Definition

Irritant contact dermatitis is an inflammatory skin condition brought on by direct touch with skin-irritating substances. Skin cells secrete molecules that cause inflammation in response to an irritant or trigger, which causes symptoms.

This is not an allergic reaction; it can be either chronic (long-term) or acute (short-term). Cleaners, detergents, soaps, and acids are common irritants.

Causes

Almost all ingredients can irritate the skin if exposure is long or frequent enough and the irritant content is high enough. Environmental factors can increase the effects of some irritants.

Dry air and temperature changes

Dry air makes the skin more prone to skin irritation. Most cases of winter itch are a result of the dry winter air. An increase in temperature can also increase the effects of skin irritation.

Water

Continuous exposure to water can lead to maceration or repeated evaporation of water from the skin and cause irritation due to the drying of the skin.

Solvents

Many patients have DKI due to exposure to solvents, especially in the workplace. Solvents such as alcohol or xylene remove the skin's fatty layer, triggering direct irritant contact dermatitis and making the skin more susceptible to other irritants, such as soap and water. Irritant contact dermatitis from alcohol is mostly cumulative or the effects increase with duration and frequency of exposure. 

Improper skin cleansing is a major cause of irritant contact dermatitis in the workplace. Workers who use their hands generally do not wash them properly, using solvents to remove oil, grease, paint, or other materials. Thus, they often experience irritant contact dermatitis. 

Irritants include aromatic, aliphatic, and chlorinated solvents such as turpentine, alcohols, esters, and ketones. Some organic solvents produce an immediate reddening reaction on the skin and remove fat from the upper layers. 

Metalworking fluids

Neat oil lubricants most commonly cause acne, folliculitis, or hair sac infections. They can also cause irritant contact dermatitis. Water-based metalworking fluids often cause irritant contact dermatitis because they contain surfactants.

Cumulative irritant contact dermatitis

DKI occurs due to continuous exposure to irritants. This is common in jobs that require frequent contact with chemicals. For example, health workers must wash their hands 20-40 times daily. Similar exposure also occurs in people who wash their hair repeatedly and in cleaners or kitchen workers.

Mechanical trauma

Pressure causes callus or fish eye formation. The impact can produce petechiae and ecchymosis, which is bleeding under the skin or bruising. Trauma or sudden friction causes blisters on the skin. Repeated rubbing or scratching will make the skin hard and rough. Sweat and friction are the main causes of dermatitis in children who use shin guards when playing soccer. 

Rubber gloves

Some rubber gloves can trigger skin irritation directly. Many workers have complained of irritation from the powder on rubber gloves. Gloves with holes expose irritants to the skin, increasing the risk of irritation. The condition of the skin covered by the gloves increases the irritating effect. Kerosene and ethylene oxide in medical materials for surgery can also cause similar skin changes, especially on covered skin.

Sodium lauryl sulfate

This chemical is found in some external medications, especially acne medications, and various soaps and shampoos.

Hydrofluoric acid

Hydrofluoric acid burns are a medical emergency. Symptoms may develop late after acute exposure (this is very important for diagnosis). Unfortunately, hydrofluoric acid burns are most common on the fingers, where the pain is most severe and treatment is most difficult. 

Alkaline or basic substances

Skin surfaces normally have an acidic pH. Alkaline conditions, for example, when exposed to a lot of soap, can cause more irritation than acidic conditions. The "acid mantle" on the top layer of the skin serves as a protective barrier and defense against germs. Skin cleansing agents, especially synthetic detergents with a pH of around 5.5, can help prevent skin diseases.

Risk factor

Healthcare professionals, metalworkers, construction workers, beauticians and hairdressers, auto mechanics, and agricultural workers are among the occupations and pastimes that may increase your chance of acquiring irritating contact dermatitis.

Symptoms

Contact dermatitis usually occurs in areas of the body that are directly exposed to irritant substances. The rash usually appears minutes to hours after exposure and may last 2-4 weeks. Signs and symptoms of contact dermatitis include:

• Red rash
• Itching, which can become severe
• Dry, cracked, scaly skin
• Bumps
• Blisters, sometimes with oozing and crusting
• Swelling
• Burning or stinging sensation
• Pressure pain

Sometime after exposure or in acute conditions, there will be redness and mild swelling, and the skin will look scaly. Meanwhile, chronic DKI is characterized by lichenification or thickened, hard, and rough skin. Small cracks can also appear on the skin until ulcers appear.

