Irritant contact dermatitis in Adult
See also in: External and Internal Eye,AnogenitalAlerts and Notices
Synopsis
The hands are the most common location for irritant contact dermatitis, although any body surface may be involved, including the genitals. Eyelid areas are also easily affected due to the very thin skin of the region and the unwitting transmission of irritant substances by the hands. Patients with a history of atopic dermatitis are particularly predisposed. Environmental factors include repeated exposure to water or frequent hand washing, soaps and solvents, fiberglass, mild acids, and alkalis. Dry air can also predispose to irritant contact dermatitis. Exposures are frequently occupational. High-risk jobs include cleaning, health care, food preparation, and hairdressing. Irritant contact dermatitis can occur at any age. It is more common in women.
Related topic: Hand dermatitis
Codes
ICD10CM:L24.9 – Irritant contact dermatitis, unspecified cause
SNOMEDCT:
110979008 – Primary irritant dermatitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Allergic contact dermatitis
- Atopic dermatitis
- Nummular dermatitis (nummular eczema)
- Dyshidrotic dermatitis (dyshidrotic eczema)
- Stasis dermatitis
- Phytophotodermatitis
- Intertrigo if present in skin fold
- Tinea corporis – When a patient presents with scaling lesions (especially on the hands or feet), it is important to perform a potassium hydroxide (KOH) preparation to rule out a fungal etiology.
- Psoriasis
- Pityriasis rosea
- Seborrheic dermatitis – The distribution of lesions is often a helpful clue in distinguishing this entity from atopic dermatitis.
- Lichen simplex chronicus
- Scabies
- Cellulitis
- Erysipelas
- Herpes simplex virus infection
- Impetigo
- Cutaneous T-cell lymphoma / mycosis fungoides – If an adult patient has persistent "eczema" that is not adequately responding to therapy, this entity should be ruled out with skin biopsies.
- Glucagonoma syndrome
- Pellagra
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/17/2017
Last Updated:12/03/2017
Last Updated:12/03/2017
Patient Information for Irritant contact dermatitis in Adult
Overview
Irritant contact dermatitis is an inflammatory rash caused by direct chemical injury to the skin. Unlike allergic contact dermatitis, which appears 48-72 hours after exposure to an allergen, the symptoms of irritant contact dermatitis can result within a few hours if the exposure is a strong irritant.- Patients typically present complaining of a burning or stinging early in the course of irritant contact dermatitis.
- As the irritation becomes chronic and the skin becomes continually inflamed, itching can become a predominant symptom.
Who’s At Risk
Irritant contact dermatitis can occur at any age.- Patients with a history of eczema (atopic dermatitis) are particularly predisposed.
- Environmental factors include frequent hand washing and repeated exposure to water, solvents, fiberglass, mild acids, and alkalis.
- Dry air can predispose to irritant contact dermatitis.
Signs & Symptoms
The most common location for irritant contact dermatitis is the hands, though any body surface can be involved, including the genitals.- Lesions can appear pink to red.
- In chronic cases, affected areas may develop scale and cracks.
- In acute cases, areas may have a sharp border corresponding to the areas of chemical exposure.
- On the fingertips, peeling of the skin, cracks, and scaling may be noted.
Self-Care Guidelines
- Remove the offending exposure and protect the skin from re-exposure.
- For irritated skin in body folds, consider a barrier cream with zinc oxide paste, such as Desitin.
When to Seek Medical Care
Seek medical evaluation for a rash that does not resolve with self-care measures.Treatments
- Your physician may recommend that you use petroleum jelly or a thick moisturizing cream applied directly to wet skin after bathing. Apply frequently (at least twice daily) to moisturize and protect the skin.
- Mild- to mid-potency topical steroids may be prescribed if inflammation is pronounced.
References
Bolognia, Jean L., ed. Dermatology, pp.227, 241-249. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1309-1314, 2370. New York: McGraw-Hill, 2003.
Irritant contact dermatitis in Adult
See also in: External and Internal Eye,Anogenital