Irritant Contact Dermatitis

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Irritant contact dermatitis involves a nonimmunologic response to a skin irritant. Injury develops over days to months through disturbance of cell hydration and functions as a result of the defatting action of prolonged exposure to weaker irritants such as water, solvents, or soaps. More concentrated solutions cause a more immediate response. Xerosis dominates. Under excessively moist working conditions, these skin irritants can cause severe cell hydration and result in maceration, most often in the feet and groin (1,8,9).

Irritant contact dermatitis typically appears in exposed or contact areas, in thin skin more often than thick, and in areas around the belt or collar. The rash may be difficult to differentiate from the rash of allergic contact dermatitis. Acute lesions are painful, weepy, and vesicular, whereas chronic lesions are dry, erythematous, cracked, and lichenified. The lesions assume a

Table 18.4. Clinical forms of occupational Irritant contact dermatitis Contact dermatitis Chemical skin burns Allergic contact dermatitis Allergic contact dermatitis Acute and chronic urticaria Latex allergy Photodermatitis Phototoxic Photoallergic Follicular and acneiform dermatoses Pigmentation disturbance Hyperpigmentation Hypopigmentation Neoplasms

Basal cell carcinoma (BCC)

skin disease in agriculture.

Squamous cell carcinoma (SCC) Actinic keratosis (AK) Melanomas Ulcerations Accidental Intentional Granulomas Animate agents Inanimate agents Infections Bacterial Viral Mycotic Rickettsial Parasitic Protozoan clearly demarcated pattern and are often asymmetric and unilateral, for example in the distribution of a glove that became soaked in chemicals. Hardening or adaptation of the skin may occur as a result of repeated contact with moderate irritants (Table 18.5) (1,8,9).

Treatment begins with removal of clothing and decontamination with water. Definitive treatment includes wet dressings and topical and systemic steroids. Secondary infections may require systemic antibiotics (1,8,9).

Table 18.5. Differences between allergic and irritant contact dermatitis.

Feature Irritant reaction Allergic reaction

Table 18.5. Differences between allergic and irritant contact dermatitis.

Feature Irritant reaction Allergic reaction

Appearance

Erythema

Polymorphic with erythema, edema,

Erosion without

and vesicles

infiltration

Glazed appearance

on bulla without

erythema

First manifestation

Immediately to

5-14 days for first manifestation

24 hours

24-72 hours following reexposure

Threshold

High

Low

Index of sensitization

Nearly 100%,

Variable, but usually fairly low

depending on

concentration

Transferable

No

Yes

Patch test

Not useful

Useful

Examples of causative

Soaps, solvents,

Nickel, chrome, epoxy

substances

acids, alkalis

Source: Reprinted from Zugerman (8), with permission.

Source: Reprinted from Zugerman (8), with permission.

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