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  Atopic eczema, irritant dermatitis and contact dermatitis
 
 
 

TREATMENT OF IRRITANT CONTACT DERMATITIS

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.