Irritant Contact Dermatitis Workup

  • Author: Daniel J Hogan, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 3, 2011
 

Approach Considerations

No diagnostic test exists for irritant contact dermatitis. The diagnosis rests on the exclusion of other cutaneous diseases (especially allergic contact dermatitis) and on the clinical appearance of dermatitis at a site sufficiently exposed to a known cutaneous irritant. Laboratory studies are generally of little value in proving a diagnosis of contact dermatitis. However, they may be of value in eliminating some disorders from the differential diagnosis.

Findings of significantly elevated serum immunoglobulin E occasionally are useful to substantiate an atopic diathesis in the absence of a personal or family history of atopy.

Go to Allergic Contact Dermatitis, Pediatric Contact Dermatitis, and Protein Contact Dermatitis for complete information on these topics.

Next

Bacterial and Fungal Studies

A bacterial culture can be obtained in cases complicated by secondary bacterial infection. A potassium hydroxide (KOH) examination of scrapings may be performed and samples for mycology may be obtained to exclude superficial tinea infections or candidal infections, depending on site and morphology of lesions.

Previous
Next

Patch Testing

Patch testing can be performed to diagnose contact allergies, but no patch test exists that proves that a cutaneous irritant is responsible for a particular case of irritant contact dermatitis. Diagnosis rests on exclusion of allergic contact dermatitis and history of sufficient exposure to a cutaneous irritant. Also see the following summaries of clinical guidelines from the Joint Council of Allergy, Asthma and Immunology:

Previous
Next

Skin Biopsy

Skin biopsy can help exclude other disorders, such as tinea, psoriasis, or cutaneous T-cell lymphoma. All clinical cases of dermatitis are similar histologically.

Skin biopsy of skin lesions of the palms and soles has several potential pitfalls. The stratum corneum and epidermis are particularly thick there, which makes the histologic diagnosis of psoriasis more difficult and increases the possibility that the specimen lacks sufficient dermis for optimal diagnosis. In the thenar area, an overly deep biopsy can cut the recurrent branch of the median nerve. A biopsy from the sole may leave a chronic painful scar on which the patient must walk. A saucerized shave biopsy is usually the most suitable method.

Previous
Next

Direct Microscopy

Skin scrapings of cutaneous lesions may help exclude scabies or may reveal fiberglass fibers as a cause of a patient's pruritus.

Previous
Next

Histologic Findings

The histopathology of acute experimental irritant contact dermatitis has been studied to a greater extent than chronic irritant contact dermatitis, which is the primary clinical complaint. Cellular changes seen in the skin vary according to the chemical nature and concentration of the irritant applied, duration of exposure, severity of ensuing response, and time of sampling for acute irritant contact dermatitis. Many primary irritants cause overt necrosis if applied in a sufficiently high concentration for sufficient time.

Most histologic examinations of irritant contact dermatitis reveal some degree of intercellular edema or spongiosis in the epidermis. Spongiosis usually is less pronounced than that seen in allergic contact dermatitis reactions.

Parakeratosis also is observed widely in irritant contact dermatitis reactions.

The histology of chronic irritant contact dermatitis is one of hyperkeratosis with areas of parakeratosis, moderate-to-marked epidermal hyperplasia (acanthosis), and elongation of the rete ridges.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Watkins SA, Maibach HI. The hardening phenomenon in irritant contact dermatitis: an interpretative update. Contact Dermatitis. Mar 2009;60(3):123-30. [Medline].

  2. Fluhr JW, Akengin A, Bornkessel A, Fuchs S, Praessler J, Norgauer J, et al. Additive impairment of the barrier function by mechanical irritation, occlusion and sodium lauryl sulphate in vivo. Br J Dermatol. Jul 2005;153(1):125-31. [Medline].

  3. Jacobs JJ, Lehé CL, Hasegawa H, Elliott GR, Das PK. Skin irritants and contact sensitizers induce Langerhans cell migration and maturation at irritant concentration. Exp Dermatol. Jun 2006;15(6):432-40. [Medline].

  4. Heinemann C, Paschold C, Fluhr J, Wigger-Alberti W, Schliemann-Willers S, Farwanah H, et al. Induction of a hardening phenomenon by repeated application of SLS: analysis of lipid changes in the stratum corneum. Acta Derm Venereol. 2005;85(4):290-5. [Medline].

  5. de Jongh CM, Khrenova L, Verberk MM, Calkoen F, van Dijk FJ, Voss H, et al. Loss-of-function polymorphisms in the filaggrin gene are associated with an increased susceptibility to chronic irritant contact dermatitis: a case-control study. Br J Dermatol. Sep 2008;159(3):621-7. [Medline].

  6. Kartono F, Maibach HI. Irritants in combination with a synergistic or additive effect on the skin response: an overview of tandem irritation studies. Contact Dermatitis. Jun 2006;54(6):303-12. [Medline].

  7. Löffler H, Kampf G, Schmermund D, Maibach HI. How irritant is alcohol?. Br J Dermatol. Jul 2007;157(1):74-81. [Medline].

  8. Weston WL, Morelli JG. Dermatitis under soccer shin guards: allergy or contact irritant reaction?. Pediatr Dermatol. Jan-Feb 2006;23(1):19-20. [Medline].

  9. Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006;19(6):296-302. [Medline].

  10. Forrester BG, Roth VS. Hand dermatitis in intensive care units. J Occup Environ Med. Oct 1998;40(10):881-5. [Medline].

  11. Cvetkovski RS, Rothman KJ, Olsen J, Mathiesen B, Iversen L, Johansen JD, et al. Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol. Jan 2005;152(1):93-8. [Medline].

  12. Dickel H, Kuss O, Schmidt A, Kretz J, Diepgen TL. Importance of irritant contact dermatitis in occupational skin disease. Am J Clin Dermatol. 2002;3(4):283-9. [Medline].

  13. Mangion SM, Beulke SH, Braitberg G. Hydrofluoric acid burn from a household rust remover. Med J Aust. Sep 3 2001;175(5):270-1. [Medline].

  14. Slotosch CM, Kampf G, Löffler H. Effects of disinfectants and detergents on skin irritation. Contact Dermatitis. Oct 2007;57(4):235-41. [Medline].

  15. Rietschel RL, Fowler JF Jr. Fisher's Contact Dermatitis. 4th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1995.

  16. Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Part 1. National Guideline Clearinghouse. Mar 2008;[Full Text].

  17. Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Part 2. National Guideline Clearinghouse. Mar 2008;[Full Text].

  18. Lakshmi C, Srinivas CR, Anand CV, Mathew AC. Irritancy ranking of 31 cleansers in the Indian market in a 24-h patch test. Int J Cosmet Sci. Aug 2008;30(4):277-83. [Medline].

  19. American Academy of Allergy, Asthma and Immunology. Contact dermatitis: a practice parameter. Ann Allergy Asthma Immunol. Sep 2006;97(3 Suppl 2):S1-38. [Medline].

  20. Levin C, Zhai H, Bashir S, Chew AL, Anigbogu A, Stern R, et al. Efficacy of corticosteroids in acute experimental irritant contact dermatitis?. Skin Res Technol. Nov 2001;7(4):214-8. [Medline].

  21. Fuchs M, Schliemann-Willers S, Heinemann C, Elsner P. Tacrolimus enhances irritation in a 5-day human irritancy in vivo model. Contact Dermatitis. May 2002;46(5):290-4. [Medline].

 
Previous
Next
 
Chronic irritant contact dermatitis of the hands in an older worker; the condition resulted in early retirement.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.