What is contact dermatitis and how is it treated?
Contact dermatitis is an acute or chronic skin inflammation accompanied by skin redness, rash, itching, burning sensations, cracking, etc. of noninfectious nature induced by physical contact with an irritant or substance to which an individual is allergic.
Short information about contact dermatitis
The disease peculiarities:
- Previous sensitization (acquired increased sensitivity) to the agent that provoked dermatitis,
- A symptomless period between contact with a damaging agent and the occurrence of dermatitis manifestations (usually, one or two days),
- Subsequent flare-up of dermatitis on all skin areas previously susceptible to it due to contact with this particular allergen;
- Persistence of allergies for many years.
Types of disease
- Atopic dermatitis is believed to be genetic, i.e. passed down from generation to generation. It is also common in the presence of other allergies, for instance, allergic rhinitis, food allergy, etc.
- Contact dermatitis (CD) starts when a predisposed person's skin is under the influence of a certain matter that this person turns out to be allergic to.
There are two kinds of CD:
- Allergic CD is provoked by the influence of an allergen, an agent that induces a pathological "abnormal" response of the immunity (normally, immunity fights against viruses, bacteria, fungi). At the first encounter of an allergen, the individual becomes sensitive to it (sensitized). With repeated exposure, such an individual develops an allergic reaction.
- Irritant dermatitis develops when the skin is under the influence of an irritating agent that hurts the skin and provokes inflammation. This skin response can occur in almost anyone with extended contact with an irritating substance.
Both types of dermatitis can lead to redness, dryness, rashes, itching, cracked skin, blisters, and other breakouts. Sometimes, the same person can develop both irritant-induced and allergic CD at the same time.
The irritant CD is more frequent than an allergic CD. Nearly 80% of CD cases develop due to the influence of irritants. About 75% of all cases of CD manifest as an inflammation of hands skin. Statistically, women are more prone to the disease than men. About 20% of women develop symptoms of CD during their lifetime. CD can develop at any age. Elderly individuals may be more prone to negative reactions as a result of drug use, while women more frequently develop the disease due to the use of cosmetics.
Both types of CD can lead to the following skin changes: redness, inflammation, blistering, dryness, thickening, cracking. Most often, these manifestations occur on the hands and face. In allergic dermatitis, not only the skin area that was under the direct influence of the allergen becomes inflamed but also unexposed skin parts can also develop symptoms. In irritant CD, only the skin in the contact area is impacted.
Possible causes of allergic CD:
- Rubber – latex;
- Textiles - paints, rubber, rosin;
- Some medicinal topical products.
Possible causes of irritant CD:
- Preservatives and perfumes;
- Acids and alkalis;
- Construction materials;
- Water (particularly, hard, limestone, or highly chlorinated);
- Some plants - anemone, mustard, and others.
Often, the influence of irritants is part of the job, so peoples of certain professions are at higher risk of irritant CD onset. For instance, people who are cooking, do house cleaning, hairdressing, are involved in agriculture and fishing, engineering, construction, medicine, dentistry and veterinary medicine, painting, are at risk of CD.
Diagnosis of CD
If contact factors can be detected from the patient's medical history, then in the future it is necessary to take maximum measures to eliminate them and reduce contact.
Patch testing is the main method for detecting substances that provoke the disease in a particular individual. During testing, small amounts of several substances are added to the patient's skin. The agents are glued to the patient's back with a special hypoallergenic adhesive plate. After 24-48 hours, patches are taken off, and skin reaction is assessed. Sometimes it is necessary to go to the dermatologist 1-2 more times after the test to assess possible delayed reactions.
With the help of drugs, you can effectively eliminate the manifestations of the disease. On the background of therapy, in some patients the symptoms disappear completely, in others, their severity significantly lowers. Detecting and eliminating contact with potential allergens or irritating agents is an important part of treating CD. If the patient can avoid such exposure, they will get rid of the symptoms without any therapy. If it is impossible to achieve complete elimination of contact, the dermatologist will help to minimize the negative effects.
In case of professional peculiarities when a person is under the influence of irritants, protective equipment (clothing, gloves) must be used. Dermatologists can also prescribe special ointments that soften and moisturize the skin without worsening the symptoms. Emollients are especially useful for the CD because, with this disease, dry and cracked skin often occurs. The type of ointment is chosen by the specialist taking into account the severity of dryness, skin area, and individual preferences. You will also need different emollients at different stages of the disease: in the acute stage - one, in the chronic - another, etc.
Drugs for CD:
- Topical (local) steroids. In the acute stage of the disease, when there is redness, inflammation, rashes, pain, topical glucocorticosteroid (CGC) can be used. These drugs are used to promptly stop skin inflammation. They are applied precisely to contact area and skin lesions.
- Systemic antihistamines, i.e. allergy medications such as Cyproheptadine can be effective in both types of CD as they suppress the inflammation by inhibiting the release of the chemicals produced by the body that promote it.
Prevention of CD
The only guaranteed way to avoid CD is to refrain from using any agents that can promote the disease flare-up. If it is impossible, it is necessary: to clean, wash off the causative factor from the skin right away, use protective equipment (masks, gloves), check all products, read labels to identify the possible content of causal factors.
Post by: John Avery, General Practitioner, Manchester, United Kingdom
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