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Skin care: dermatitis (irritant contact dermatitis) SKIN CARE: DERMATITIS (IRRITANT CONTACT DERMATITIS)
Dermatitis is a pattern of skin inflammation which may follow contact with an injurious substance or may develop without any apparent external cause.
The recognition of skin disorders is essentially a visual art. It requires experience to distinguish what is dermatitis or eczema from what is not; disorders that might be confused with dermatitis or eczemh include such conditions as diffuse skin malignancies, known as reticuloses, or infections either fungal or parasitic.
Dermatitis which develops in response to contact with a foreign, but not necessarily a newly-contacted, substance is called Contact Dermatitis. There are two broad types: the irritant, and the allergic.
Irritant contact dermatitis is an inflammatory response of the skin to certain irritants provided that the concentration and duration of exposure are sufficient. It is not an allergic reaction but rather a direct chemical one. Some people are able to with' stand high concentrations of primary irritants, while others react to low concentrations of the same substances. Predisposing factors include age. skin dryness, trauma, dampness, infection and whether you are prone to atopic eczema or not. When a strong irritant such as an acid or alkali is applied to the skin it may produce an acute irritant dermatitis, and the diagnosis is seldom in doubt.
More important is the dermatitis resulting from repeated exposure to weaker irritants, and this may be more difficult to recognize. Primary irritant eczema of this kind is caused and perpetuated by a variety of factors, some of which may break down the barrier properties of the skin, while others inflict damage on the vulnerable skin once this has happened.
The areas most likely to be affected are those most exposed to daily irritation—the hands and forearms. The commonest form of the condition is seen in housewives' hands, and is called ‘Housewives’ dermatitis (or 'dishpan hands'). It is suffered by about 1 per cent of women, particularly mothers with young children. The winter months, when the temperature is lower and the circulation poorer, are the worst for this condition. The humidity is also lower in the winter, allowing the skin to dry, lose its elasticity and crack. Repeated wetting and drying alters the natural defences of the outermost layers of the skin, so that substances commonly encountered in household work penetrate the skin more easily and cause irritation. These include household soaps, detergents, foods (particularly citrus fruit, potatoes, and tomatoes), household chemicals, polishes and soil. Of course any pre-existing skin problem or abrasion, as well as bacteria or fungal infections, may also play a role. In addition, 40-50 per cent of women with housewives' dermatitis will show a positive patch test to at least one of a battery of common allergens.
Although the setting in which housewives' dermatitis occurs is complex, a woman can do many things to prevent or minimize the problem. These include washing hands as seldom as possible and, if wet work is unavoidable, wearing cotton gloves under rubber ones, or plastic gloves with cotton lining. Tasks which require the wearing of gloves include such things as cutting up meat and vegetables, peeling fruit and potatoes, bathing the baby, and shampooing hair. Whenever the hands are hot, they must be well dried, and a good hand-cream immediately applied each and every time. Special attention should be given to the area of skin under a person's rings, as this is a common and persistent source of trouble, not from allergy to the rings but from trapped noxious substances.
Primary irritant hand eczema is also seen in manual workers, particularly those who work with oils or some of the many chemicals which are now used in industry. One of the more important aspects of industrial medicine is the provision of adequate protection for workers from the harmful effects of Such substances. Irritant dermatitis is also seen on children's feet, particularly in winter, and may be aggravated by the cold or by wearing nylon socks and rubber footwear.
No test has been devised to confirm the diagnosis of irritant contact dermatitis, since patch testing will produce a positive reaction in most people if the concentration and duration of application is appropriate. The diagnosis is made on a knowledge of the irritant potential of the substances contacted, on the patient's history and on the clinical appearance of the disorder.
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