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CONTACT DERMATITIS. (49) Marienelle R. Maulion Section C Group 5. 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

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Contact dermatitis

CONTACT DERMATITIS

(49) Marienelle R. Maulion

Section C Group 5


Contact dermatitis1
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



Tests for sensitivity
Tests for Sensitivity

PATCH TEST

  • To detect hypersensitivity to a substance that is in contact with skin so that the allergen may be determined and corrective measures taken


Tests for sensitivity1
Tests for Sensitivity

Provocative 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 Test

  • To evaluate for contact photoallergy to such substances as sulfonamides, phenothiazines, PABA, oxybenzone, musk ambrette


Types of contact dermatitis
Types of Contact Dermatitis

Irritant 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 Dermatitis

  • An acquired delayed sensitivity to various substances that produce inflammatory reactions in only those who have been previously sensitized to the allergen


Irritant contact dermatitis
Irritant Contact Dermatitis

Etiologic 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 salts

    Predisposing Factors

  • History of atopic dermatitis

  • Occupational exposure/ Repeated exposure

  • Low temperature/ Low humidity

  • Condition of the skin


Irritant contact dermatitis1
Irritant Contact Dermatitis

Pathogenesis

  • 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.


Irritant contact dermatitis2
Irritant Contact Dermatitis

Acute Irritant Contact Dermatitis

  • Burning, stinging, painful sensations can occur immediately within seconds after exposure or may be delayed up to 24 hour

    LESION

    Erythema with a dull, nonglistening surface  vesiculation (blister formation)  erosion  crusting  shedding of crusts and scaling or erythema necrosis  shedding of necrotic tissue  ulceration  healing


Irritant contact dermatitis3
Irritant Contact Dermatitis

Acute Irritant Contact Dermatitis


Irritant Contact Dermatitis

Acute Irritant Contact Dermatitis


Irritant contact dermatitis4
Irritant Contact Dermatitis

Chronic 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 develop

    LESION

    Dryness  chapping erythema hyperkeratosis and scaling  fissures and crusting

  • Lichenification, vesicles, pustules, and erosions


Irritant contact dermatitis5
Irritant Contact Dermatitis

Chronic Irritant Contact Dermatitis


Allergic contact dermatitis
Allergic Contact Dermatitis

Etiologic 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



Allergic contact dermatitis2
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.


Allergic contact dermatitis3
Allergic Contact Dermatitis

Acute Allergic Contact Dermatitis


Allergic Contact Dermatitis

Acute Allergic Contact Dermatitis


Allergic contact dermatitis4
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

    LESION

    Papules scalinglichenification excoriations


Allergic contact dermatitis5
Allergic Contact Dermatitis

Chronic Allergic Contact Dermatitis


Allergic contact dermatitis6
Allergic Contact Dermatitis

Chronic Allergic Contact Dermatitis


Management for contact dermatitis
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


Management for contact dermatitis1
Management for Contact Dermatitis

Treatment 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


Management for contact dermatitis2
Management for Contact Dermatitis

Treatment 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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