Introduction Demographics Causes Clinical features Variation in skin types Complications Diagnosis Differential diagnoses Treatment Outcome
Irritant contact dermatitis is a form of skin inflammation caused by contact with substances and/or environmental factors that injure the skin, damaging the skin barrier.
Irritant contact dermatitis will affect anyone with sufficient exposure to irritants, but those with atopic dermatitis are particularly susceptible. Occupational hand dermatitis is due to irritants in 80% of cases, most often affecting those who involved in wet work such as cleaners, hairdressers, food handlers, and healthcare personnel. Irritant contact dermatitis can affect all age groups, both sexes, and any race.
Irritant contact dermatitis develops when chemical or physical agents damage the skin surface faster than the skin can repair. Irritants remove oils and natural moisturising factor from the outer layer of the skin, allowing chemical irritants to penetrate the skin barrier and trigger inflammation.
Factors influencing the development and severity of the dermatitis include:
Everyday examples of common skin irritants are water, soaps, and, in the era of COVID-19, hand sanitisers. Occupational irritants can include wet work, detergents, solvents, acids, alkalis, adhesives, and metalworking fluids. Topical medications such as retinoids and benzoyl peroxide, may cause irritant contact dermatitis with long-term use. Friction, sweating, and heat are examples of environmental factors. Irritant dermatitis is often the result of the cumulative impact of multiple irritants.
Irritant contact dermatitis:
Interdigital dermatitis, also called the ‘sentinel sign’, is regarded as an early stage of irritant contact dermatitis affecting the hands. It is commonly seen in occupations involving wet work.
Erythema of dermatitis may be more difficult to observe in darker skin types, and postinflammatory hyperpigmentation is more common after resolution of the dermatitis.
Irritant contact dermatitis may be diagnosed on detailed medical history, including occupational exposures, and clinical examination. There is no test for irritant contact dermatitis. Patch testing may be necessary to distinguish it from allergic contact dermatitis. Irritant and allergic contact dermatitis can co-exist.
Chronic irritant contact dermatitis can be slow to improve or resolve, especially of the hands, without obsessive care.
