CONTACT DERMATITIS

(49) Marienelle R. MaulionSection C Group 5

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Contact Dermatitis• The generic term applied to acute and chronic inflammatory reactions to substances that come in contact with the skin• Acute dermatitis: pruritus, erythema, and vesiculation • Chronic dermatitis: pruritus, xerosis, lichenification, hyperkeratosis, and/or fissuring

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Regional Sites of Predilection

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Tests for SensitivityPATCH TESTPATCH TEST• To detect hypersensitivity to a substance that is in

contact with skin so that the allergen may be determined and corrective measures taken

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Tests for Sensitivity

Provocative Use TestProvocative Use Test • Confirms a positive closed patch test reaction

to ingredients of a substance; to test products that are made to stay on the skin once applied

Photopatch TestPhotopatch Test • To evaluate for contact photoallergy to such

substances as sulfonamides, phenothiazines, PABA, oxybenzone, musk ambrette

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Types of Contact Dermatitis

Irritant Contact DermatitisIrritant Contact Dermatitis• An inflammatory reaction in the skin resulting

from exposure to a substance that causes an eruption in most people who come in contact with it

Allergic Contact DermatitisAllergic Contact Dermatitis• An acquired delayed sensitivity to various

substances that produce inflammatory reactions in only those who have been previously sensitized to the allergen

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Irritant Contact Dermatitis

Etiologic AgentsEtiologic Agents• Water, soaps, detergents, bleaches, lye, drain

pipe cleaners, toilet bowl and oven cleansers• Acids and Alkalis• Solvents and Hydrocarbons• Fiberglass, dust, capsaicin, teargas, metal saltsPredisposing FactorsPredisposing Factors• History of atopic dermatitis• Occupational exposure/ Repeated exposure• Low temperature/ Low humidity• Condition of the skin

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Irritant Contact Dermatitis

PathogenesisPathogenesis• The irritants cause cell damage if applied for

sufficient time and in adequate concentration. Inflammatory response occurs because of the inability of the skin to defend and repair its integrity and function from penetrating chemicals.

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Irritant Contact Dermatitis

Acute Irritant Contact DermatitisAcute Irritant Contact Dermatitis • Burning, stinging, painful sensations can occur

immediately within seconds after exposure or may be delayed up to 24 hour

LESIONErythema with a dull, nonglistening surface

vesiculation (blister formation) erosion crusting shedding of crusts and scaling or erythema necrosis shedding of necrotic tissue ulceration healing

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Irritant Contact DermatitisAcute Irritant Contact Dermatitis

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Irritant Contact DermatitisAcute Irritant Contact Dermatitis

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Irritant Contact Dermatitis

Chronic Irritant Contact DermatitisChronic Irritant Contact Dermatitis• Prolonged and repeated exposures of the skin to

irritants results to a chronic disturbance of the barrier function, subsequently, elicit a chronic inflammatory response.

• Stinging and itching, pain as fissures developLESIONDryness chapping erythema

hyperkeratosis and scaling fissures and crusting

• Lichenification, vesicles, pustules, and erosions12

Irritant Contact DermatitisChronic Irritant Contact Dermatitis

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Allergic Contact DermatitisEtiologic Agents/AllergensEtiologic Agents/Allergens• Poison Ivy, raw cashew nuts, mango, chrysanthemum,

pollens, castor bean, latex of fig and rubber trees• Fabric finishers, dyes, rubber additives, anti-wrinking

and crease-holding chemicals, brassieres, tight clothes• Rubber accelerators, leathers, adhesives, foam rubber

padding, felt, cork liners, formaldehyde in shoes• Nickel-containing (earrings, watch), Chromate (paint,

gloves), Mercury (waving solution, amalgams), Cobalt (paints, glass), Arsenic (fabric dyes, disinfectants), Gold (dental gold, gold jewelry contaminated with radon)

• Fragrance, cosmetic preservatives, permanent hair dye, acid permanent wave preparation, sunscreens, mechanical hair removers, nail lacquers, deodorants

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Allergic Contact DermatitisPathogenesisPathogenesis

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Allergic Contact Dermatitis

Acute Allergic Contact Dermatitis• Well-demarcated erythema and edema on

which are superimposed closely spaced, nonumbilicated vesicles, and/or papules

LESION: Erythema Papules vesicles erosions

crusts scaling.

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Allergic Contact DermatitisAcute Allergic Contact Dermatitis

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Allergic Contact DermatitisAcute Allergic Contact Dermatitis

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Allergic Contact Dermatitis

Chronic Allergic Contact Dermatitis• Plaques of lichenification (thickening of the

epidermis with deepening of the skin lines in parallel or rhomboidal pattern), scaling with satellite, small, firm, rounded or flat-topped papules, excoriations, erythema, and pigmentation

LESIONPapules scaling lichenification excoriations

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Allergic Contact DermatitisChronic Allergic Contact Dermatitis

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Allergic Contact DermatitisChronic Allergic Contact Dermatitis

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Management for Contact Dermatitis

Prevention • Avoid exposure to potential allergen• Avoid repeated and prolonged exposure to

irritants• Wear protective clothing• Check skin reactions to cosmetics before

applying

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Management for Contact DermatitisTreatment for Irritant Contact DermatitisTreatment for Irritant Contact Dermatitis• Identify and remove the etiologic agent• Wet dressings with gauze soaked in Burow's solution,

changed every 2 to 3 hours• Larger vesicles may be drained, but tops should not

be removed• Topical class I glucocorticoid preparations• Severe cases: systemic glucocorticoids

– Prednisone, 2-week course, 60 mg initially, tapering by steps of 10 mg

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Management for Contact DermatitisTreatment for Allergic Contact DermatitisTreatment for Allergic Contact Dermatitis• Identify and remove the etiologic agent.• Topical glucocorticoid ointments/gels (classes I to III)

for early nonbullous lesions• Larger vesicles may be drained, but tops should not

be removed• Wet dressings with cloths soaked in Burow's solution

changed every 2 to 3 hours• Systemic glucocorticoids: Severe & Exudative lesions

– Prednisone, initial 70 mg (adults), tapering by 5 to 10 mg/d over a 1- to 2-week period.

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Thank you.

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