CONTACT DERMATITIS (49) Marienelle R. Maulion Section C Group 5 1

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 2

Regional Sites of Predilection 3

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 4

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 5

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 6

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 7

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. 8

Irritant Contact Dermatitis Acute 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 9

Irritant Contact Dermatitis Acute Irritant Contact Dermatitis 10

Irritant Contact Dermatitis Acute Irritant Contact Dermatitis 11

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 12

Irritant Contact Dermatitis Chronic Irritant Contact Dermatitis 13

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 14

Allergic Contact Dermatitis Pathogenesis 15

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. 16

Allergic Contact Dermatitis Acute Allergic Contact Dermatitis 17

Allergic Contact Dermatitis Acute Allergic Contact Dermatitis 18

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 19

Allergic Contact Dermatitis Chronic Allergic Contact Dermatitis 20

Allergic Contact Dermatitis Chronic Allergic Contact Dermatitis 21

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 22

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 23

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. 24

Thank you. 25