rubber latex. When latex-containing medical devices or supplies come in contact with mucous membranes, the membranes may absorb latex proteins. In some susceptible people, the immune system produces antibodies that react immunologically with these antigenic proteins. Many items contain or are made from natural rubber, including shoe soles, pen grips, hot water bottles, elastic bands, rubber gloves, condoms, baby-bottle nipples, and balloons; consequently, there are many possible routes of exposure that may trigger a reaction. People with latex allergies may also have or develop allergic reactions to some fruits, such as bananas.

<span class="mw-page-title-main">Hives</span> Skin disease characterized by red, raised, and itchy bumps

Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and does not leave any long-lasting skin change. Fewer than 5% of cases last for more than six weeks. The condition frequently recurs.

<span class="mw-page-title-main">Quaternium-15</span> Salt used as a surfactant

Quaternium-15 is a quaternary ammonium salt that has been used as a surfactant and preservative. It acts as an antimicrobial agent because it slowly releases formaldehyde, which is a preservative with biocidal properties.

<span class="mw-page-title-main">Dyshidrosis</span> Human disease

Dyshidrosis is a type of dermatitis that is characterized by itchy blisters on the palms of the hands and bottoms of the feet. Blisters are generally one to two millimeters in size and heal over three weeks. However, they often recur. Redness is not usually present. Repeated attacks may result in fissures and skin thickening.

<span class="mw-page-title-main">Urushiol-induced contact dermatitis</span> Medical condition

Urushiol-induced contact dermatitis is a type of allergic contact dermatitis caused by the oil urushiol found in various plants, most notably sumac family species of the genus Toxicodendron: poison ivy, poison oak, poison sumac, and the Chinese lacquer tree. The name is derived from the Japanese word for the sap of the Chinese lacquer tree, urushi. Other plants in the sumac family also contain urushiol, as do unrelated plants such as Ginkgo biloba.

<span class="mw-page-title-main">Patch test</span> Medical test to determine substances causing allergic reactions

A patch test is a diagnostic method used to determine which specific substances cause allergic inflammation of a patient's skin.

<span class="mw-page-title-main">Perioral dermatitis</span> Medical condition

Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved. It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.

<span class="mw-page-title-main">Allergic contact dermatitis</span> Medical condition

Allergic contact dermatitis (ACD) is a form of contact dermatitis that is the manifestation of an allergic response caused by contact with a substance; the other type being irritant contact dermatitis (ICD).

<span class="mw-page-title-main">Balsam of Peru</span> Type of tree balsam

Balsam of Peru or Peru balsam, also known and marketed by many other names, is a balsam derived from a tree known as Myroxylon balsamum var. pereirae; it is found in El Salvador, where it is an endemic species.

<span class="mw-page-title-main">Tetrazepam</span> Chemical compound

Tetrazepam is a benzodiazepine derivative with anticonvulsant, anxiolytic, muscle relaxant and slightly hypnotic properties. It was formerly used mainly in Austria, France, Belgium, Germany and Spain to treat muscle spasm, anxiety disorders such as panic attacks, or more rarely to treat depression, premenstrual syndrome or agoraphobia. Tetrazepam has relatively little sedative effect at low doses while still producing useful muscle relaxation and anxiety relief. The Co-ordination Group for Mutual Recognition and Decentralised Procedures-Human endorsed the Pharmacovigilance Risk Assessment Committee (PRAC) recommendation to suspend the marketing authorisations of tetrazepam-containing medicines across the European Union (EU) in April 2013. The European Commission has confirmed the suspension of the marketing authorisations for Tetrazepam in Europe because of cutaneous toxicity, effective from the 1 August 2013.

Eyelid dermatitis is commonly related to atopic dermatitis or allergic contact dermatitis. Volatile substances, tosylamide, epoxy hardeners, insect sprays, and lemon peel oil may be implicated, with many cases of eyelid contact dermatitis being caused by substances transferred by the hands to the eyelids.

