Symptoms
Irritant contact dermatitis is a common inflammatory condition of the skin. It often occurs on the hands and manifests in the following possible signs and symptoms:
- Redness
- Swellings
- Dry skin
- Scaling, often between the fingers
- Itching, burning, pain, tightness, tingling.
- Increased sensitivity, for example, to alcohol in disinfectants.
- Skin thickening
- Painful tears
- Crusts
- Erosions
- Vesiculation, blisters (rare, especially in allergic contact dermatitis).
Causes
The cause of the disease is an overload of the skin by physical and chemical stimuli. Although an acute course is possible, for example, after contact with a corrosive chemical. However, chronic irritant contact dermatitis is far more common. In this case, the skin is repeatedly exposed to mildly irritating substances such as water, soaps, disinfectants, solvents, acids and bases. The protective layer of the skin is lost and the irritants penetrate deeper, causing the symptoms mentioned above through tissue damage and non-specific activation of the immune system. It is an occupational disease – for example, hairdressers, housewives, nurses, industrial workers, health professionals, cooks, fishermen, bakers and cleaners are affected. In addition to environmental factors, individual susceptibility also plays a crucial role (e.g., atopy, sweating, age).
Diagnosis
The diagnosis is made in dermatological treatment. Numerous other diseases with a similar appearance must be excluded. Allergic contact dermatitis manifests itself in similar complaints, but occurs less frequently and is additionally manifested in hypersensitivity to one or more allergens, which can be determined with an epicutaneous test.
Nonpharmacologic treatment
- Whenever possible, avoid direct contact with irritating substances.
- Wear gloves at work (no latex). Caution: the occlusion can also aggravate the symptoms. Some sources recommend wearing additional cotton gloves under the gloves, which absorb sweat.
- Apply a protective cream before work and a hand cream after work. Use mild soaps.
- Do not scratch, cut nails short.
- During time off from work and weekends, the discomfort usually goes away on its own.
- Disinfectants used should be re-lubricating. Alcohols (propanol, ethanol and derivatives) are usually well tolerated by the skin, non-allergenic and a component of most hand disinfectants. They only burn if the skin is already injured. Aldehydes and quaternary amines, for example, benzalkonium chloride and chlorhexidine should be avoided.
- Training of employees, building a corresponding infrastructure, work organization.
- Get medical treatment at an early stage.
- Do not wash hands too often and wash only when they are also dirty. Otherwise, only disinfect.
- The eczema may also recede on its own as part of a “hardening”.
Drug treatment
Basic therapy with replenishing and drug-free preparations should be carried out. For drug treatment, the anti-inflammatory, immunosuppressive and antiproliferative glucocorticoids are mainly used. They are applied locally. Because of the possible adverse effects, the duration of treatment should not be too long. In alternative medicine, cardiosperm ointments are used as a cortisone alternative. Keratolytics such as salicylic acid and urea can dissolve the horny layer thickening and make the skin more supple. In a severe and chronic course, phototherapy, retinoids such as alitretinoin, topical calcineurin inhibitors, and systemic immunosuppressants such as ciclosporin, azathioprine, and glucocorticoids are also used. One problem with these is the potential adverse effects. Other options: Dexpanthenol creams and ointments (Bepanthen, generics), alternative medicine, antipruritic agents, tanning agents, almond oil ointments, medicated baths.
