Dermatology - Irritant contact dermatitis (ICD)

Dermatology - Irritant contact dermatitis (ICD)
ICD is a result of chemical irritants and can happen after either a one-time or repeated exposure. It is influenced by the concentration of the irritants and happens once the exposure beyond a specific threshold.
Allergic contact dermatitis, on the other hand, relies on the process of sensitization. ICD is primarily occupational, although exposure can potentially occur in any setting. The predominant agents include abrasives, cleaning compounds, oxidizing agents, reducing agents, plant and animal enzymes, desiccants, dust, soil, and excessive water.


The symptoms of ICD manifest in the specific area of the body that has been exposed, resulting in a sensation of burning, stinging, and itching that can start between seconds to hours after the exposure. Short-term exposure to severe irritants can lead to a reaction, but most cases are caused by long-term cumulative exposure.
Abnormalities
The observed erythema and superficial edema have distinct boundaries and do not extend beyond their current location, indicating exposure.
In severe situations, vesicles and blisters may develop and progress to erosions or complete necrosis.
The lesion's pattern frequently exhibits an irregular or linear nature, resembling an external influence, which corresponds to the contact pattern. The duration of lesions in acute ICD ranges from a few days to a few weeks. Chronic ICD is characterized by persistent redness, itching, and burning, which result in prolonged rubbing and the development of thickened skin with scales, indistinct borders, and lichenification that can last for months to years.

The diagnosis is determined by the patient's medical history and a thorough clinical examination. Allergic contact dermatitis is the primary differential diagnosis of utmost significance. The differential diagnosis for skin conditions on the palms and soles includes palmoplantar psoriasis and photoallergic contact dermatitis in areas that are exposed to sunlight.

Determine and eliminate the causative agent, followed by the application of moist dressings soaked in Burow's solution, to be changed at intervals of 2-3 hours. Empty the bigger vesicles, while leaving the caps intact. Counsel patients on the use of preventive measures such as the use of protective clothes, barrier creams, and considering a change in occupation to minimize exposure.
Manage lesions by applying topical glucocorticoids such as betamethasone dipropionate or clobetasol propionate. Additionally, ensure sufficient lubrication, which should be sustained throughout the healing process while progressively reducing the use of glucocorticoids.