DERMATITIS

Maria Soleil Bernadette M. Malonzo

CONTACT
DERMATITIS
 CONTACT DERMATITIS
 common inflammatory skin disorder
 most common recognized as eczematous inflammation
 allergic or irritant skin reaction caused by an external agent

Dermatitis derives from Greek word

derma = “skin”
+
-itis = “inflammation”
In U.S., overall prevalence rate 24,400 /100,000 people
Cohort population-based studies in Europe prevalence
rates 0.7% - 18.6% for ACD
Incidence of OCD in other countries 1.3 – 19 cases per
10,000
All age groups are affected with slight female
preponderance prevalence increases with age decreased
prevalence in patients >70 years
 CLASSIFICATIONS

1. Irritant Contact Dermatitis

- A form of contact dermatitis, in which the skin is injured
by friction, environmental factors such as cold, over-
exposure to water or chemicals such as acids, alkalis,
detergents and solvents.
- Occurs 80% more than allergic contact dermatitis.
ICD…
Develops following prolonged and repeated exposure to
irritants
Inflammatory cells have role in development of dermatitis
Allergen-specific lymphocytes not involved in pathogenesis
Prior sensitization is not necessary
Irritant contact dermatitis after doing mehendi
Different Types of Irritant Contact Dermatitis:
1. Cumulative contact dermatitis
2. Asteatotic Dermatitis
3. Traumatic Irritant Contact Dermatitis
4. Pustular and Acneform Irritant Contact Dermatitis
5. Airborne Irritant Contact Dermatitis
6. Frictional Irritant Contact Dermatitis
 SOURCES OF IRRITANT CONTACT DERMATITIS
ACIDS
• Cause epidermal damage via protein denaturation and
cytotoxicity
• Symptoms include erythema, vesicle, and necrosis
• Hydrofluoric and sulfuric acid can cause the most severe burns
• Chromic acid causes ulcerations known as ‘chrome holes’ and often
perforates the nasal septum

• Chemical burns and irritant dermatitis from nitric acid can cause a
distinctive yellow discoloration
 SOURCES OF IRRITANT CONTACT DERMATITIS
ALKALIS
• Often more painful and damaging than acids
• Strong Alkalis include sodium, ammonium, potassium
hydroxide, sodium and potassium carbonate, and calcium
oxide
• Found in soaps, detergents, bleaches, ammonia preparations,
drain pipe cleaner, toilet bowl cleansers, and oven cleaner
• No vesicles, necrotic skin that appears dark brown then black,
ultimately becomes hard, dry, and cracked
 SOURCES OF IRRITANT CONTACT DERMATITIS
METAL SALTS
• Include arsenic trioxide, beryllium compounds, calcium oxide,
copper salts, inorganic mercury, thimerosal, and selenium

• Signs ranging from ulceration to folliculitis

 SOURCES OF IRRITANT CONTACT DERMATITIS
SOLVENTS
• Act mainly by dissolving the intercellular lipid barrier of the
epidermis
• Prolonged skin contact can result in severe burns and well as
systemic toxicity
• Examples include turpentine, benzene, toluene, xylene, carbon
tetrachloride, gasoline, and kerosene
Professional paint and crayon illustrator with bilateral palmar dermatitis secondary to
repeated contact with pain solvents.
 SOURCES OF IRRITANT CONTACT DERMATITIS
DETERGENTS & CLEANSERS
• Include any surface active agent (surfactant) that concentrates at
the oil-water interfaces and has both emulsifying and cleansing
properties
• Found in skin cleansers, cosmetics, and household cleaning
products. Hence, commonly known as housewife’s eczema
• Anionic detergents such as alkyl sulfates and alkyl carboxylate
salts are the most irritating
 SOURCES OF IRRITANT CONTACT DERMATITIS
DISINFECTANTS
• Include, alcohols,
aldehydes, phenolic
compounds, halogenated
compounds, surfactants,
dyes, oxidizing agents,
and mercury compounds
• Weak toxic agents that
can cause chronic ICD.
 SOURCES OF IRRITANT CONTACT DERMATITIS
WATER
• Ubiquitous skin irritant
• Tropical immersion foot, seen
during Vietnam War
• Hairdressers, hospital cleaners,
cannery workers, bartenders

