Irritant contact dermatitis with synonyms toxic, traumiterative or housewife’s eczema and non-allergic contact dermatitis is the most common variant with a point prevalence of 1-2 % in the healthy population. Localized almost exclusively to the hands it occurs most frequently in ‘wet work’ occupations such as hairdressers, health care personnel, cleaners, cooks and caterers.
Contactants are detergents and surfactants, acid and alkaline solutions, organic solvents, sometimes even water. The deleterious effect of these agents is the removal of the fat emulsion on the skin surface, a damage to the function of the epidermal skin barrier, and a removal of the water- binding substances of the horny layer. A single exposure is usually harmless but by repetition can be destructive. The damage can be documented by an increased epidermal water loss.
The clinical consequences are desiccation, scaling and fissuring, progressing to eczematous dermatitis. Promoting factors for the development of this type of contact dermatitis are individual, such as the presence of an atopic constitution, thickness of the horny layer, a previously damaged skin barrier etc, physicochemical, such as type of contact with the agent, concentration and pH of the offending material, solubility of the substance etc, and environmental, such as room temperature and humidity.
Testing for Irritant contact dermatitis
Diagnostic tests have not been developed, and a biopsy for histopathology is not contributary. The diagnosis is clinical, often by exclusion. A frequent complication is contact allergy. The best therapy is prohylaxis, i.e. avoidance of harmful contacts including a change of living pattern, and frequent use of moisturising creams. The healing period is often protracted.