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CONTACT DERMATITIS Contact
dermatitis is a reaction, which occurs when skin comes in
contact with certain substances. Two mechanisms exist by which substances
can cause skin inflammation - Irritation (Irritant
contact dermatitis) or Allergic reaction (Allergic
contact dermatitis). Common irritants include soap, detergents,
acids, alkalis and organic solvents (as are present in nail varnish
remover). Contact dermatitis is most often seen around the hands or areas
that touched or were exposed to the irritant/allergen.
Contact dermatitis of the feet also exists but differs in that it is due
to the warm, moist conditions in the shoes and socks. An allergic reaction
does not generally occur the first time one is exposed to a particular
substance but on subsequent exposures, which can cause dermatitis in 4 to
24 hours. Treatment includes removal or avoidance of the substance causing
the irritation and cleansing the area with water and mild soap (to avoid
infection). A recent recommendation for mild cases is to use a manganese
sulfate solution to reduce the itching. Antihistamines
are generally not very helpful for treatment of contact dermatitis.
Another common treatment for severe contact dermatitis is with corticosteroid
tablets, ointments or creams, which diminish the immune attack and
resulting inflammation. Corticosteroids will not cure the problem.
Overuse, misuse and/or prolonged use of steroids can worsen the problem or
create an even more difficult condition. Never use steroids on the face.
Many laundry
soaps contain chemical additives which are the actual irritants (e.g.,
sodium silicate, sodium phosphate, sodium carbonate). Hand cleaner soaps
contain small harsh particles to assist in grease removal, such as pumice,
talc, borax, corn meal or wood flour. These are sometimes irritating. Some
yellow laundry soaps contain "rosin" to make the bar more
soluble, which is also a sensitizer. Flowers, herbs,
and vegetables can also affect the skin of some people. Burns
and sunburn
increase the risk of dermatitis developing, and chemical irritants that
can cause the condition include:
Allergic
contact eczema (dermatitis)
is a red, itchy, weepy reaction where the skin has come into contact with
a substance that the immune system recognizes as foreign, such as poison
ivy or certain preservatives in creams and lotions. Red, bumpy, scaly,
itchy, and swollen skin are all symptoms which can signify an allergic
skin condition. These skin problems are often caused by an immune system
reaction, signifying an allergy. Allergic skin conditions can take several
forms and are due to various causes. Toxicodendron
dermatitis, also
called Allergic
phytodermatitis or Rhus dermatitis
is an allergic contact dermatitis that occurs from exposure to members
of the plant genus Toxicodendron. In Nickel
Allergy -
Contact
allergic dermatitis to nickel may develop at any age. Once this nickel
allergy has occurred, it persists for many years, often life-long. Nickel
allergy is more common in women, probably because they are more likely to
have pierced ears than men, although this is changing. The degree of
allergy varies. Some people develop dermatitis (also called eczema) from
even brief contact with nickel-containing items, while others break out
only after many years of skin contact with nickel.
In
jewelry - necklaces, necklace-clips, earrings,
bracelets, watch-straps and rings may contain nickel.
"Hypoallergenic", solid gold (12 carat or more) and silver
jewelry should be safe. Nine carat gold and white gold both contain
nickel. Plastic covers for earring studs can be obtained. Coating the stud
with nail varnish is not recommended In
clothing - metal zips, bra hooks, suspender clips,
hair-pins, buttons, studs, spectacle frames etc. are likely to contain
nickel. Use substitutes made of plastic, coated or painted metal or some
other material. Consider
lipstick holders, powder compacts, handbag catches, cigarette lighters,
razors, keys, key rings, pocket knives, pens as potential causes of nickel
dermatitis. Metal
items in the home such as cupboard handles, kitchen utensils,
cutlery, toaster, metal teapots, scissors, needles, pins, thimble, vacuum
cleaners, torches, bath plugs... may all contain nickel. Choose tools with
plastic handles. Stainless steel does not usually cause dermatitis unless
it is nickel-plated. Silver coins
are composed of cupro-nickel. Cashiers with nickel allergy may develop
hand dermatitis from this source. Wear gloves to handle money or pay with
a credit card or check Nickel
dermatitis may also be aggravated by contact with paper clips, typewriter
keys, instruments, or metal fragments from a lathe or chain saw. ives
or urticaria are
red, itchy, swollen areas of the skin that can range in size and appear
anywhere on the body. Most common are acute
cases of hives, where the cause is identifiable—often a viral infection,
drug, food or latex. These hives usually go away spontaneously. Some
people have chronic hives
that occur almost daily for months to years. For these individuals,
various circumstances or events, such as scratching, pressure or
"nerves," may aggravate their hives. However, eliminating these
triggers has little effect on this condition. Angioedema,
a swelling of the deeper layers of the skin, sometimes occurs with hives.
