Dermatitis Disease

BASICS

DESCRIPTION

The cutaneous reaction to an external substance

Primary irritant dermatitis is due to direct injury of the skin. It affects individuals exposed to specific irritants and generally produces discomfort immediately after exposure.
Allergic contact dermatitis (ACD) affects only individuals previously sensitized to the contactant. It represents a delayed hypersensitivity reaction, requiring several hours for the cascade of cellular immunity to be completed to manifest itself.
System(s) affected: Skin/Exocrine
Genetics: Increased frequency of ACD in families with allergies
Incidence/Prevalence in USA: N/A
Predominant age: All ages
Predominant sex: Male = Female. Variations due to differences in exposure to offending agents as well as normal cutaneous variations between male and female (eccrine and sebaceous gland function and hair distribution).

SIGNS AND SYMPTOMS

Acute
- Papules, vesicles, bullae with surrounding erythema
- Crusting and oozing may be present
- Pruritus (itching)
Chronic
- Erythematous base
- Thickening with lichenification
- Scaling
- Fissuring
Distribution
- Where epidermis is thinner (eyelids, genitalia)
- Areas of contact with offending agent (e.g., nail polish)
- Palms and soles more resistant
- Deeper skin-folds spared
- Linear arrays of lesions
- Lesions with sharp borders and sharp angles - pathognomonic

CAUSES

Plants
- Rhus-urushiol (poison ivy, oak, sumac)
- Primary contact - plant (roots/stems/leaves)
- Secondary contact - clothes/fingernails (not blister fluid)
Chemicals
- Nickel - jewelry, zippers, hooks, watches
- Potassium dichromate - tanning agent in leather
- Paraphenylenediamine - hair dyes, fur dyes, industrial chemicals
- Turpentine - cleaning agents, polishes, waxes
- Soaps, detergents
Topical medicines
- Neomycin - topical antibiotics
- Thimerosal (Merthiolate) - preservative in topical medications
- Anesthetics - benzocaine
- Parabens - preservative in topical medications
- Formalin - cosmetics, shampoos, nail enamel

RISK FACTORS

Occupation
Hobbies
Travel
Cosmetics
Jewelry

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Intercellular edema
Bullae

SPECIAL TESTS

Patch tests for allergic contact dermatitis (systemic corticosteroids or recent, aggressive use of topical steroids may alter results)

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Patch test

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Removal of offending agent
Topical soaks with cool tap water, Burow's solution (1:40 dilution), or saline (1 tsp/pint water), or silver nitrate solution (25.5%)
Lukewarm water baths - antipruritic
Aveeno (oatmeal) baths
Chronic - emollients (white petrolatum, Eucerin)

SURGICAL MEASURES

N/A

ACTIVITY

Stay active, but avoid overheating

DIET

No special diet

PATIENT EDUCATION

Avoidance of irritating substance
Cleaning of secondary sources (nails, clothes)
Fallacy of blister fluid spreading disease

FOLLOW UP

PREVENTION/AVOIDANCE

Avoid causative agents. Use of protective gloves (with cotton lining) may be helpful.

POSSIBLE COMPLICATIONS

Generalized eruption secondary to autosensitization
Secondary bacterial infection

EXPECTED COURSE AND PROGNOSIS

Self-limited, benign

MISCELLANEOUS

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: Younger individuals - increased incidence of positive patch testing due to better delayed hypersensitivity reactions
Geriatric: Increased incidence of irritant dermatitis secondary to skin dryness
Others: N/A

PREGNANCY

Usual cautions with medications

OTHER NOTES

N/A

ABBREVIATIONS

ACD = allergic contact dermatitis

Clinical Investigations

ROLE OF HOMOEOPATHY

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