The primary therapeutic practice for any form of contact dermatitis, whether
allergic or irritant, is the avoidance of exposure to the causative
agent. Only when this approach fails, the secondary options involving
the treatment of symptoms become applicable.
The secondary options for irritant contact dermatitis are mainly established
treatment with corticosteroids and phototherapy. However, before we go
into their details we will discuss the irritant contact dermatitis prevention
strategies.
Avoidance can be achieved in two ways; prevention at home and prevention
in the workplace.
Prevention at home
It should involve the following steps:
- Detection of irritant agents and their suitable replacement
- The
implementation of alternative mechanisms to decrease encounter with
the irritants
- Safeguard with personal shielding tools such as gloves,
specialized garments and added protection with ointments, emollients
or creams
- Proper personal hygiene and care
- Regular participation in instructive
programs about domestic irritants
- Regular health screening
Prevention at workplace
The work-related strategies that should be followed are:
- Technical prevention with effective shielding and personal protection
of the employees
- Restricting the use of strong irritants to closed
or mechanized practices
- Precautionary skin care at the workplace
includes use of shielding creams to normal skin, elimination of irritant
elements by gentle
cleansing and
improvement of barrier activity by application of emollients or
moisturizers. However, the effectiveness of barrier creams over
ordinary emollients
is unclear
- Regular instructive prevention programs at the workplace
can effectively check the spread of the disease, its aggravation and
development
of chronic forms. For instance, in Finland some workers with
occupational hand dermatitis
attended an eczema clinic organized by a trained nurse. These
workers showed significant improvement in conditions compared
to those who
did not attend the clinic.
The second line of therapy involves a symptomatic treatment aimed at
restoring normal skin barrier functions. However, the best drug for the
treatment either of allergic or irritant contact dermatitis is not yet
a reality. Despite the progress in its diagnosis with patch testing (for
over 100 years) and hence the accurate finding of causative agents, there
is still no medication that can be topically applied, is surely effective,
user-friendly and with negligible side effects. However, several therapeutic
means are used, though they are not fully effective for everyone:
Corticosteroids
Research results about the effectiveness of corticosteroids in the treatment
of irritant contact dermatitis remain highly inconsistent. A certain research
study (Levin and others) reported the failure of corticosteroids in curing
surfactant-triggered irritant dermatitis.
In this research, six healthy individuals were subjected to an open application
of 10% sodium lauryl sulfate (SLS) fives times in a day on the hands in
order to trigger irritant contact dermatitis. The open employment was
preferred to the regular closed patch tests, as they have proved to be
more accurate in replicating the real-life occurrence of the disease.
Once irritant contact dermatitis was induced, therapy began with mild
(hydrocortisone 1%) and moderate (0.1% betamethasone-17-valerate) strength
steroids with petrolatum as the medium of application. Five days layer,
there was no major difference noticed (on the basis of factors used
to analyze comparative reaction) among corticosteroids administered
and untreated skin.
Most research results about that the clinical relevance of corticosteroid
therapy in irritant contact dermatitis patients have been inconclusive.
Topical corticosteroids have shown contradictory results; while systemic
corticosteroids are of some help in acute cases they have been a total
failure in chronic irritant contact dermatitis. It probably requires further
research with new procedures and offending substances to come up with
results that are more consistent.
Phototherapy
Photochemotherapy (PUVA) and superficial radiation (Grenz ray) can be
the second line of therapy in irritant contact dermatitis if other methods
fail. Ultraviolet rays work as immunosuppressive functions that have proved
beneficial in certain types of allergic contact dermatitis and irritant
contact dermatitis. Oral psoralen photochemotherapy (PUVA) and shortwave
ultraviolet light (UVB) have proved successful in the treatment of chronic
allergic and irritant contact dermatitis of the hands. The combined use
of systemic retinoids may also be helpful in patients with acitretin hyperkeratotic
palmoplantar dermatitis from frictional or chronic irritant contact dermatitis.
Biologic agents
New brands of drugs that have anti-inflammatory properties have been
the latest development in the treatment of contact dermatitis. They work
by acting upon a chemical signal produced by immune cells called tumor
necrosis factor alpha (TNF-alpha). In fact, TNF-alpha has been identified
as the protein produced by cells with a vital role in promoting an inflammatory
response in irritant contact dermatitis and allergic contact dermatitis.
Antibodies to this protein reduce the skin inflammation characteristic
to both irritant contact dermatitis and allergic contact dermatitis. Contact
allergens and irritants such as tributylin (TBT), initrochlorobenzene,
and oxazolone have proved to trigger TNF-alpha synthesis.
Another new development has been phosphodiesterase inhibitors (PDE-4),
which has been suggested to have topical, non-steroidal, anti-inflammatory
action in patients with contact dermatitis. Studies have shown that PDE-4
does have exercise restrain on TNF-alpha and other proteins associated
with irritant contact dermatitis. However, though cipamfylline proved
effective in atopic dermatitis, it failed so far as irritant contact dermatitis
was concerned.
