Contact dermatitis is an inflammatory reaction of the skin that occurs in response to direct exposure to irritating substances (alkalis, acids, detergents, solvents, bleach, etc.). The symptoms of the disease depend on the strength and nature of the exposure. This may be redness of the skin, dryness and cracks, swelling, blistering or ulceration covered with scab. Diagnosis and its differentiation from other dermatitis is based on the identification of the association of the occurrence of the disease with the exposure of the affected area of the chemical substance to the skin. Treatment consists in eliminating the causal factor, topical application of glucocorticoids, anti-inflammatory, healing and antibacterial agents.
Along with contact dermatitis, the group of contact dermatitis includes allergic contact dermatitis. However, it is less common in dermatological practice. Disease is a reaction to the direct impact of an irritant and occurs at the first contact with it. The allergic variant of contact dermatitis is caused by an allergic reaction of a delayed type and develops with repeated exposure to an allergen.
Clinical dermatology distinguishes acute and chronic forms of disease. Depending on the nature of the substance affecting the skin and the individual characteristics of the permeability of the epidermis, one of three variants of acute contact dermatitis may develop: erythematous, bullous or necrotic.
Erythematous dermatitis is manifested by redness and swelling of the skin area in contact with the irritant. Soreness and itching are weakly expressed. Possible dryness of the skin and the appearance of cracks on it. The bullous variant of contact dermatitis is represented by bubbles of various sizes filled with a transparent liquid. Bubbles appear on a hyperemic background and burst with the formation of erosions. It is characterized by soreness, a feeling of heat or burning.
Necrotic dermatitis occurs when exposed to caustic substances and is characterized by the formation of ulceration, the surface of which is covered with a scab. Pain syndrome is pronounced. After the ulcers heal, scars remain on the skin.
The chronic form of contact dermatitis develops with repeated exposure to a weak stimulus. The skin of the hands is most often affected. The disease is usually associated with the use of household chemicals or professional activities. Chronic dermatitis is characterized by increased skin pattern, congestive hyperemia, infiltration, dry skin and hyperkeratosis. In some cases, atrophic processes in the skin are observed. Subjective sensations are weakly expressed and do not bother the patient much.
The diagnosis of contact dermatitis is established by a dermatologist according to the characteristic clinical manifestations and a clearly traceable connection between the occurrence of symptoms and the effect of an irritant on the skin. If you suspect an allergic nature of contact dermatitis, you need to consult an allergist and conduct skin allergy tests. The appearance of signs of purulent inflammation indicates the infection of the lesion site and is an indication for the bacposev of the discharge with the mandatory preparation of an antibioticogram.
Histological examination of the affected skin sample reveals blisters containing clusters of neutrophils inside the upper layers of the epidermis. In chronic contact dermatitis, acanthosis, hyperkeratosis, expansion and elongation of the dermal papillae are observed.
Contact dermatitis treatment
The main principle of treatment is to determine and eliminate the cause of contact dermatitis. Erythematous dermatitis usually does not require treatment and passes on its own when the causal factor is eliminated. To reduce the symptoms of inflammation, it is possible to use anti-inflammatory powders or creams. In the bullous variant, large bubbles are punctured without removing their tires. To prevent secondary infection, lubricate the area of the bubbles with a solution of potassium permanganate or aniline dyes. In the treatment of necrotic dermatitis, healing ointments are used.
In severe cases of acute contact dermatitis, local application of glucocorticoid ointments and systemic administration of small doses of corticosteroids is possible. The addition of a secondary infection is an indication for antibiotic therapy. In case of chronic dermatitis, regular use of emollient ointments and creams is recommended, in case of hand damage, the use of protective gloves is recommended.