It may also develop if youve been in contact with a stronger irritant for a short while. Recent progress in understanding the pathogenesis has reignited the interest of clinicians in this area of dermatology. Irritant contact dermatitis develops when the skin is in contact with irritating substances like detergents and solvents. It is a nonspecific local inflammatory dermatosis caused by single or repeated skin contact with irritants. Irritant contact dermatitis is the most common form of contact dermatitis, and yet is often overlooked. Diagnosis of allergic contact dermatitis can often be supported by patch testing.
Gross eyelid swelling usually indicates allergic contact dermatitis, but degrees of eyelid swelling can occur in both irritant contact dermatitis and endogenous eczema. Youre at an increased risk of irritant contact dermatitis if you also have atopic eczema, which is. Patients with ad and acd may have a lower inflammatory threshold for developing icd. Irritant contact dermatitis is an eczematous reaction in the skin of external origin. Irritant contact dermatitis is common, nonallergic, and develops as dry, itchy, irritated areas on the skin around the area of contact. Mar 17, 2016 irritant contact dermatitis is common, nonallergic, and develops as dry, itchy, irritated areas on the skin around the area of contact. Irritant contact dermatitis, a nonimmunologic reaction, occurs due to mechanical factors eg, friction or contact with chemicals, which can have irritating and dehydrating effects. Contact dermatitis treatment algorithm bmj best practice. What is the pathophysiology of irritant contact dermatitis icd. Improved diagnosis and management of cd and availability of more comprehensive databases of causa. Irritant contact dermatitis usually occurs only on the parts of the body in direct contact with the irritant substance e. The two types of contact dermatitis are irritant and allergic. The clinical picture is extremely variable and ranges from chemical burns to chronic irritant forms, often indistinguishable from allergic contact dermatitis. Phototoxic dermatitis occurs when the allergen or irritant is activated by sunlight.
Patch testing should be done by a dermatologist or. Icd is a complex reaction modulated by both intrinsic and extrinsic factors 24. Irritant contact dermatitis icd is often caused by cumulative exposure to weak irritants, accounting for 80% of all cases of contact dermatitis. Contact dermatitis accounts for 95% of occupational skin disorders. Individuals with irritant contact dermatitis do not have true latex allergy and will not necessarily develop a reaction to products. It arises as a result of activated innate immunity to direct injury of the skin without prior sensitization. Contact dermatitis symptoms, diagnosis and treatment bmj. Pdf pathophysiology of allergic and irritant contact.
Irritant contact dermatitis icd is a nonspecific inflammatory dermatitis brought about by activation of the innate immune system by the proinflammatory properties of chemicals. Introduction contact dermatitis can be divided into irritant and allergic subtypes. Although it is a common occupational dermatitis, it is the. Allergic contact dermatitis acd corresponds to a delayedtype hypersensitivity response with a skin inflammation mediated by haptenspecific t cells. Irritant contact dermatitis may be caused by frequent exposure to a weak irritant, such as soap or detergent. Special emphasis is given to immunological mechanisms, molecular aspects of sensitizers, atypical clinical forms, reactions to medicaments, and occupational and environmental factors. Icd from plants is commonly divided into mechanical irritant contact dermatitis micd and chemical irritant contact dermatitis cicd. Irritant contact dermatitis is a nonspecific response of the skin to direct chemical damage that releases mediators of inflammation predominately from epidermal cells. Chemical irritant contact dermatitis is either acute or chronic, which is usually associated with strong and weak irritants respectively. Contact dermatitis is a type of inflammation of the skin. Contact dermatitis is a physiological reaction that occurs when skin comes in contact with certain substances.
Irritant contact dermatitis is caused by the nonimmunemodulated irritation of the skin by a substance, leading. Allergic contact dermatitis can result from exposure to accelerators and other chemicals used to manufacture rubber gloves or from exposure to other chemicals found in the dental practice setting. Contact dermatitis is the most common professional skin disease, with frequencies ranging from 24 to 170 every 00 people. In contrast to allergic contact dermatitis, no eliciting allergens can be iden tified.
Irritant contact dermatitis is produced by a substance that has a direct toxic effect on the skin. Intrinsic factors which influence the susceptibility to icd include genetic. People with a background of atopic eczema, asthma and hayfever atopy are more likely to suffer from irritant contact dermatitis than people without this history. Occupational risk assessment and irritant contact dermatitis.
The fifth edition of contact dermatitis covers in detail every conceivable aspect of irritant and allergic contact dermatitis and its modernday management. Contact dermatitis an overview sciencedirect topics. Contact dermatitis symptoms and causes mayo clinic. Irritant contact dermatitis is caused by direct toxicity without prior sensitisation, and allergic contact dermatitis is a delayed hypersensitivity reaction. It is a reaction to a caustic or irritating product that injures the skin. Results in localized burning, stinging, itching, blistering, redness, and swelling at the area of contact with the allergen or irritant. Allergic contact dermatitis versus irritant contact dermatitis 3 cumulative irritant contact dermatitis this is the most prevalent type of icd. Irritant substances are those that can cause inflammation in almost everyone if they are in contact for long enough, often enough and in strong enough concentration. Irritant contact dermatitis icd is an inflammatory response of the skin to various external stimuli. Irritant contact dermatitis icd is the most common form of contact dermatitis and is often overlooked. The escd best paper award 2019 has been awarded for the contribution allergic contact dermatitis caused by hydroperoxides of limonene and dose. Results in localised burning, stinging, itching, blistering, redness, and swelling at the area of contact with the allergen or irritant. This is caused by direct contact with a substance which irritates the skin.
