Irritant contact dermatitis is caused by physical or chemical substances capable of acutely or chronically irritating the skin. ICD (irritant contact dermatitis) can occur after a single exposure of the irritant for a sufficient time and quantity as also following chronic cumulative exposure to a single or multiple skin irritants.
Hands are the most commonly affected part in this type of contact dermatitis.
Which Occupations are the Most Affected in Irritant Contact Dermatitis?
- Housewives
- Housekeeping
- Hairdressers
- Healthcare professionals
- Cleaning services
- Agriculture, gardening
- Cooking and catering
- Printing and painting
- Engine workers, mechanics
- Construction and metal works
- Fishing
What are the Most Common Irritant Substances that Cause Contact Irritant Dermatitis?
- Soaps, detergents, waterless cleansers
- Acids and alkalis: Cement, chromic acids, phosphorus, phenol, metal salts
- Industrial solvents: coal tar solvents, petroleum, alcohol solvents, acetone, turpentine, carbon dioxide etc
- Plants: Croton, spurges, poinsettias, machneel tree, buttercup, black mustard, nettles, pepper, capsaicin, prickly pear
- Others: Fiberglass, wool, other synthetic clothing.
How Does the Irritants Cause Dermatitis in Skin?
Acute irritant reactions are caused through direct cell damage to the skin, while chronic irritant dermatitis is caused by accumulation of toxins, which disrupt the skin barrier, seep in and cause slow damage through protein denaturation and cellular toxicity within the skin cells.
Signs and Symptoms of Irritant Contact Dermatitis
In minor irritant contact dermatitis, a burning or stinging sensation may be the only symptom. It may occur immediately after exposure, or delayed after 1-2 minutes, peaking at 5-10 minutes and fading away by 30 minutes. In acute delayed ICD, symptoms may start after 8 to 24 hours.
The stinging skin rashes start as dull red patches, on which blisters appear soon. The severity of blistering depends upon the caustic nature of the irritant. Later, these blisters breakdown to form erosions and crusting. In severe irritant contact dermatitis the whole area is swollen, and the skin blisters break down forming necrotic ulcers due to sloughing of the damaged skin cells.
In the cumulative chronic type of eczema, the skin findings are more of dryness, scaling and chapping, as happens in hand eczema following exposure to detergents and solvents. Painful fissures are common, especially on the palms and soles.
Healing occurs spontaneously when the irritant contact is avoided, the skin returning to normal over a period of 2 weeks or so. The chronic irritant dermatitis can take up to 6 weeks or more to clear. Some patients may have to change their occupation for a permanent cure.
In contrast to allergic contact dermatitis, the skin rashes are limited to the area of contact in the irritant contact dermatitis.
Prevention of Irritant Contact Dermatitis
- Avoid contact with irritants by wearing protective clothing and gloves
- If accidental contact occurs, wash with copious amount of water or weak neutralizing solutions
- Use barrier creams while handling the irritants
Treatment of Irritant Contact Dermatitis
- Acute Irritant Contact Dermatitis: Wet soaks, with Burow’s solution or potassium permanganate solution, changed every 2 to 3 hours. Larger blisters may be drained, but preserve the roofs. Systemic and topical steroids according to the severity of the acute eruptions.
- Sub acute ICD: Potent topical steroidsand adequate lubrication will control the dermatitis fast.
- Chronic ICD: Topical steroids, Phototherapy with local psoralen soaks and UV radiation will help relieve the ICD. Topical anti-inflammatory applications like tacrolimus and pimecrolimus are also effective for prolonged usage.
Reference
- Contact Dermatitis, in Rook’s Textbook of Dermatology, 7th Edition, 2004
- Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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