Angioedema is not red or itchy, and most often occurs in soft tissue such
as the eyelids, mouth or genitals. Hives and angioedema may appear
together or separately on the body. Hives are caused by a chemical called histamine
and are responsible for many of the symptoms of allergic layers of the
skin. Angioedema results from the actions of these chemicals in the deeper
layers of the skin. These chemicals are usually stored in our bodies’ mast
cells, which are
cells heavily involved in allergic reactions. There are several
identifiable triggers that release histamine and other chemicals from the
mast cells, causing hives. In adults,
reactions to medicines are a common cause of acute hives. Medications
known to cause hives or angioedema include aspirin and other non-steroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen, high blood pressure
medicines known as ACE-inhibitors, or pain-killers containing codeine or
codeine-like drugs. Like all drug-induced hives, these reactions occur
within only minutes to an hour of taking the drug. Adults can also develop
hives after eating certain foods, including nuts, eggs, shellfish, soy,
wheat or milk—the culprits in more than 90% of proven food-induced
hives. In children, foods or viral infections such as a cold can trigger
acute hives. Physical urticaria
is hives resulting from an outside source: rubbing of the skin, cold,
heat, physical exertion or exercise, pressure or direct exposure to
sunlight. Patients with chronic hives often report that at least one of
these triggers induces their hives. Whenever there
is an identifiable trigger of hives, it should be eliminated. In patients
with acute hives, some drugs or foods may take days to be eliminated from
the body. CONTACT DERMATITIS - SENSITIZER TYPE An allergic
contact dermatitis can be caused by fabric finishes, dyes, oils, tars,
rubber, soap, cosmetics and perfume, insecticides, wood resins, plants,
paints, plastics, glues, fiber glass, metals, polishes, ointments (home
remedies) and occupational hazards (e.g., lithographers). The
sensitization type of allergic contact dermatitis usually occurs anywhere
from CONTACT DERMATITIS - COSMETICS DERMATITIS Most commonly
occurs from hair dyes, nail polishes, perfumes, lipsticks and sunscreen
agents. The chief site of the eruption is the eyelids area, with ears and
neck next. Eye makeup,
such as mascara, eye shadow and eye pencil, seldom causes dermatitis
(although eyeliner often does) whereas nail polish, while seldom causing
trouble around the fingernails, affects the eyelids first. Lower eyelid
dermatitis is often form wetting solutions or eye drops. Various
formaldehyde resins are used in nail lacquers and nail lacquers and nail
hardeners, as are sulfonamide derivatives, both of which sensitize. Lipsticks
contain waxes and fats (occasionally cocoa butter sensitizes), perfumes
(occasionally sensitize), and dyes (especially tetrabromofluorescein),
which may occasionally dry the lips and produce photosensitivity. Special
lipsticks are available which contain neither fluorescent dyes, nor
perfumes, like, such as, Almay (Texas Pharmacal) or Ar-Ex. Sunscreen
preparations containing PABA (para-aminobenzoic acid), hydroquinone or
digalloy trioleate can sensitize, and in some cases, photosensitize.
Bleaching creams are sensitizers too, either mercury, or hydroquinone
being the culprit. Toothpaste and
mouthwashes can cause dermatitis from oils, cinnamon or other flavoring,
or antiseptics. This is called peri-oral dermatitis. Using a non-tartar,
non-fluoride toothpaste can often help in these cases. Hair dyes are
mostly of the permanent or "oxidation" type, containing
para-phenylene diamine (PPDA), soap, ammonia and other modifiers which
penetrate and color the hair when mixed with 20 volumes of peroxide. This
type of dye accepts shampoos and cold waves and sensitizes most commonly.
