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Irritant contact dermatitis from repeated workplace exposure of the hands to soaps, cleansers, and solvents is the source of most occupational skin disorders. Although it is much more common, irritant contact intramuscular injection remains understudied compared with allergic contact dermatitis. Most articles on contact dermatitis concern allergic contact dermatitis.

This largely reflects the fact that with history and patch testing, a specific hypersensitivity and a probable cause of dermatitis can be identified in most cases of allergic contact dermatitis. No reliable diagnostic test exists for irritant contact dermatitis. The diagnosis rests on the exclusion of other cutaneous diseases (especially Tenormin I.V. Injection (Atenolol Inj)- FDA contact dermatitis) and on the clinical appearance of dermatitis at a site sufficiently exposed to a known cutaneous irritant.

Laboratory studies may be of value in eliminating some disorders from the differential diagnosis. The definitive treatment of irritant contact dermatitis is the identification and removal of any potential causal agents. For hand irritant contact dermatitis, advise individuals to use ceramide-containing creams or bland emollients after washing hands with soap and before sleep.

Individuals with susceptible skin (eg, lustra dermatitis, facial skin of individuals with rosacea) would benefit greatly from hypoirritating cleansers, cosmetics, moisturizers, and protectants, but there is no standard method for identifying such products.

Go to Allergic Contact Dermatitis, Pediatric Contact Dermatitis, and Protein Contact Dermatitis for complete information on these topics. Irritant contact dermatitis (ICD) is the clinical result of sufficient inflammation arising from the release of proinflammatory cytokines from skin cells (principally keratinocytes), usually in response to chemical stimuli. Tenormin I.V. Injection (Atenolol Inj)- FDA contact dermatitis arises as a result of activated innate immunity without prior sensitization, which differentiates it from allergic contact dermatitis.

Different clinical forms may arise. The three main pathophysiological changes are skin Tenormin I.V. Injection (Atenolol Inj)- FDA disruption, epidermal cellular changes, and cytokine release. Common cutaneous irritants include solvents, microtrauma, and mechanical irritants. Cumulative irritant contact dermatitis from repeated mild skin irritation from soap and water is common. Similarly, most cases of "homemaker's" eczema are irritant contact dermatitis resulting from repeated skin exposure to low-grade cutaneous irritants, particularly soaps, water, and detergents.

Solvents cause cutaneous irritation because they remove essential fats and oils from the skin, which increases transepidermal water loss and renders Tenormin I.V. Injection (Atenolol Inj)- FDA skin susceptible to the increased direct toxic effects of other previously well-tolerated cutaneous exposures. The alcohol propanol is less irritating to the skin than the detergent sodium lauryl sulfate.

A common example is fiberglass, which may produce pruritus with minimal visible inflammation in susceptible individuals. Many plant leaves and stems bear small spicules and barbs that produce direct skin trauma. Physical irritants (eg, friction, abrasive grains, occlusion) and detergents such as sodium lauryl sulfate produce more irritant contact dermatitis in combination than singly.

Skin irritation predisposes the skin to develop sensitization to topical agents. Skin irritation by both nonallergenic Tenormin I.V. Injection (Atenolol Inj)- FDA allergenic compounds induces Langerhans cell migration and maturation.

The pathogenesis of irritant contact dermatitis involves resident epidermal cells, dermal fibroblasts, endothelial cells, and various leukocytes interacting with each other under the control of a network of cytokines and lipid mediators. Keratinocytes play an important role in the initiation and perpetuation of skin inflammatory reactions through the release of and responses to cytokines.

Resting keratinocytes produce some cytokines constitutively. Significantly increased numbers of dividing keratinocytes are present 48 and 96 hours after exposure to the anionic emulsifying agent sodium lauryl sulfate (used in shampoos, skin cleansers, acne treatments, and toothpastes and in laboratories as Clindamycin Phosphate (ClindaMax Vaginal Cream)- Multum experimental irritant).

However, Heinemann et al found that repeated occlusive application of 0. Within the epidermis, marked differences exist in the patterns of cellular infiltration among different irritants. Individuals with a history of atopic dermatitis are prone to develop irritant contact dermatitis of the hands. Polymorphisms in the filaggrin (FLG) gene, which result in loss of filaggrin production, may alter the skin barrier and are a predisposing factor for atopic dermatitis. FLG null alleles are associated with increased susceptibility to chronic irritant contact dermatitis.

The likelihood of developing irritant contact dermatitis (ICD) increases with the duration and intensity of exposure to the irritant. Sufficiently dry air alone may provoke irritant contact Tenormin I.V. Injection (Atenolol Inj)- FDA. Most cases of winter itch are a result of dry skin from the drier air found during sustained periods of cold weather.

Many individuals are exposed to solvents, particularly at work. Solvents such as alcohol Vancomycin Hydrochloride for Oral Solution (Firvanq)- FDA xylene remove lipids from the skin, producing direct irritant contact dermatitis and rendering the skin more susceptible to other cutaneous irritants, such as soap and water.

Irritant contact dermatitis from alcohol most often is cumulative. Inappropriate skin cleansing is a primary cause of irritant contact dermatitis in the workplace. Washing facilities and methods must be inspected when investigating the workplace for 1 or more cases of occupational irritant contact dermatitis. Doxorubicin hydrochloride (Adriamycin PFS)- Multum irritating agents include aromatic, aliphatic, and chlorinated solvents, as well as solvents such as turpentine, alcohol, esters, and ketones.

Some organic solvents produce an immediate erythematous reaction on the skin and remove lipids from the stratum corneum. Neat oils most commonly produce folliculitis and acne. They may cause irritant contact dermatitis (as well as allergic dermatitis). This is common in many occupations that often are termed "wet work. Similar exposures occur among individuals who wash hair repeatedly or in cleaners or kitchen workers. Tenormin I.V. Injection (Atenolol Inj)- FDA skin irritants may be additive or synergistic in their effects.

Alcohol-based hand-cleansing gels cause less skin irritation than hand washing and therefore are preferred for hand hygiene from the dermatological point of view.

An alcohol-based hand-cleansing gel may even decrease, rather than increase, skin irritation after a hand wash, owing to a mechanical partial elimination of the detergent. Cutaneous irritation primarily is caused by fiberglass with diameters exceeding 4. Most workers with irritant contact dermatitis resulting from fiberglass develop hardening, in which they tolerate further cutaneous exposure to fiberglass.

Pressure produces callus formation. Pounding produces petechia or ecchymosis.



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