Irritancy of water is exacerbated by

occlusion.
 TESTING FOR ICD
Patch testing can be performed to diagnose contact
allergies, but no patch test exists that proves that a
cutaneous irritant is responsible for a particular case
of irritant contact dermatitis. Diagnosis rests on
exclusion of allergic contact dermatitis and history of
sufficient exposure to a cutaneous irritant.
 CLASSIFICATIONS

2. Allergic Contact Dermatitis

- occurs when a substance to which you're sensitive
(allergen) triggers an immune reaction in the skin. It
usually affects only the area that came into contact
with the allergen.
- But it may be triggered by something that enters your
body through foods, flavorings, medicine, or medical or
dental procedures (systemic contact dermatitis).
COMMON ALLERGENS INCLUDE:
1. Nickel
2. Medications
3. Balsam of Peru
4. Formaldehyde
5. Personal care products
6. Plants such as poison ivy and mango, which contain a highly
allergenic substance called urushiol
7. Airborne substances
8. Products that cause a reaction when you're in the sun (photoallergic
contact dermatitis), such as some sunscreens and oral medications
 SIGN & SYMPTOMS
Irritant Contact Dermatitis VS Irritant Contact Dermatitis
• Mild swelling • Skin reddening
• Stiff, tight-feeling skin • Blisters that ooze (Fluid from blisters is
• Dry, cracking skin not contagious. It will not spread the
skin rash to other parts of the body
• Blisters or to other people.)
• Painful ulcers • Itching which can become intense
• Swelling in eyes, face, and genital
areas (severe cases)
PATHOPHYSIOLOGY
 TREATMENT
1. Steroid creams or ointments
2. Oral medications

4A’s for home remedies:

1. Avoid the irritant or allergen
2. Apply cool, wet compresses
3. Avoid scratching
4. Apply mild soaps only and hand creams and lotion frequently
 ATOPIC
DERMATITIS
 ATOPIC DERMATITIS
• AD is the most common type of eczema.
• Atopic dermatitis typically begins in childhood, usually in the
first six months of a baby’s life.
• It is chronic and tends to flare periodically.
• Atopic dermatitis exists with two other allergic conditions:
asthma and hay fever (allergic rhinitis). People who have
asthma and/or hay fever or who have family members who
do, are more likely to develop AD.
 CAUSES
RESEARCH SAYS…
1. It is a combination of genetics and other factors are involved.
When a substance from inside or outside the body triggers the
immune system, it over-reacts and produces inflammation. It is
this inflammation that causes the skin to become red, rash and
itchy.
2. Research also shows that some people with eczema, especially
atopic dermatitis, have a mutation of the gene responsible for
creating filaggrin.
3. If one parent has AD, asthma, or hay fever, there’s about a 50%
chance that their child will have at least one of these diseases. If
both parents have one or more of these conditions, the
chances are much greater that their child will, too.
 SIGNS & SYMPTOMS
In infancy:
•Red, very itchy dry patches of skin
•Rash on the cheeks that often begins at 2 to 6 months of age
•Rash oozes when scratched. Symptoms can become worse if the child
scratches the rash

In adolescence and early adulthood:

•Rash on creases of hands, elbows, wrists, and knees, and sometimes on the
feet, ankles, and neck
•Dry, scaly, brownish-gray skin rash
•Thickened skin with markings
•Skin rash may bleed and crust after scratching
HOW CAN ATOPIC DERMATITIS GET WORSE?
• Dry skin
• Chemical irritants
• Stress
• Hot/cold temperatures and sweating
• Infection from bacteria and viruses that live in your
environment
• Allergens
• Hormones
 HOW TO CONTROL
ATOPIC DERMATITIS
1. Avoid long, hot baths
2. Apply lotion immediately after bathing.
3. Keep the room temperature as regular as possible.
4. Keep your child dressed in cotton. Wool, silk, and manmade fabrics
such as polyester can irritate the skin.
5. Use mild laundry soap and make sure that clothes are well rinsed.
6. Watch for skin infections
7. Avoid rubbing or scratching the rash.
8. Use moisturizers several times daily. In infants, with atopic
dermatitis, moisturizing on a regular basis (with each diaper
change for example) is extremely helpful.