The azo and aniline dyes produce a semi-permanent coloring which is
tolerated well in most PPDA-sensitive patients, but lasts through only a
few washings. Metallic hair dyes (Romans used a lead comb dipped in
vinegar to darken gray hair) are also referred to as hair
"restorers" and are mostly still based on lead and do not
sensitize. Vegetable rinses are usually made form henna, which is
non-sensitizing, although some pyrogallol combinations are sensitizing.
Methylene PPDA can cross-react with PABA in sunscreens, local anesthetics
and sulfonamides-thiazides (Diruil), tolbutamide (Orinase), chlorpropamide
(Diabinase) and saccharin. Permanent-wave
solutions, usually thioglycolates, are alkaline reducing agents which make
the hair malleable; the hair is "waved" on rollers and then
"fixed" with an oxidizer (hydrogen peroxide, perborate, bromates
of citric acid). Thioglycolates rarely sensitize, but do occasionally
cause primary irritation if not carefully mopped up, and can split and
break the hair. The adhesive
used to attach toupees and false eyelashes occasionally cause dermatitis.
Bleaching or freckle creams usually contain mercury or quinones, and all
can sensitize; Benzoquin (Elder) is a very potent sensitizer. Face powders
and rouge rarely cause dermatitis. For toupees and ileostomy stoma
irritated by other rubber cements, Duo brand surgical adhesive (Johnson
& Johnson) is well tolerated by many. People should
be advised to apply perfume to their clothes if possible rather than to
their skin and certainly should avoid using photosensitizing perfumes (one
such example is Shalimar) on their skin in bright sun. Contact
Dermatitis-Rubber
Fully
finished and polymerized plastics seldom cause an allergic contact
dermatitis, whereas fully "cured" rubber articles do so quite
frequently. Of the antioxidants used to prolong the life of the rubber,
monobenzyl ether of hydroquinone (which can depigment skin) and
phenyl-beta-naphthylamine are the most common sensitizers. The
accelerators, mercaptobenzothiazole, tetramethyl thiuram monosulfide and
diphenyguanidine, and the peptizer, thio-beta napthal, are the chemicals
causing most of the dermatitides attributable to rubber. Two other
accelerators, disulfuram (Antabuse) and thiuram, will produce itching,
redness and hives in those exposed who ingest alcohol. Thiuram is also
used as a lawn fungicide (Tersan). Occasionally bleach will activate a
rubber accelerator, zinc dibenzyl dithiocarbamated (ZDC) to become highly
allergenic.
Elastic in hair
nets may cause dermatitis, and ribbons or wrap-around hair nets may have
to be substituted. Where an eruption is due to a rubber condom, Fourex
(Schmidt) fish-skins can be substituted. Adhesive tape
can cause a miliaria-like occlusion of poral openings, although true
contact dermatitis spreads beyond the margin of the contact with the tape.
Latex cements
are used in the shoe and textile trade. Vulcanizing solutions come in two
solutions which, when mixed, seal punctures. It takes a few hours to cure,
and sensitization can occur from the various chemicals. Non-vulcanizing
rubber solutions are used in the shoe industry and automobile trimmings
and can cause dermatitis. Non-rubber
Adhesives. These
are chiefly synthetic resin adhesives which can sensitize, although fish
glues generally do not. Glues made from cotton (e.g., cellulose acetate)
are not sensitizers, and neither is collodion. Vegetable gums such as
karaya, acacia and tagacanth are sensitizers. Contact
Dermatitis to Soaps and Detergents
Dishwashers, housewives, laundresses and
surgeons, often show dehydration or shriveling of the keratin layers,
which leads to irritation (primary irritant type dermatitis).
Coconut-oil-containing soap is often the worst culprit. Neutral soaps,
such as Cetaphil, Lowila, Basis, Oilatum, or Dove are much less drying.
