Contact dermatitis is a common occupational disease and occurs at home to
cosmetics, skin care products and to other chemicals. Outdoors plants are common
causes of contact dermatitis poison ivy is prototype of a skin irritant that
produces dramatic inflammation on contact. Textile dyes in clothing are a
common source of skin problems.
Our strategy of managing skin diseases is to treat them as ecological
problems. You get better results if you assume that several factors interact to
produce skin disease than if you assume that each disease has a single cause and
single cure. The skin is a meeting place for disease- causing agents coming from
the outside and the inside at the same time. Skin irritants and allergens
combine forces to produce skin chronic skin disease. Food allergy and contact
allergy may be two expressions of the same or similar antigens. Food allergy may
start eczema, and the inflamed skin, in turn, becomes more vulnerable to
irritants, allergens and infections.
Contact dermatitis has been divided into two categories:
1. allergic contact dermatitis
2. and irritant contact dermatitis
Both allergic contact dermatitis and irritant contact dermatitis have similar
presentations. Acute skin lesions may be red, swollen and weeping
crusting lesions may appear after a few days. In chronic cases skin reddening, scaling
and fissuring are common. The distribution of the lesions may provide clues to
the irritant or allergen trigger. Identifying and removing the contact solves
Allergic Contact Dermatitis
Allergic contact dermatitis is a delayed, type IV allergic reaction. Latex
rubber is a well recognized source of contact reactions. Healthcare personnel.
now wear latex gloves routinely in all patient encounters and sensitization
estimates go as high as 40%.
Patients who have been sensitized to
skin-contact allergens may develop generalized eczematous inflammation if these
allergens or chemically related substances are ingested. For example, a patient
with a history of nickel allergy may get a widespread involvement after eating
foods rich in nickel. Patients sensitized to latex may cross-react to bananas
and kiwifruit. Patients sensitized to topical ethylenediamine may develop
generalized inflammation following treatment with aminophylline.
Contact urticaria is a local immediate or delayed hive-like reaction
reaction at the site of contact . The skin contact may also cause a generalized
allergic reaction with rhinitis, asthma, or anaphylaxis. Natural rubber
latex, for example can cause contact urticaria. Symptoms vary from mild itching
to asthma and anaphylaxis. Ethylene oxide, isocyanates, chloramine-T, epoxy
resins and nickel sulphate have caused IgE-mediated skin reactions.
Ahmed and Richardson described patients with hand dermatitis
occupations were in healthcare, followed by laborers, service workers, and
machinists/mechanics. The most commonly positive patch tests were: formaldehyde
& releasers, other preservatives, fragrances, rubber, nickel, and
neomycin/bacitracin. Bacitracin is an antibiotic that is used in several types of consumer
products, including cosmetics and ophthalmic and skin ointments. Bacitracin is
often combined with two other antibiotics, polymyxin and neomycin, in first aid
antibiotic products (Polysporin). Increasing reports of allergic contact
dermatitis reactions and near fatal anaphylaxis
concerns the North American Contact Dermatitis Group.
Allergic contact dermatitis of the feet may be caused by rubber and leather
components of shoes substances identified by patch testing included
chromated leather, p-tert butylphenol formaldehyde resin,
dithiodimorpholine, 2- mercaptobenthiazole, thiurams and isocyanates.
Textile contact dermatitis often presents itching and red patches with or
without fine skin peeling. Huntley suggests: “Usually these lesions develop at
sites where the garments fit tightly, such as inner and posterior thighs, back
of knees, buttocks, waistband area, and anterior and posterior axillary folds.”
Treating Contact Dermatitis
Recall our strategy of managing skin diseases as ecological problems. You get
better results if you assume that several factors interact to produce skin
disease than if you assume that each disease has a single cause and single cure.
The skin is a meeting place for disease- causing agents coming from the outside
and the inside at the same time.
Skin irritants and allergens combine forces to produce skin chronic skin
disease. Food allergy and contact allergy may be two expressions of the same or
Food allergy may start eczema, and the inflamed skin, in turn, becomes more
vulnerable to irritants, allergens and infections. Agner et al reported that the
combined effect of an irritant and an allergen was substantially greater than
the effect produced by either of the substances alone. They studied 20
nickel-sensitized subjects were exposed to patch testing with nickel chloride
and sodium lauryl sulphate (the detergent in most shampoos) alone and in
combination. [i] Elsner reported that skin exposure to a
variety of irritants such as surfactants and solvents is common and the irritant
effects may combine. They showed that a tandem application of 0.5% sodium lauryl
sulfate, an anionic detergent and undiluted toluene, applied twice daily for 30
minutes to the forearms of 20 volunteers, induced stronger irritant reactions
than those caused by application of the single irritants. [ii]
[i] Tove Agner, Jeanne Duus Johansen, Lene Overgaard,
Aage Vølund, David Basketter, Torkil Menné. Combined effects of irritants and
allergens. Presented at the annual meeting of the Contact Dermatitis Society.
[ii] P. Elsner, W. Wigger-Alberti, A. Krebs, N.
Goeritz, J. Spoo, U. Kappes, Interactions Of Irritants - A New Approach To
Irritant Contact Dermatitis