Id reactions are types of acute dermatitis developing after days or weeks at skin locations distant from the initial inflammatory or infectious site. They can be localised or generalised. This is also known as an 'autoeczematous response' and there must be an identifiable initial inflammatory or infectious skin problem which leads to the generalised eczema. Often intensely itchy, the red papules and pustules can also be associated with blisters and scales and are always remote from the primary lesion. It is most commonly a blistering rash with itchy vesicles on the sides of fingers and feet as a reaction to fungal infection on the feet, athlete's foot. Stasis dermatitis, allergic contact dermatitis, acute irritant contact eczema and infective dermatitis have been documented as possible triggers, but the exact cause and mechanism is not fully understood. Several other types of id reactions exist including erythema nodosum, erythema multiforme, Sweet's syndrome and urticaria.

<span class="mw-page-title-main">Nickel allergy</span> Medical condition

Nickel allergy is any of several allergic conditions provoked by exposure to the chemical element nickel. Nickel allergy often takes the form of nickel allergic contact dermatitis (Ni-ACD), a form of allergic contact dermatitis (ACD). Ni-ACD typically causes a rash that is red and itchy and that may be bumpy or scaly. The main treatment for it is avoiding contact with nickel-releasing metals, such as inexpensive jewelry. Another form of nickel allergy is a systemic form: systemic nickel allergy syndrome (SNAS) can mimic some of the symptoms of irritable bowel syndrome (IBS) and also has a dermatologic component.

<span class="mw-page-title-main">Lip licker's dermatitis</span> Medical condition

Lip licker's dermatitis is a type of skin inflammation around the lips due to damage by saliva from repetitive lip licking and is classified as a subtype of irritant contact cheilitis. The resulting scaling, redness, chapping, and crusting makes a well-defined ring around the lips. The rash may extend as far as the tongue can reach and usually does not occur at the corners of the mouth. It commonly occurs during winter months but some people can have it year-round if lip licking is a chronic habit.

<span class="mw-page-title-main">Metal allergy</span> Medical condition

Metal allergies inflame the skin after it has been in contact with metal. They are a form of allergic contact dermatitis. They are becoming more common, as of 2021, except in areas with regulatory countermeasures.

