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.