| Contact dermatitis | |
|---|---|
 | |
| Contact dermatitis rash. | |
| Specialty | Dermatology |
Contact dermatitis is a type of acute or chronicinflammation of the skin caused by exposure to chemical or physical agents.[1] Symptoms of contact dermatitis can include itchy or dry skin, a redrash, bumps,blisters, or swelling. These rashes are not contagious or life-threatening, but can be very uncomfortable.
Contact dermatitis results from either exposure toallergens (allergic contact dermatitis), orirritants (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 theepidermal cells of the skin, which activates animmune 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 bypatch testing.[3][4][5]
Metanalysis of research on the incidence and prevalence of contact dermatitis suggests that as much as 20% of the general population is contact‐allergic to patch tests for common environmental allergens. Prevalence is lower in people under 18 years of age, and higher in women than in men.[6][7]Contact dermatitis constitutes 90%[3] to 95% of all occupationalskin disorders.[8]
Contactdermatitis 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 theepidermis (the outermost layer of skin) and the outerdermis (the layer beneath the epidermis).[9]
Contact dermatitis results in large, burning, and itchy rashes. These can take anywhere from several days to weeks to heal. This differentiates it fromcontact 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.[10] If contact dermatitis lasts for more than six weeks, either because exposure continues or the skin can't recover, it can be referred to as chronic.[11][12]
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. Airborne irritant contact dermatitis can occur when airborne irritants come into contact with exposed areas of skin.[13] Symptoms of both irritant and allergic dermatitis 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 containing an irritant. Common irritants include water, soaps, solvents, and detergents.[3][12]
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.[16]
Common causes of allergic contact dermatitis include:nickel allergy, 14K or 18K gold,Balsam of Peru (Myroxylon pereirae), andchromium. In theAmericas they include the oily,urushiol-containing coating from plants of the genusToxicodendron:poison ivy,poison oak, andpoison sumac. Millions of cases occur each year in North America alone.[17] Thealkyl resorcinols inGrevillea banksii andGrevillea 'Robyn Gordon' are responsible for contact dermatitis.[18]Bilobol, another alkyl resorcinol found inGinkgo biloba fruits, is also a strong skin irritant.[19]
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,[20] food flavorings and spices,[21]perfumes and otherfragrances used incosmetics andcleaning products,[22][20] 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.[23]
There are four types of contact dermatitis:irritant contact dermatitis;allergic contact dermatitis;protein contact dermatitis; andphoto contact dermatitis. Photo contact dermatitis is divided into two categories: phototoxic and photoallergic.[3]
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]
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 withsurfactants);latex;kerosene;ethylene oxide; surfactants in topical medications and cosmetics (sodium lauryl sulfate); andalkalis (drain cleaners, strong soap withlye residues).[citation needed]
Physical irritant contact dermatitis may most commonly be caused by low humidity from air conditioning.[24] Also, many plants directly irritate the skin.
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.[25] By its allergic nature, this form of contact dermatitis is ahypersensitive reaction that is atypical within the population. The development of the disease occurs in two phases, which are induction and elicitation.[25] 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.[25] The mechanisms by which this reaction occurs are complex, with many levels of fine control. Their immunology centres on the interaction of immunoregulatorycytokines and discrete subpopulations ofT lymphocytes.[citation needed]
Allergens includenickel,gold,Balsam of Peru (Myroxylon pereirae),chromium, and the oily coating from plants of the genusToxicodendron, such aspoison ivy,poison oak, andpoison sumac. Acrylates, rubber chemicals, emulsifiers and dyes, epoxy resin chemicals are just several of the substances that might induce Allergic Contact Dermatitis.[25] 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.[25]
Sometimes termed "photoaggravated",[26] and divided into two categories,phototoxic and photoallergic, PCD is the eczematous condition which is triggered by an interaction between a substance on the skin andultraviolet light[3][27] (320–400 nm UVA) (ESCD 2006), therefore manifesting itself only in regions where the affected person has been exposed to such rays.[citation needed]
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.[28] The mechanism of action varies fromtoxin to toxin, but is usually due to the production of a photoproduct. Toxins which are associated with PCD include thepsoralens. Psoralens are in fact used therapeutically for the treatment ofpsoriasis,eczema, andvitiligo.[citation needed]
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.
Protein contact dermatitis (PCD) is a form of chronic eczema resulting from immediate hypersensitivity to plant, animal, or hydrolized proteins. It is most frequently seen in occupational settings involving food handling. PCD is diagnosed by prick tests.[29][30][31]
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 havingpatch tests, one of various methods commonly known asallergy testing.[3] Thepatch 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.[32] The top three allergens found in patch tests from 2005 to 2006 were:nickel sulfate (19.0%), Myroxylon pereirae (Balsam of Peru, 11.9%), andfragrance mix I (11.5%).[33] 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.[34]
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.[35] Using histology on its own is insufficient, as these findings have been acknowledged not to distinguish,[35] and even positive patch testing does not rule out the existence of an irritant form of dermatitis as well as an immunological one.
In an industrial setting the employer has aduty 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, orbarrier 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.[37][38] When they are used, it is inappropriate, and the person recovering from surgery is at significantly increased risk of developing contact dermatitis.[37]
If the rash does not improve or continues to spread after two to three of days of self-care, or if the itching and/or pain is severe, the patient should contact adermatologist or other physician. Medical treatment usually consists of lotions, creams, or oral medications.
In severe cases, a stronger medicine likehalobetasol may be prescribed by a dermatologist.
