Contact Dermatitis

Occupational Hazards of Contact Dermatitis

• Significant cause of workplace disability, affecting approximately 15 million US workers annually.
• Types of contact dermatitis: Irritant Contact Dermatitis (ICD) and Allergic Contact Dermatitis (ACD).

Irritant Contact Dermatitis (ICD)

• Accounts for about 80% of contact dermatitis cases.
• Common irritants include:
  • Strong acids and bases
  • Harsh detergents and soaps
  • Frequent handwashing or use of disinfectants
  • Irritating foods like garlic, onions, and citrus fruits.
• Symptoms typically involve:
  • Dry, cracked skin, usually localized to hands and arms.
  • Well-defined lesions or vesicles where irritants made contact.
  • Chronic exposure may lead to lichenification (thickened skin).

Allergic Contact Dermatitis (ACD)

• Caused by allergens like benzocaine, certain chromium salts, formaldehyde, and latex.
• Characterized by:
  • Less defined rash boundaries than ICD.
  • Red, inflamed skin often covering larger areas with papules and vesicles.
  • Severe itching associated with the rash.
• Urushiol-Induced ACD:
  • Specific allergen present in poison ivy, poison oak, and poison sumac.
  • Commonly causes severe skin reactions; about 80% of US population is sensitive.

Initial Assessment and Diagnosis

• Medical history is crucial to differentiate between ICD and ACD.
• ICD symptoms show clear demarcation whereas ACD does not.
• Chronic cases in both types can lead to skin thickening.

Treatment Goals for Dermatitis

• Remove irritants or allergens from the skin.
• Treat inflammation and relieve symptoms like itching.
• Educate patients on proper treatments and prevention methods.

Exclusions for Self Treatment

• Patients under 2 years old.
• Symptoms persisting more than one week.
• Extensive dermatitis covering >10% for ICD or >20% for ACD.
• Signs of infection (pus, tenderness).

General Treatment Recommendations

1. Non-Pharm Treatments for ICD:*
   • Wash affected area with lukewarm water and mild soap.
   • Avoid irritants and harsh soaps.
2. Pharmacologic Treatments:
   • Barrier creams and emollients (e.g., petrolatum) to hydrate skin.
   • Aluminum acetate (Burrow's solution) for its antibacterial and anti-inflammatory effects.
   • Use colloidal oatmeal baths for symptom relief.
   • Avoid: topical anesthetics (e.g., benzocaine) and steroids, which may worsen ICD.

Management for ACD

• Remove allergen (e.g., jewelry, irritants).
• Gentle cleansing with mild soap.
• Topical corticosteroids (e.g., hydrocortisone) effective for inflammation.
• Astringents may help with weeping areas but avoid on open wounds.

Prevention Strategies

• Educate patients to identify irritants and allergens.
• Train on proper hygiene practices and skin care.
• Focus on avoiding known allergens and treating symptoms promptly.

Specific Case Management Considerations

• Patient JD (waitress with hand rash):
  • Recommend gloves when cleaning. Avoid harsh cleaning solutions and frequent washing.
• Urushiol exposure prevention:
  • Wash with mild soap immediately after exposure to poison ivy/oak/sumac.

Clinical Cases Discussion

• Focus on assessment of symptoms and determining appropriate care.
• Recognize when to recommend medical attention or self-care based on symptom severity.

Summary of Insect Bites and Stings

• Differentiates Between Bites (e.g., mosquitoes, fleas) and Stings (e.g., bees):
  • Bites often result in localized redness/itching.
  • Stings may cause broader reactions including swelling.
• Major treatment goals:
  • Relieve symptoms, prevent secondary infections, and educate for prevention.
• Exclusions for self-treatment include severe reactions or suspect bites/stings requiring medical intervention.

Final Notes

• Review appropriate use of topical treatments and non-pharmacological interventions for both ICD and ACD types.
• Highlight key recommendations for preventing contact dermatitis and managing skin irritations effectively.