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Dermatology
Irritant Contact Dermatitis
Built from Dermatology, 5th Edition
What’s inside
6 sections · 121 slides
Overview
- What this topic covers
Overview and Epidemiology
What irritant contact dermatitis is, how common it is, and who is most at risk
- Irritant contact dermatitis: key features
- Irritant vs. allergic contact dermatitis
- A brief history of recognizing irritant skin disease
- 70–80%
- How common ICD is in the clinic
- Exposures to irritants by occupation
- Exposures to irritants by occupation (continued)
- Exposures to irritants by occupation (continued)
- Exposures to irritants by occupation (continued)
- Host factors that predispose to ICD
- Wet work: the single biggest risk factor
- Irritant contact dermatitis of the feet and ankles
Pathogenesis and Pathology
How direct chemical or physical injury turns into visible skin inflammation
- How ICD develops: the big picture
- Acute-phase pathogenesis: the injury cascade
- Chronic-phase pathogenesis: barrier breakdown
- Irritants and mechanisms of toxicity
- Histopathology of irritant contact dermatitis
Clinical Presentations
ICD has at least a dozen distinct clinical patterns, from a single chemical burn to years of subtle hand eczema
- Many faces, one underlying process
- Acute irritant contact dermatitis
- Acute delayed irritant contact dermatitis
- Irritant reaction ICD
- Cumulative irritant contact dermatitis
- Asteatotic dermatitis (eczema craquelé)
- Traumatic irritant contact dermatitis
- Pustular and acneiform irritant contact dermatitis
- Non-erythematous and subjective (sensory) ICD
- Airborne irritant contact dermatitis
- Frictional irritant contact dermatitis
- Contact urticaria
- Clinical features suggesting an irritant or toxic etiology
- Clinical features suggesting an irritant or toxic etiology (continued)
- Clinical features suggesting an irritant or toxic etiology (continued)
- Clinical features suggesting an irritant or toxic etiology (continued)
- Classification of hand dermatitis
- Classification of hand dermatitis
Classification of Irritant Chemicals
Acids, alkalis, metals, solvents, detergents, disinfectants, plastics, food, water, and body fluids
- Acids: how they injure the skin
- Organic acids: generally milder
- Chemical burn from hydrochloric acid
- Alkalis: more painful than most acids
- Wet cement: a common alkali burn
- Metal salts
- Solvents: how they damage the skin
- Solvents then soap and water: a dangerous combination
- Irritant contact dermatitis from paint solvents
- Alcohols and glycols
- Detergents and cleansers: how they irritate
- Comparing common surfactants
- Irritant contact dermatitis from homemade slime
- Disinfectants: cumulative, weak-toxin irritants
- Irritant contact dermatitis from disinfectants
- Disinfectant-related hand dermatitis in a dentist
- Plastics: three families, damage from the leftovers
- Why plastics cause skin reactions
- Food, plants, and irritant contact dermatitis
- Chemical compounds in plants responsible for chemical irritant contact dermatitis
- Chemical compounds in plants responsible for chemical irritant contact dermatitis (continued)
- Chemical compounds in plants responsible for chemical irritant contact dermatitis (continued)
- Chemical compounds in plants responsible for chemical irritant contact dermatitis (continued)
- Chemical burn from apple cider vinegar
- Water: the universal irritant
- Irritant chemicals: uses, properties and side effects
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Irritant chemicals: uses, properties and side effects (continued)
- Bodily fluids: urine, feces, and saliva
- Granuloma gluteale infantum: chronic irritant diaper dermatitis
- Jacquet erosive diaper dermatitis
- Granuloma gluteale infantum of the vulva
- Irritant cheilitis from lip licking
- Causes of cheilitis in patients referred for patch testing (n = 75)
- Causes of cheilitis in patients referred for patch testing (n = 75) (continued)
Diagnosis, Prognosis, and Treatment
Telling ICD apart from allergic dermatitis, what determines its course, and how it is prevented and treated
- Differential diagnosis: ICD vs. allergic contact dermatitis
- Prognosis: the "accommodation" or "hardening" phenomenon
- What predicts a worse or better outcome
- Treatment: avoidance comes first
- Workplace prevention: the most effective lever
- Protective gloves: a double-edged tool
- Education programs work
- Medical treatment of ICD
- Treatment options for stubborn chronic disease
- Measuring hand eczema severity
- The Hand Eczema Severity Index (HECSI)
- The Hand Eczema Severity Index (HECSI) (continued)
- The Hand Eczema Severity Index (HECSI) (continued)
- How HECSI is scored
- The modified Total Lesion Symptom Score (mTLSS) for hand eczema
- The modified Total Lesion Symptom Score (mTLSS) for hand eczema (continued)
- A practical approach to irritant contact dermatitis
- Key takeaways
- References
- References (continued)
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- References (continued)
- Dermatology, 5th Edition (2-Volume Set)