CLINICAL IRRITANT CONTACT DERMATITIS SYNDROMES

Abstract

Irritant contact dermatitis (ICD) is a frequent and important condition in general and occupational dermatology. 18,33 It is probably more frequent than allergic contact dermatitis, although reliable data are still very limited. Despite their different pathogenesis, allergic and irritant contact dermatitis, especially of the chronic type, show a remarkable similarity with respect to clinical appearance, histology, 7,8 and immunohistology. 9,44 Frequently, even therapy is similar. 6,36 In contrast to allergic contact dermatitis, ICD is defined as being the result of a primarily unspecific damage to the skin (Table 1). It is not a clinical entity, but rather a spectrum of diseases. The clinical aspect of ICD is determined by the dose-effect relationship. 47 The morphology of acute ICD shows erythema, edema, vesicles that may coalesce, bullae, and oozing. Necrosis and ulceration is only seen with primary irritants. The clinical features of chronic ICD include redness, lichenification, excoriations, scaling, and hyperkeratosis. Most frequently affected by ICD are the hands, as they are the human tools that interact with the environment most and have intensive contact to irritants; however, spilling of fluids may irritate the forearms or other body sites, especially when fluids soak through work clothes. The incidence of irritant dermatitis correlates with irritant exposure of the workers in a given profession. 28 Some high-risk occupations are caterers, 11 furniture industry workers, 23 hospital workers 24 (nurses, 31 cleaners, 49 kitchen workers), hairdressers, 51 chemical industry workers, 10 dry cleaners, 2 metal workers, 13,14,21,27 florists, 4 and warehouse workers. 3 Airborne irritant dermatitis develops in irritant-exposed sensitive skin, mostly the face and especially the periorbital region. 15,34 Irritant dermatitis caused by dust may mimic textile dermatitis, with lesions most prominent in sites with close skin-garment contact, such as the axilla, the gluteal region, or the thighs.