Irritant contact dermatitis by dr maria saeed
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Irritant contact dermatitis is a form of skin inflammation caused by contact with substances that damage the skin barrier. It can be caused by chemicals, environmental factors like heat and friction, or physical agents like wet work. The skin loses oils and moisture, allowing irritants to penetrate and cause inflammation. Symptoms include stinging, burning, redness, swelling and blistering. Treatment focuses on avoiding irritants, using emollients and barrier creams, and topical anti-inflammatory medications.
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Irritant contact dermatitis by dr maria saeed
- 2. What is irritant contact dermatitis? Irritant contact dermatitis is a form of skin inflammation caused by contact with substances and/or environmental factors that injure the skin, damaging the skin barrier.
- 3. Types of irritant contact dermatitis Immune mediated Cosmetic dermatitis chelitis Napkin dermatitis Air borne irritant contact dermatitis Non immune mediated Phototoxic contact dermatitis burns Subjective sensory irritation Immediate‐type stinging Delayed‐type stinging
- 4. Introduction and general description Reversible cellular injury may cause contact urticaria or dermatitis dependent on the nature of the insult. Where there is no apparent cellular injury, various sensory symptoms such as stinging, smarting and burning may occur. The following types of irritant contact reaction may be distinguished: Burns. Irritant contact dermatitis: • Acute (toxic) irritant contact dermatitis. • Cumulative irritant/insult contact dermatitis. Transient or immediate‐type, non‐immune, contact urticaria. Symptomatic (subjective) irritant responses. Other: pigmentary and granulomatous responses and those localized to appendageal structures
- 6. •Irritant hand eczema 35% •Atopic hand eczema 22% •Allergic contact dermatitis 19% •soaps (22.0% of cases) •wet work (19.8%) •petroleum •products (8.7%), and cutting oils and coolants (7.8%) Epidemiology • Females may be twice as commonly affected as males sex
- 7. Who gets irritant contact dermatitis? Irritant contact dermatitis will affect anyone with sufficient exposure to irritants with atopic dermatitis are particularly susceptible. Occupational hand dermatitis is due to irritants in 80% of cases in cleaners, hairdressers, food handlers,and healthcare personnel. Irritant contact dermatitis can affect all age groups, both sexes, and any race.
- 8. What causes irritant contact dermatitis? Irritant contact dermatitis develops when chemical or physical agents damage the skin surface faster than the skin can repair. Irritants remove oils and natural moisturising factor from the outer layer of the skin, allowing chemical irritants to penetrate the skin barrier and trigger inflammation. common skin irritants 1) water, soaps, and, in the era of COVID-19, hand sanitisers. 2) Occupational irritants can include wet work, detergents, solvents, acids, alkalis, adhesives, and metalworking fluids 3) Topical medications such as retinoids and benzoyl peroxide. 4) Friction, sweating, and heat are examples of environmental factors
- 9. Common irritants 1.Household cleaners 2. Industrial Cleaning agents 3.Alkalis (cement) 4.Water and wet work 5.Acids 6.Cutting oils 7.Oxidizing agent 8.Reducing agents 9.Pesticides 10.Raw food 11.Desiccant powder 12.Miscellan eous chemicals
- 11. Pathophysiology Skin barrier dysfunction is a key reason for irritation. skin provides the first and most important line of defence many substances penetrate readily into and through the epidermis principal epidermal barrier resides almost entirely in the stratum corneum Damage to the stratum corneum is normally followed by an increase in percutaneous absorption and in transepidermal water loss (TEWL) lipids are arranged as stacked membrane sheets in the intercellular space and are produced from lamellar granules in the cells of the granular cell layer of the epidermis tight junctions between epidermal cells have also been shown to provide a block to water loss filaggrin mutations may predispose to irritant contact dermatitis
- 13. Mechanism of action of irritants Detergents : Destruction of lysosomal enzymes in horny layer causing dryness and scaling signs of chronic inflammation increased DNA synthesis, acanthosis and changes in cellular metabolism irritants such as croton oil and phenolesters are chemotactic : for polymorphonuclear leukocytes at non‐toxic concentrations may cause pustular reactions. Organic solvents such as methanol or chloroform: will damage blood vessels, causing hyperaemia. dimethyl sulfoxide(DMSO): effective degranulator of mast cells
- 14. barrier disruption has been shown to induce: release of interleukin 1α (IL‐1α) upregulation of tumour necrosis factor α (TNF‐α) and granulocyte–macrophage colony‐stimulating factor (GM‐CSF). rise in Langerhans cell‐derived IL‐1α stimulated by GM‐CSF and IL‐1α production. the loss of the normal extracellular calcium gradient stimulates lamellar body secretion and barrier repair Oxidative stress also contributes to the development of inflammation with various
- 16. Clinical features of irritant contact dermatitis Resembles dermatitis of any cause Usually is confined to the site of contact with the irritant stinging, smarting, burning sensations of dryness and tightness, through delayed stinging. Irritants may also penetrate skin via appendageal structures and cause folliculitis. Burning and pain more common symptoms than itch Acute dermatitis due to a single severe exposure Chronic dermatitis due to mild irritants or repetitive cumulative exposure
- 17. Comparison between changes in acute and chronic dermatitis Acute CD Localised well-defined, redness, papules, swelling, blistering (vesicles/bullae) Example: kneeling in wet cement, which is very alkaline, causing severe dermatitis of the knees Chronic CD Initial dryness and cracking of the skin Evolves to include inflammatory changes with redness and itch May develop tolerance or hardening with time Examples include dribble rash, napkin dermatitis, housewife’s e czema, ring dermatitis
- 19. Mechanical irritation involving digits House wife type eczema
- 21. Classification of severity no objective ways of classify severity Non‐specific assessment: Dermatology Life Quality Index (DLQI) or quantify the irritant response by measuring: • Erythema • Transepidermal water loss • Hydration • Skin tightness
- 22. Interdigital dermatitis, also called the ‘sentinel sign’, is regarded as an early stage of irritant contact dermatitis affecting the hands. It is commonly seen in occupations involving wet work. Interdigital dermatitis
- 23. complications of irritant contact dermatitis • Disseminated secondary eczema • Lichenification • Secondary bacterial infections DE
- 24. Diagnosis Detailed medical history including occupational exposures clinical examination. There is no test for irritant contact dermatitis. Patch testing may be necessary to distinguish it from allergic contact dermatitis. Irritant and allergic contact dermatitis can co- exist.
- 25. Differential diagnosis • Allergic contact dermatitis — which may co-exist • Other causes of hand dermatitis such as atopic hand dermatitis • Psoriasis
- 26. Treatment General measures: Avoidance of all potential irritants Emollients Barrier creams Specific measures: Specific treatments for some chemical irritants eg, calcium gluconate gel for hydrogen fluoride burn Topical medications — topical steroids, calcineurin inhibit ors, crisaborole Phototherapy.