Irritant Contact Dermatitis

Key Points
Inflammation of the skin as a result of direct toxic insult by chemical irritants
Consists of scaly, red patches and plaques in the affected areas

Thickening and secondary infection is possible in longstanding affected areas

Irritant contact dermatitis is a common skin disorder due to direct chemical irritation of the skin, with resulting inflammation. This inflammation manifests as red, scaly patches of skin that Itch or burn. As opposed to allergic contact dermatitis, in which a person is allergic to the offending agent, likely via specific genetic tendencies in the immune system, any person can have irritant dermatitis. A wide range of chemicals with sufficient concentration or duration of exposures are capable of acting as cutaneous irritants. Common cutaneous irritants include soaps and detergents. For example, a common scenario would be a nurse or food handler that washes their hands 25-50 times during a shift at work. This frequency causes loss of essential fats and oils from the skin, which increases transepidermal water loss and renders the skin susceptible to injury.

Differential Diagnosis (Other conditions with similar appearance)
Atopic Dermatitis
Burns (chemical and thermal)
Dyshidrotic Eczema
Allergic contact Dermatitis
Tinea Infection (Ringworm)

Diagnosis
Key Points
Diagnosis based on skin appearance
Patch tests may be performed to rule out Allergic contact dermatitis
Skin biopsy may be used occasionally to confirm diagnosis

Irritant contact dermatitis is generally diagnosed based on appearance. Health care professionals may administer patch tests to rule out allergic contact dermatitis. There are no other tests available for this disorder.

Treatment
Discontinuing contact with the offending agent, once identified, is key
Avoiding common triggers is recommended
*Goal of treatment is to control and alleviate symptoms

OTC Options: Emollients/moisturizers

Once irritant contact dermatitis is diagnosed and the offending agent is identified, discontinuing contact with the element causing the reaction is the first and best treatment. After that, the use of moisturizers on the affected area is recommended.

In severe cases, health care professionals may prescribe oral antihistamines to control itching, and Topical steroids to control the rash itself. If the affected area is large, an oral steroid course may be prescribed.