Many of the stronger antibacterial soaps, such as Dial, Zest, Lifebuoy,
Safeguard and Palmolive Gold, are sensitizing as well as drying, and may
be photosensitizing. Contact with
clothing washed in strong soaps or detergents (for instance sheets used by
bed patients) can lead to dermatitis. This is especially true if bleach or
whitener is used. The laundry detergents most likely to cause a reaction
include Axion, Bold, Ajax Detergent, Cold Power, Salveo Tabs, Coldwater
All, Amway, Arm & Hammer, Era and Dynamo. Contact
Dermatitis to Deodorants and Antiperspirants
These products often contain neomycin, zirconium,
formaldehyde and antibacterial agents, such as hexa chlorophene, which can
sensitize, as well as aluminum salts. Deodorant soaps containing
salicylanilide derivatives or hexachlorophene analogs can photosensitize.
(Examples include Dial, Zest, Lifebuoy, Safeguard, Palmolive Gold, Irish
Spring, or Coast). Contact
Dermatitis from Clothing
Natural
fiber clothing, made from wool, cotton, linen and mohair, have never in
themselves been shown to be sensitizers. Sizing and stiffening cotton with
starch orrosin may produce dermatitis.
Dermatitis may
occur more frequently from the use of dark clothing. Heavy perspiration,
especially in oily-skinned individuals, causes more bleeding of the dye
(e.g., widow's dermatitis). Fabric finishes
which are used to increase durability, to soften of stiffen a fabric, or
to impart waterproofing, crease resistance or other properties to the
fabric. The use of formaldehyde or its resins in clothing is widespread,
but the incidence of resulting dermatitis is comparatively low. These are
used to make fabrics crease resistant, water-repellent and shrink
resistant. Dermatitis occurs mostly in obese women who demonstrate a
dermatitis starting in the axilla and later affecting the sides of the
neck, the antecubitals and the inguinals. In men, it is usually in the
inner thighs, gluteal folds and back of the knees. Stoddard
solvent or other dry-cleaning solutions will occasionally produce a
clothing-oriented dermatitis, as will moth crystals. Airing the clothes
for a few days before wearing them will usually prevent this. Management of
clothing dermatitis involves the use of Decadron spray, which contains
isopropyl myristate, a film or "spray-on-shield" which
suppresses sweat and may protect the fabric and acts as a deodorant.
Weight loss in obese women sometimes seems to help, as well as avoidance
of panty girdles. Those who are sensitive to formaldehyde must avoid
wash-and-dry or wash-and-wear and drip-dry clothing. Contact
Dermatitis in Footwear
the chief cause here is the thermoplastic or
rubber-boxed toes, and the cements and dichromates used in tanning. Dyes,
anti-mildew agents, formaldehyde and nickel eyelets or nickel in arch
supports also can cause dermatitis. A waterproofing silicone spray
externally applied to the shoe can also be the cause. The dermatitis
usually begins on the big toe and spreads to the rest of the foot. Socks
washed in Bold or bleached with a strong whitener can also cause
dermatitis. Formaldehyde is
used in the tanning of white leather shoes in "elk," "white
kid" and "new bucks." Tannins obtained from trees are used
to tan leather (vegetable tanning) and do not cause dermatitis. However,
if the shoe is made of vegetable-tanned leather, the lining should not be
chrome- tanned. Sweat leaches
out chromates from the leather, so controlling perspiration is essential.
