Irritant Contact Dermatitis 2

8/2/2019 Irritant Contact Dermatitis 2

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DEFINITION

Derm/o skin

-itis inflamation

Irritant Contact Dermatitis (ICD)nonimmunologic inflammation of the skincaused by contact with a chemical, physical,or biologic agent

DERMATITIS

The conditionthat makesinflammation ofthe skin


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EPIDEMIOLOGY

Almost 90% skin disease in Indonesia iscontact dermatitis (ICD,ACD,Photo ContactDermatitis)

Up to 80% of contact dermatitis is irritant andis commonly related to occupation


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ETIOLOGY

ICD is a multifactorial disease Exogenous factors

Chemical properties of the irritant Characteristics of exposure

Environtmental factors Endogenous factors

Genetic factors Gender (women > men) Age (child and ealdery easier to irritation)

Ethnicity Skin site (differences in the thickness of the skin) Atopy hystory


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PATHOGENESIS

Four interrelated mechanisms have beenassociated with ICD:

1. Removal of surface lipids and water-holdingsubstances

2. Damage to cell membrane

3. Epidermal keratin denaturation

4. Direct cytotoxic effect


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SIGN AND SYMPTOMS

irritant reaction

acute ICD

delayed acute irritancy

chronic cumulative ICD subjective (symptomatic, sensory)

Nonerythematous

frictional dermatitis traumatic reaction

pustular or acneiform reaction

exsiccation eczematid.


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IRRITANT REACTION

Exposed to wet work

Acute monomorhic presentScaling

Low-grade erythemaVesicles

erosions

Location: dorsum of the hand and fingerCan resolve or progress to cummulative

irritant dermatitis


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Erythematous irritant reaction


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ACUTE ICD

Single skin exposure to a strong irritant or chemical(acids, alcalis)

Most cases consequence of accident at work

Occur immediately after exposure

Sensation of burning, itching, stinging Present with erythema, edema, vesiculation with

excudation, bullae formation, tissue necrosis (insevere cases)

Healing process: decrescendo phenomenon Complete healing in 4 weeks

Prognosis: good


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Dermatitis kontak akut pada pekerjaindustri bahan kimia


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DELAYED ACUTE IRRITANCY

Clinical manifestation same like acute ICD,appear in 8 to 24 hour after exposure

Ex: dermatitis venenata

Prognosis: good


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CHRONIC CUMULATIVE ICD

Most common Develops as a result of Repeated insult to the

skin

Chemical involve

multiple and weak Most common marginal irritant: soap, detergent,

organic solvent, oil Symptoms appear after days, months, or years

of exposure Clinical manifestation: itch, pain, few localized

patches of dry skin Erythema, hyperkeratosis, fissuring


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Dermatitis Kontak Iritan kronis dengan eksaserbasi akutpada ibu rumah tangga. Penderita menggunakanterpuntine untuk membersihkan tangan sesudahmengecat. Terdapat gambaran eritem, fissure dansquama


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Dermatitis kontak iritan pada pekerja bangunan yang bekerjadengan semen. Terdapat hyperkeratosis, squama, fissura danminimal pustule


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SUBJECTIVE (SYMPTOMATIC, SENSORY)

Itching, burning sensation within minutes ofcontact with irritant, without visible cutaneouschanges.


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NONERYTHEMATOUS

The irritation is not visually apparent,buthistological visible

Symptoms: burning, itching, stinging


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FRICTIONAL DERMATITIS

Result from repeated microtrauma andfriction

Usually leads to dry, hyperceratotic abradedskin

Nipple dermatitis with ill-fitting bras

Dermatitis from prosthetic limbs

Handling coarse paper , glass, and rock woolfiber


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TRAUMATIC REACTION

Develop after acute skin trauma as burn orlaceration

Commonly occurs on the hands

Symptoms same like nummular dermatitis

The healing process at least 6 weeks


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PUSTULAR OR ACNEIFORM REACTION

Seen after occupational exposure to oils,tars, heavy metals, halogen, but alsocosmetics

Pustular lesions: steril, transient

Seen among atopic and seborrheic patient


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EXSICCATION ECZEMATID

Occurs in elderly patient

Itching, dry skin


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DIAGNOSIS

major minor

subjective

Onset : after minutes, hours itching, stinging, burning

onset: after 2 weeks many people in the environment

affected similarly

objective

macula erythem, hyperceratosis,fissure glazed, parched, scalded of epidermis healing process promptly on withdrawalof exposure to the offending agentPatch test : (-)

morphologic changes suggesting smallconcentration differences or contact timeproduce large differences in skindamage


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DIFFERENTIAL DIAGNOSIS

ACD

Atopic Dermatitis

Tinea


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LABORATORY EXAMINATION

Patch test to exclude ACD

Gram staining to secondary infection

KOH exclude dermatomikosis


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TREATMENT

Identifications and elimination of the irritants

Emmolient improve barier repair in dry,lichenified skin

Topical corticosteroid antiinfalammation

Prolonged use of topical corticosteroidsleads to epidermal atrophy and increasedsusceptibility to irritants


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PROGNOSIS

Good if the causative irritant can be identifiedand eliminated

Cummulative and chronic irritant dermatitis

and atopic dermatitis hystory worse


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IDENTITY

Mr. S

65 yo

No MR: 760982

Ngampau Rt 04/04 Mojosongo, Jebres,Surakarta

Examine on March 24th 2012

Major ComplainCracks and peels on both hands


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7 years bfr entering

hospital

1 month bfr entering

hospital

Patient works as abricklayer and

complain the samesymptoms

Patient helps his child

to build a house, he

wasnt using gloves but

only a pair of boots,

Then he complain

about feeling ache, itch,

burn, and thickness on

both hands,

Symptoms were shown

after he mix the cement

without using gloves

Historical Report of Present Disease1 weeks bfr entering

hospital

Both hands are cracked

not long after that, then

its peeled

Patient was reffered

to the clinic of

dermatologist

moewardi hospital


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HISTORY OF PREVIOUS ILLNESS HISTORY OF FAMILY ILLNESS

Similar illness about 7 years ago

History of atopic : denied

History of allergy : denied History of DM/HT: (+)

History of cardiac illness: (+) 4years ago

History of prolong cough : denied

Occupation : bird cage craftsman

Drug allergy : denied

Food allergy : denied

Atopy : denied

DM/HT Histories: denied


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PHYSICAL EXAMINATION

Status Dermatologis - R. folar manus dextra et sinistra: eritem plaque

with hyperkeratosis, and squama.

- R. Dorsum manus dextra et sinistra:hipopigmentation plaque with squama andlichenification


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DIFFERENTIAL DIAGNOSIS

Dermatitis Kontak Iritan

Dermatitis Kontak Alergi

Working Diagnosis

Dermatitis Kontak Iritan


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TREATMENT

Non pharmacology

education to avoid irritating substance e.g.cement

Using self safety device e.g hand-gloves


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PHARMACOLOGY

Systemic:

Corticosteroid: metilprednisolon 16 mg/day(5 days)

Anti-histamin : cetirizine 1 x 10 mg

Topical:

Corticosteroid : Betametason cream 2 dd ueUrea cream 10% 2 dd ue


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PLANS

Patch test

Prognosis

Ad vitam :bonamAd sanam :bonamAd fungsionam :bonam

Ad Kosmetikum :bonam


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THANK YOU

Documents

Irritant Contact Dermatitis 2