Hands are the most common location for irritant contact dermatitis. Irritant contact dermatitis due to repeated exposure to soaps, sanitizers, and solvents is the cause of most occupational skin disorders.

Diagnosis 

The doctor diagnoses by conducting a medical interview, reviewing the patient's medical history, assessing their exposure to irritants, and examining their skin.

The doctor may recommend patch testing in severe or persistent cases, where the cause of the rash is unclear, or to rule out allergic contact dermatitis.

Management

The definitive treatment for irritant contact dermatitis is to identify the causative irritant and avoid or eliminate exposure to it. Here are some treatment options. 

Lifestyle changes and home remedies

To help reduce itching and soothe inflamed skin, try these simple treatments:

• Avoid irritants. The key is to know what irritant is causing the skin symptoms.
• Apply anti-itch cream or lotion. Over-the-counter creams containing 1% hydrocortisone may temporarily relieve itching. Steroid ointments can be applied once or twice a day for 2-4 weeks. Or you can also try calamine lotion
• Take anti-itch medication. Over-the-counter corticosteroids and oral antihistamines (taken by mouth) may help if the itching worsens.
• Cold compresses. Wet a soft washcloth and place it on the inflamed skin to soothe the skin for 15-30 minutes. Repeat several times a day
• Avoid scratching. Cut your nails. If you can't resist scratching, cover the itchy area with a gauze pad or shield.
• Protect your hands. Rinse and dry your hands well and gently after washing. Use moisturizer throughout the day and choose gloves that do not contain irritants
• People with vulnerable skin, for example, in atopic dermatitis or facial rosacea, should use cleansers, cosmetics, moisturizers or protectants that are mildly irritant

If home treatments do not relieve the signs and symptoms, your doctor may prescribe medication, such as:

• Stronger steroid creams or ointments help calm the rash of contact dermatitis. Topical steroids (external medication) may be applied once or twice a day for 2-4 weeks.
• Oral medications. In severe cases, your doctor may prescribe oral corticosteroids to reduce inflammation, antihistamines to relieve itching, or antibiotics to fight bacterial infection.

Complications

Inflamed skin can harbor germs, including Staphylococcus aureus bacteria. This complication occurs especially if you repeatedly scratch the affected area and it becomes wet and oozes fluid. This condition creates a good place for bacteria or fungi to grow and can lead to infection.

Secondary neurodermatitis or chronic lichen simplex may appear in irritant contact dermatitis patients, especially those exposed at work or under psychological stress. Neurodermatitis is a long-term, relapsing inflammation of the skin. 

Hyperpigmentation (dark patches) or hypopigmentation (patches lighter than the skin color) post-inflammation may occur in the affected area or persist after DKI heals in people with more pigmented skin.

Scarring may occur due to exposure to corrosive substances, skin breakdown, or injury to the skin. Irritant contact dermatitis increases the risk of sensitization to topical medications.

Prevention

Common precautions to avoid contact dermatitis are:

• Stay away from irritants. Try to identify the irritants that cause contact dermatitis and avoid them.
• After coming into contact with the irritant, wash the skin immediately. Use warm water and a mild soap that is devoid of dyes and smells. Then, give it a good rinsing. It is also recommended that clothing and other items that might have come into contact with the irritant be cleaned.
• Put on gloves or other protective gear. Wearing a face mask, goggles, gloves, and other protective gear can shield you from irritants, such as household cleaners.
• Apply moisturizer. Regular moisturizing lotion can help maintain soft, healthy skin, and lessen irritation by restoring the outermost layer of the skin.

When to see a doctor? 

Consult a doctor if:

• The rash becomes blisters
• The rash and other skin symptoms recur
• Persistent itching
• The rash is so uncomfortable that you lose sleep or interfere with daily activities
• The rash is suddenly painful, severe, or widespread
• The rash does not go away within a week of treatment
• The rash affects the face or genitals

Seek immediate medical care in the following situations: 

• You suspect an infection of the skin, indicated by fever, redness, swelling, warmth, or pus oozing from blisters
• An irritant damages the mucus lining in the mouth and digestive tract

If you experience any of these signs or symptoms, seeking medical attention for further evaluation, an accurate diagnosis, and appropriate management is important.

Looking for more information about other diseases, Click here!