Diagnosis the diagnosis of irritant contact dermatitis is usually based upon a persons history and physical examination. Irritant contact dermatitis icd is a localized inflammatory skin response to a wide range of chemical or physical agents. Previously thought of as an immunologic inert process, at present there is increasing evidence showing that icd is a complex, interlinked process involving perturbations in the skin barrier integrity, cellular changes, and release of various proinflammatory mediators 5, 6. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters.
It is the result of multiple subthreshold insults induced by weak irritants. Common examples of such substances are water such as in repeated hand washing, soaps and detergents, acidic substances, solvents and other industrial chemicals. Gross eyelid swelling usually indicates allergic contact dermatitis, but degrees of eyelid swelling can occur in both. Irritant contact dermatitis is a nonspecific response of the skin to direct chemical damage that releases mediators of inflammation predominantly. Cleveland clinic is a nonprofit academic medical center. Icd can coexist with atopic dermatitis ad and allergic contact dermatitis acd. Diagnostic approach in allergic and irritant contact dermatitis.
Cumulative irritant contact dermatitis from repeated mild skin irritation from soap and water is common. Irritant contact dermatitis this is the most common cause of vulvar contact dermatitis. Allergic contact dermatitis versus irritant contact dermatitis wsiat. Irritant contact dermatitis is an inflammatory rash caused by direct chemical injury to the skin. If skin is exposed to a strong irritant such as acid, alkali, solvent, strong soap, or detergent, skin damage can be immediate. The substance could be one of thousands of known allergens and irritants.
Common irritants are wet work, cutting oils, solvents and degreasing agents, which remove the skins outer oily barrier layer and allow easy. For instance a strong chemical burn from trichloroacetic acid used to burn off warts would cause an irritant contact dermatitis. Irritant contact dermatitis is usually caused by frequent and repeated use of known irritating substances, such as soapy water, cleansers, and. Read the article for free by clicking the below title.
Irritant contact dermatitis is caused by direct toxicity without prior sensitization, and allergic contact dermatitis is a delayed hypersensitivity reaction. Some of these substances may cause both irritant contact dermatitis and allergic contact dermatitis. Unlike allergic contact dermatitis, which appears 4872 hours after exposure to an allergen, the symptoms of irritant contact dermatitis can result within a few hours if the exposure is a strong irritant. Irritant contact dermatitis icd is inflammation of the skin typically manifested by erythema, mild edema, and scaling. Differentiation of latex allergy from irritant contact dermatitis. The sap of agave americana, a popular ornamental plant, may cause irritant contact dermatitis. Allergic contact dermatitis versus irritant contact dermatitis. Youre at an increased risk of irritant contact dermatitis if you also have atopic eczema, which is the most common form of eczema. Pdf pathophysiology of allergic and irritant contact dermatitis. For example, handwashing frequency of more than 35 times per shift was associated strongly. Irritant contact dermatitis icd is caused by repeated exposure to substances that aggravate the skin.
Irritant contact dermatitis is generally localized and limited to the area of the skin that came in direct contact with the hazardous agent. The exposure to irritants is specific to the developmental stages of children and can occur from neonates to adolescents. Purpuric irritant contact dermatitis induced by agave. Irritant contact dermatitis harpers textbook of pediatric. Irritants to the skin cause 80 percent of these reactions, while the remaining 20 percent are caused by allergens, which trigger an allergic response. The repetitive nature of the irritants does not allow the skin to recover leading to persistent dermatitis or chronic dermatitis.
However, it is more common in people with sensitive skin. The author presents an approach to the diagnosis of allergic and irritant contact dermatitis and identification of the causative agents, as well as a discussion of future therapeutic strategies. A simple example is how exposure to water and the permanent use of dissolvent and detergents can promote irritant contact dermatitis in a housewife, as well as hairdressers, nurses, and cooks. Irritant contact dermatitis icd can occur on initial exposure and is a result of excessive moisture or irritation on the skin surface. Cytokines and chemokines in irritant contact dermatitis. Irritant contact dermatitis occurs when chemicals or physical agents damage the. Allergic contact dermatitis triggers an immunologic reaction that causes tissue inflammation. Icd results from direct cytotoxic effect of irritants and, unlike allergic contact dermatitis, is not immune mediated. Irrespective of the varying etiology type iv or type i allergy or skin irritation, a form of dermatitis develops. Irritant contact dermatitis icd is common but is under.
The following is a list of the most cited articles based on. May 05, 2020 cumulative irritant contact dermatitis from repeated mild skin irritation from soap and water is common. Irritant eyelid contact dermatitis can occur in anyone. Examples of irritants include acids, alkalis, solvents, and. Irritant contact dermatitis irritant contact dermatitis is the most common skin eruption seen in the diaper area and is caused by skin rubbing. Examples of irritants include acids, alkalis, solvents, and detergents. In some cases, a patch test applying a small amount of a substance to the skin may be recommended to determine if the dermatitis is allergic or irritanttype. Irritant contact dermatitis is a form of contact dermatitis that can be divided into forms caused by chemical irritants and those caused by physical irritants.
992 429 305 451 875 130 1487 95 49 190 144 673 1459 959 337 859 1525 1489 806 1549 152 635 543 729 22 196 338 1583 841 1378 1398 1459 570 1511 384 482 1312 632 1361 1498 1484 62 1393 660 290