Pathophysiologic Treatment Approach to Irritant Contact Dermatitis

Abstract

Irritant contact dermatitis (ICD) is a commonly occurring non-specific cutaneous inflammatory response to topical chemical, physiologic, and biologic toxins. Direct damage to the skin induces barrier dysfunction, epidermal cell stimulation, and pro-inflammatory mediator release leading to a visibly variable, itchy cutaneous reaction. Workplace exposure of the hands to water, cleansers, and solvents remains the most common source of ICD. There is no diagnostic test for ICD, as such a diagnosis is based on history and clinical findings. Exclusion of allergic contact dermatitis, atopic dermatitis, and other xerotic conditions is a key part of the work-up. Prevention and treatment of ICD lies in the utilization of barrier protectants, incorporation of hydrating cleansers to decrease disruption of the barrier, and avoidance protocols and protective gear (fabrics, gloves, etc.). Therapeutic tools to treat ICD include acute anti-pruritic and antibacterial soaks, cutaneous barrier protectants such as petrolatum, paraffin, and dimethicone; lipid-laden moisturizers rich in wool wax alcohols, ceramides, and cholesterol esters and colloidal oatmeal based creams; and, when there is an eczematous component, the restrained use of anti-inflammatory agents such as topical corticosteroids may be warranted. Future research in ICD pathophysiology will yield more precise treatment options for future patients and clinicians.