II. Pathophysiology

  1. Occurs in all members of population
    1. Elderly and very young more susceptible
    2. Great variations in individual susceptibility exists

III. Risk Factors

  1. Atopic Patients are more susceptible
  2. Filaggrin Mutation
    1. Results in keratinization disorder
  3. Nickel Hypersensitivity

IV. Causes

  1. Very potent irritants
    1. Wet cement
    2. Strong acids (e.g. Hydrofluoric Acid)
    3. Ethylene oxide
    4. Heavy Metals
  2. Common other topical causes
    1. Rubbing Alcohol
    2. Nail polish remover
    3. Propylene glycol
    4. Soaps
    5. Solvents
    6. Acids or vinegar
    7. Monistat
  3. Sports exposure related
    1. See Sport-related Contact Dermatitis

V. Symptoms

  1. Severe Pain or Burning (Early symptom)
  2. Moderate Pruritus (Late symptom)

VI. Signs

  1. Marked Erythema
  2. Sharply demarcated
  3. Xerosis
  4. Exposed skin affected
    1. Thin skin (e.g. Dorsum of hands as opposed to palms)
    2. Well demarcated area
  5. Numerous Pustules
    1. Contrast with Vesicle in Allergic Contact Dermatitis
  6. Hyperkeratosis or fissuring
    1. More common than in Allergic Contact Dermatitis
  7. Reaction delay after contact: minutes to hours

VII. Management

  1. Severe irritant exposure
    1. Remove contaminated clothing
    2. Continous and prolonged water irrigation of skin
    3. Do not neutralize acids with base or vice versa
      1. Results in increased damage due to heat reaction

VIII. Complications

  1. Skin necrosis
  2. Skin Ulceration

IX. Resources

  1. Haz-Map (Occupational Exposure Database)
    1. http://www.haz-map.com

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