II. Pathophysiology
- Occurs in all members of population
- Elderly and very young more susceptible
- Great variations in individual susceptibility exists
III. Risk Factors
- Atopic Patients are more susceptible
- Filaggrin Mutation
- Results in keratinization disorder
- Nickel hypersensitivity
IV. Causes
- Very potent irritants
- Wet cement
- Strong acids (e.g. Hydrofluoric acid)
- Ethylene oxide
- Heavy metals
- Common other topical causes
- Rubbing Alcohol
- Nail polish remover
- Propylene glycol
- Soaps
- Solvents
- Acids or vinegar
- Monistat
- Sports exposure related
V. Symptoms
- Severe Pain or Burning (Early symptom)
- Moderate Pruritus (Late symptom)
VI. Signs
- Marked Erythema
- Sharply demarcated
- Xerosis
- Exposed skin affected
- Thin skin (e.g. Dorsum of hands as opposed to palms)
- Well demarcated area
- Numerous Pustules
- Contrast with Vesicle in Allergic Contact Dermatitis
- Hyperkeratosis or fissuring
- More common than in Allergic Contact Dermatitis
- Reaction delay after contact: minutes to hours
VII. Management
- Severe irritant exposure
- Remove contaminated clothing
- Continous and prolonged water irrigation of skin
- Do not neutralize acids with base or vice versa
- Results in increased damage due to heat reaction
VIII. Complications
- Skin necrosis
- Skin Ulceration
IX. Resources
- Haz-Map (Occupational Exposure Database)
X. References
- Habif (1996) Clinical Dermatology, p. 82-84
- Bebko (2016) Am Fam Physician 93(12): 1000-6 [PubMed]
- Lushniak (2000) Prim Care 27(4):895-916 [PubMed]
- Peate (2002) Am Fam Physician 66(6):1025-40 [PubMed]