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Irritant contact dermatitis in Adult
See also in: External and Internal Eye,Anogenital
Other Resources UpToDate PubMed

Irritant contact dermatitis in Adult

See also in: External and Internal Eye,Anogenital
Contributors: Jeffrey M. Cohen MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Irritant contact dermatitis is a reaction caused by direct physical or chemical injury to the epidermis. The damage caused by an irritant leads to inflammation, manifested in the skin as erythema, edema, and scaling. Irritant contact dermatitis should be differentiated from true allergic contact dermatitis, which is a delayed type-IV hypersensitivity (immune) reaction. Early in the course of irritant contact dermatitis, patients typically present complaining of a burning or stinging sensation; the symptoms and skin eruption usually follow the exposure by hours if the irritant is strong (whereas in allergic contact dermatitis, symptoms are usually delayed by approximately 2 days following exposure). As the irritation becomes chronic and the skin continually inflamed, pruritus can become a predominant symptom.

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

Best Tests

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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.

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References

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Last Reviewed:10/17/2017
Last Updated:12/03/2017
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Patient Information for Irritant contact dermatitis in Adult
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Contributors: Medical staff writer

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.
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Irritant contact dermatitis in Adult
See also in: External and Internal Eye,Anogenital
A medical illustration showing key findings of Irritant contact dermatitis : Burning skin sensation, Erythema, Intertriginous distribution, Pruritus, Scaly plaques
Clinical image of Irritant contact dermatitis - imageId=3921662. Click to open in gallery.  caption: 'Dry skin and scaling of the fingertips.'
Dry skin and scaling of the fingertips.
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