Zeasorb Powder (Stiefel) and Dr. Scholl's foot granules in soap are
excellent for reducing some of this. Diaper
dermatitis, better known as diaper rash, is a sore, red rash
that appears on skin that is covered by a diaper. A type of irritant
contact dermatitis, diaper rashes are usually caused by prolonged contact
with moisture. In addition, the bacteria found in bowel movements react
with chemicals in urine and creates a build up of ammonia and other
chemicals that irritate the skin. There is no apparent link between diaper
rash and cloth or disposable diapers. The best
treatment for diaper rash is to keep the area as clean and dry as
possible. This requires frequent diaper changes. Gently cleanse the skin
after a bowel movement with a mild soap, rinse with warm water, and then
dry the skin completely. If the skin is cracked, you can apply a barrier
cream to protect the skin from moisture. It’s recommended that you let
the child’s skin get as much air as possible. You can do this by letting
the child nap without a diaper, placing a waterproof pad or open diaper
under his or her bottom to protect the bed from urine or bowel movements
while the child is sleeping. If you use cloth diapers, avoid plastic
pants, which do not allow airflow. It’s a good idea to use disposable
diapers at night because they pull the moisture away from the child’s
skin. With treatment, diaper rashes should begin to heal within three
days. Because a baby has a large ratio of skin to body weight, it is best
to avoid steroid creams, which are absorbed into the bloodstream through
the skin. Only use a steroid cream if recommended by your doctor for
severe cases of diaper rash. A yeast infection is treated with a special
antifungal cream. You can prevent
diaper rash by changing diapers frequently so the skin stays dry. Applying
a light layer of cornstarch may help to prevent diaper rash. Talcum powder
should not be used because it can be inhaled and cause respiratory
infections. If you wash your own cloth diapers, be sure to use bleach to
sterilize the diapers. Contact your doctor if a diaper rash does not
improve with treatment after several days. Contact
dermatitis can occur on any part of the body, but it usually affects the
hands, feet, and groin. Contact dermatitis usually does not spread from
one person to another, nor does it spread beyond the area exposed to the
irritant unless affected skin comes into contact with another part of the
body. However, in the case of some irritants, such as poison ivy, contact
dermatitis can be passed to another person or to another part of the body.
Contact
dermatitis can be prevented by avoiding the source of irritation. If the
irritant cannot be avoided completely, the patient should wear gloves and
other protective clothing whenever exposure is likely to occur.
Immediately washing the exposed area with soap and water can stem allergic
reactions to poison ivy, poison oak, or poison sumac, but because soaps
can dry the skin, patients susceptible to dermatitis should use them only
on the face, feet, genitals, and underarms. Clothing should
be loose fitting and 100% cotton. New clothing should be washed in
dye-free, unscented detergent before being worn. Irritant
contact dermatitis is produced by a substance that has a direct
toxic effect on the skin. After exposure to an irritant, a skin reaction
can occur immediately or gradually after repeated exposure. Examples of
common irritants include acids (certain toilet bowl and drain cleaners,
dishwasher detergents), alkalis (ammonia, lye), cement, turpentine, and
paint thinners. Itching
and burning are common in both categories of contact dermatitis. With
acute and mild exposure, there is typically redness, swelling, and oozing.
If left untreated, the condition can result in dry, thickened, cracked
skin. Irritant
contact dermatitis is often more painful than itchy, and is the
result of an offending agent that actually damages the skin with which it
comes into contact. The longer the skin is in contact—or the more
concentrated the agent—the more severe the reaction. Water with added
soaps and detergents is the most common cause. Thus, it is not surprising
that these reactions appear most often on the hands, and are frequently
work-related Individuals with other skin diseases, especially eczema,
are most susceptible. This is generally found in men who clean grease off their hands, using either methylated spirit or a detergent or trichloroethylene parts cleaner, in mechanics who use other strong primary irritant chemicals, and in housewives who use detergents. In this International Eczema-Psoriasis Foundation website, you will find information about eczema, psoriasis, dermatitis, seborrheic dermatitis, contact dermatitis, atopic dermatitis, perioral dermatitis, guttate psoriasis, their symptoms, causes and treatments. You will be able to distinguish between eczema and similar conditions such as contact dermatitis, atopic dermatitis, stasis dermatitis, seborrheic dermatitis, neurodermatitis, contact eczema, light sensitive eczema, juvenile plantar eczema, eczema craquele, eczema herpeticum, atopic eczema, infantile eczema, adult seborrheic eczema, varicose eczema, discoid eczema, dyshidrotic eczema, palmoplantar psoriasis, plaque psoriasis, guttate psoriasis, inverse psoriasis, erythrodermic psoriasis, pustular psoriasis, psoriatic arthritis, scalp & ear psoriasis, and nail psoriasis. Treatment, symptoms and medications used in the treatment of eczema, dermatitis, psoriasis and skin conditions that co-exist with dermatitis, such as adult acne, lupus, and rosacea will be presented. The informative text on eczema, dermatitis and psoriasis discusses treatment, causes, and lifestyle changes that help treat dermatitis, eczema, and psoriasis.Here are some other websites dealing with skin diseases: |