References

  1. 1 2 3 4 5 6 7 8 Bains, Sonia N.; Nash, Pembroke; Fonacier, Luz (2019-02-01). "Irritant Contact Dermatitis". Clinical Reviews in Allergy & Immunology. 56 (1): 99–109. doi:10.1007/s12016-018-8713-0. ISSN   1559-0267. PMID   30293200. S2CID   52931782.
  2. ↑ Cohen, David E.; Heidary, Noushin (September 2004). "Treatment of irritant and allergic contact dermatitis". Dermatologic Therapy. 17 (4): 334–340. doi: 10.1111/j.1396-0296.2004.04031.x . ISSN   1396-0296. PMID   15327479. S2CID   42322170.
  3. ↑ Mowad CM (July 2016). "Contact Dermatitis: Practice Gaps and Challenges". Dermatologic Clinics. 34 (3): 263–267. doi:10.1016/j.det.2016.02.010. PMID   27363882.
  4. ↑ Bains SN, Nash P, Fonacier L (February 2019). "Irritant Contact Dermatitis". Clinical Reviews in Allergy & Immunology. 56 (1): 99–109. doi:10.1007/s12016-018-8713-0. PMID   30293200. S2CID   52931782.
  5. 1 2 Diepgen, Tl; Weisshaar, E (September 2007). "Contact dermatitis: epidemiology and frequent sensitizers to cosmetics". Journal of the European Academy of Dermatology and Venereology. 21 (s2): 9–13. doi:10.1111/j.1468-3083.2007.02381.x. ISSN   0926-9959. PMID   17716286. S2CID   38860619.
  6. ↑ European Society of Contact Dermatitis. "What is contact dermatitis".
  7. ↑ "DermNet NZ: Contact Dermatitis" . Retrieved 2006-08-14.
  8. ↑ RAJAGOPALAN, R (September 1998). "An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis*1". American Journal of Contact Dermatitis. 9 (3): 149–154. doi:10.1016/s1046-199x(98)90017-3. ISSN   1046-199X. PMID   9744907.
  9. ↑ Nicholson, Paul J. (May 2011). "Occupational contact dermatitis: Known knowns and known unknowns". Clinics in Dermatology. 29 (3): 325–330. doi:10.1016/j.clindermatol.2010.11.012. ISSN   0738-081X. PMID   21496742.
  10. ↑ Gladman AC (2006). "Toxicodendron dermatitis: poison ivy, oak, and sumac". Wilderness & Environmental Medicine. 17 (2): 120–128. doi: 10.1580/pr31-05.1 . PMID   16805148.
  11. ↑ Menz J, Rossi ER, Taylor WC, Wall L (September 1986). "Contact dermatitis from Grevillea 'Robyn Gordon'". Contact Dermatitis. 15 (3): 126–131. doi:10.1111/j.1600-0536.1986.tb01311.x. PMID   2946534. S2CID   2846186.
  12. ↑ Matsumoto K, Fujimoto M, Ito K, Tanaka H, Hirono I (February 1990). "Comparison of the effects of bilobol and 12-O-tetradecanoylphorbol-13-acetate on skin, and test of tumor promoting potential of bilobol in CD-1 mice". The Journal of Toxicological Sciences. 15 (1): 39–46. doi: 10.2131/jts.15.39 . PMID   2110595.
  13. 1 2 "Balsam of Peru contact allergy". DermNet NZ. 2013-12-28. Retrieved 2014-04-17.
  14. ↑ Taylor JS, Amado A. "Contact Dermatitis and Related Conditions". Clevelandclinicmeded.com. Archived from the original on 25 July 2012. Retrieved 2014-04-17.
  15. ↑ Irritant Contact Dermatitis. DermNetNZ.org
  16. ↑ Morris-Jones R, Robertson SJ, Ross JS, White IR, McFadden JP, Rycroft RJ (August 2002). "Dermatitis caused by physical irritants". The British Journal of Dermatology. 147 (2): 270–275. doi:10.1046/j.1365-2133.2002.04852.x. PMID   12174098. S2CID   8444176.
  17. 1 2 3 4 5 Kimber I, Basketter DA, Gerberick GF, Dearman RJ (February 2002). "Allergic contact dermatitis". International Immunopharmacology. 2 (2–3): 201–211. doi:10.1016/S1567-5769(01)00173-4. PMID   11811925.
  18. ↑ Bourke J, Coulson I, English J (December 2001). "Guidelines for care of contact dermatitis". The British Journal of Dermatology. 145 (6): 877–885. doi:10.1046/j.1365-2133.2001.04499.x. PMID   11899139. S2CID   26038634.
  19. ↑ "Photocontact Dermatitis". www.skinchannel.com. Archived from the original on 21 April 2011. Retrieved 31 March 2011.
  20. ↑ Hristakieva E, Gancheva D, Gancheva T (2014). "Contact dermatitis in patient with chronic venous insufficiency". Trakia Journal of Sciences. 12 (3): 245–249. doi: 10.15547/tjs.2014.03.005 .
  21. ↑ Schwartz, Louis; Peck, Samuel M. (1944). "The Patch Test in Contact Dermatitis". Public Health Reports. 59 (17): 546. doi:10.2307/4584864. JSTOR   4584864.
  22. ↑ Zug KA, Warshaw EM, Fowler JF, Maibach HI, Belsito DL, Pratt MD, et al. (2009). "Patch-test results of the North American Contact Dermatitis Group 2005-2006". Dermatitis. 20 (3): 149–160. doi:10.2310/6620.2009.08097. PMID   19470301. S2CID   24088485.
  23. ↑ DermNet dermatitis/contact-allergy
  24. 1 2 Rietschel RL (1997). "Mechanisms in irritant contact dermatitis". Clinics in Dermatology. 15 (4): 557–559. doi:10.1016/S0738-081X(97)00058-8. PMID   9255462.
  25. ↑ Mathias, C.G. Toby (October 1990). "Prevention of occupational contact dermatitis". Journal of the American Academy of Dermatology. 23 (4): 742–748. doi:10.1016/0190-9622(90)70284-o. ISSN   0190-9622. PMID   2146291.
  26. 1 2 American Academy of Dermatology (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation , American Academy of Dermatology , retrieved 5 December 2013
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