Irritant Contact Dermatitis

Definition

DKI is an inflammatory skin reaction nonimunologik, where damage occurs directly without any prior skin sensitization process. Irritant contact dermatitis (DKI) is an inflammation of the skin which manifests as erythema, mild edema and cracked. DKI is a non-specific response against chemical damage direct skin that release inflammatory mediators, mostly from epidermal cells.

Etiology

Causes of irritant contact dermatitis are materials that are irritants, such as solvents, detergents, lubricating oils, acids alkalis, sawdust, abrasive materials, enzymes, oils, concentrated salt solution, low molecular weight plastic or hygroscopic chemicals. Skin disorder that appears depends on several factors, including factors of the irritant itself, environmental factors and individual patient factors.

Pathogenesis

Skin disorders arising from cell damage caused by chemical irritants through work or physical. Irritants damage the stratum corneum, keratin denaturation, get rid of the fat layer of horn and change the water holding capacity of skin. Mostly irritants (toxin) damage the fatty membrane of keratinocytes but some can penetrate cell membranes and damage the lysosomes, mitochondria or complement the core. Kerisakan membrane activate phospholipase and release of arachidonic acid (AA), diasilgliserida (DAG), platelet actifating factor (PAF) and inositida (IP3). AA is converted to prostaglandin (PG) and leukotrienes (LT). PG and LT induces vasodilatation, increased vascular permeability and thus facilitate the transudation of complement and kinin. PG and LT also act as a strong kemoatraktan for lymphocytes and neutrophils, and activated cells release histamine mas, LT and other PG, and PAF, thereby strengthening the vascular changes.
Second messengers DAG and other mengstimulasi gene expression and protein synthesis, such as interleukin-1 (IL-1) and granulocyt-macrophage colony stimulating factor (GMCSF). IL-1 activates T-helper cells release IL-2 receptor expressing an IL-2 that cause autocrine stimulation and cell proliferation.

 Clinical
A detailed history is needed because the diagnosis of Capital depend on a history of cutaneous irritant exposure on places on the body. Patch tests are also used in cases of severe or persistent to get rid of ACD. Primary subjective symptoms usually include the following:
Adequate history of exposure to skin irritants Onset of symptoms appear within a few minutes to several hours in acute Establishments. In subacute ICD is a hallmark of certain irritants such as benzalkonium chloride (on disinfektak) which brought an inflammatory reaction 8-24 hours after exposure. Onset and the symptoms can be delayed several weeks in Jakarta cumulative. Pain, burning, stinging or uncomfortable feeling in the early phase. Other subjective symptoms include: onset within 2 weeks of exposure and the same complaint adalanya coworkers or other family members. Establishments occupational usually occur on new employees or those who have not learned to protect skin from irritants. Individuals with atopic dermatitis (especially of the hands) were exposed to ICD hand.

Diagnosis

Diagnosis is based ICD thorough anamnesis and clinical observations. Establishments acute easier to detect, because the emergence of faster, so people generally still remember what the cause. Instead Establishments arising chronic slow and have a wide variety of clinical picture, so it is sometimes difficult to distinguish from ACD. This is necessary to patch test with the suspected material.

Management

Treatment efforts are most important irritant contact dermatitis is to avoid exposure to irritants, whether they are mechanical, physical or chemical factors that aggravate and get rid of. When can be done perfectly and without complications, it is not necessary and adequate topical treatment with a moisturizer for dry skin repair.
When it is necessary to overcome the inflammation can be given topical corticosteroids. Use of the adequate protection needed for those who work with irritants as a preventive effort.

a.Acute dermatitis
For acute dermatitis, compresses locally administered physiological saline solution or potassium permanganas 1/10.000 for 2-3 days and after drying was given a cream containing hydrocortisone 1 to 2.5%.
Systemically administered antihistamines (CTM 3x1 tablet.hari) to relieve itching. If the weight / area can be given prednisone 30 mg / day and if there are corrections made tapering. If there is a secondary infrksi antibiotics administered at a dose of 3x500 mg for 5-7 days.
b.Dermatitis chronic
Given topical steroid ointment containing hydrocortisone is more potent as an experienced Fluorination like desoksimetason, diflokortolon. Systemically administered antihistamines (CTM 3x1 tablet.hari) to relieve itching.

Complication The ICD complications are as follows:
Capital increases the risk of sensitization to topical treatment
Skin lesions may develop secondary infections, especially by Staphylococcal aureus
Secondary neurodermatitis (lichen simplex chronic) can occur terutapa in workers exposed to irritants at work or with psychological stress
Hipopignemtasi post inflammatory hyperpigmentation or in areas exposed to Establishments
Scarring appears on exposure to corrosive materials, ekskoriasi or artifacts.

Prognosis
Good prognosis in non-atopic individuals where Establishments diagnosed and treated properly. Individuals with atopic dermatitis are prone to Jakarta. When irritants can not be ruled out completely, the prognosis is not good, where the condition is often the case that the cause is multifactorial chronic Establishments.

Posted in: Skin