Download - Irritant Contact Dermatitis 2
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DEFINITION
Derm/o skin
-itis inflamation
Irritant Contact Dermatitis (ICD)nonimmunologic inflammation of the skincaused by contact with a chemical, physical,or biologic agent
DERMATITIS
The conditionthat makesinflammation ofthe skin
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EPIDEMIOLOGY
Almost 90% skin disease in Indonesia iscontact dermatitis (ICD,ACD,Photo ContactDermatitis)
Up to 80% of contact dermatitis is irritant andis commonly related to occupation
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ETIOLOGY
ICD is a multifactorial disease Exogenous factors
Chemical properties of the irritant Characteristics of exposure
Environtmental factors Endogenous factors
Genetic factors Gender (women > men) Age (child and ealdery easier to irritation)
Ethnicity Skin site (differences in the thickness of the skin) Atopy hystory
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PATHOGENESIS
Four interrelated mechanisms have beenassociated with ICD:
1. Removal of surface lipids and water-holdingsubstances
2. Damage to cell membrane
3. Epidermal keratin denaturation
4. Direct cytotoxic effect
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SIGN AND SYMPTOMS
irritant reaction
acute ICD
delayed acute irritancy
chronic cumulative ICD subjective (symptomatic, sensory)
Nonerythematous
frictional dermatitis traumatic reaction
pustular or acneiform reaction
exsiccation eczematid.
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IRRITANT REACTION
Exposed to wet work
Acute monomorhic presentScaling
Low-grade erythemaVesicles
erosions
Location: dorsum of the hand and fingerCan resolve or progress to cummulative
irritant dermatitis
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Erythematous irritant reaction
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ACUTE ICD
Single skin exposure to a strong irritant or chemical(acids, alcalis)
Most cases consequence of accident at work
Occur immediately after exposure
Sensation of burning, itching, stinging Present with erythema, edema, vesiculation with
excudation, bullae formation, tissue necrosis (insevere cases)
Healing process: decrescendo phenomenon Complete healing in 4 weeks
Prognosis: good
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Dermatitis kontak akut pada pekerjaindustri bahan kimia
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DELAYED ACUTE IRRITANCY
Clinical manifestation same like acute ICD,appear in 8 to 24 hour after exposure
Ex: dermatitis venenata
Prognosis: good
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CHRONIC CUMULATIVE ICD
Most common Develops as a result of Repeated insult to the
skin
Chemical involve
multiple and weak Most common marginal irritant: soap, detergent,
organic solvent, oil Symptoms appear after days, months, or years
of exposure Clinical manifestation: itch, pain, few localized
patches of dry skin Erythema, hyperkeratosis, fissuring
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Dermatitis Kontak Iritan kronis dengan eksaserbasi akutpada ibu rumah tangga. Penderita menggunakanterpuntine untuk membersihkan tangan sesudahmengecat. Terdapat gambaran eritem, fissure dansquama
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Dermatitis kontak iritan pada pekerja bangunan yang bekerjadengan semen. Terdapat hyperkeratosis, squama, fissura danminimal pustule
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SUBJECTIVE (SYMPTOMATIC, SENSORY)
Itching, burning sensation within minutes ofcontact with irritant, without visible cutaneouschanges.
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NONERYTHEMATOUS
The irritation is not visually apparent,buthistological visible
Symptoms: burning, itching, stinging
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FRICTIONAL DERMATITIS
Result from repeated microtrauma andfriction
Usually leads to dry, hyperceratotic abradedskin
Nipple dermatitis with ill-fitting bras
Dermatitis from prosthetic limbs
Handling coarse paper , glass, and rock woolfiber
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TRAUMATIC REACTION
Develop after acute skin trauma as burn orlaceration
Commonly occurs on the hands
Symptoms same like nummular dermatitis
The healing process at least 6 weeks
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PUSTULAR OR ACNEIFORM REACTION
Seen after occupational exposure to oils,tars, heavy metals, halogen, but alsocosmetics
Pustular lesions: steril, transient
Seen among atopic and seborrheic patient
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EXSICCATION ECZEMATID
Occurs in elderly patient
Itching, dry skin
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DIAGNOSIS
major minor
subjective
Onset : after minutes, hours itching, stinging, burning
onset: after 2 weeks many people in the environment
affected similarly
objective
macula erythem, hyperceratosis,fissure glazed, parched, scalded of epidermis healing process promptly on withdrawalof exposure to the offending agentPatch test : (-)
morphologic changes suggesting smallconcentration differences or contact timeproduce large differences in skindamage
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DIFFERENTIAL DIAGNOSIS
ACD
Atopic Dermatitis
Tinea
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LABORATORY EXAMINATION
Patch test to exclude ACD
Gram staining to secondary infection
KOH exclude dermatomikosis
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TREATMENT
Identifications and elimination of the irritants
Emmolient improve barier repair in dry,lichenified skin
Topical corticosteroid antiinfalammation
Prolonged use of topical corticosteroidsleads to epidermal atrophy and increasedsusceptibility to irritants
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PROGNOSIS
Good if the causative irritant can be identifiedand eliminated
Cummulative and chronic irritant dermatitis
and atopic dermatitis hystory worse
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IDENTITY
Mr. S
65 yo
No MR: 760982
Ngampau Rt 04/04 Mojosongo, Jebres,Surakarta
Examine on March 24th 2012
Major ComplainCracks and peels on both hands
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7 years bfr entering
hospital
1 month bfr entering
hospital
Patient works as abricklayer and
complain the samesymptoms
Patient helps his child
to build a house, he
wasnt using gloves but
only a pair of boots,
Then he complain
about feeling ache, itch,
burn, and thickness on
both hands,
Symptoms were shown
after he mix the cement
without using gloves
Historical Report of Present Disease1 weeks bfr entering
hospital
Both hands are cracked
not long after that, then
its peeled
Patient was reffered
to the clinic of
dermatologist
moewardi hospital
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HISTORY OF PREVIOUS ILLNESS HISTORY OF FAMILY ILLNESS
Similar illness about 7 years ago
History of atopic : denied
History of allergy : denied History of DM/HT: (+)
History of cardiac illness: (+) 4years ago
History of prolong cough : denied
Occupation : bird cage craftsman
Drug allergy : denied
Food allergy : denied
Atopy : denied
DM/HT Histories: denied
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PHYSICAL EXAMINATION
Status Dermatologis - R. folar manus dextra et sinistra: eritem plaque
with hyperkeratosis, and squama.
- R. Dorsum manus dextra et sinistra:hipopigmentation plaque with squama andlichenification
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DIFFERENTIAL DIAGNOSIS
Dermatitis Kontak Iritan
Dermatitis Kontak Alergi
Working Diagnosis
Dermatitis Kontak Iritan
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TREATMENT
Non pharmacology
education to avoid irritating substance e.g.cement
Using self safety device e.g hand-gloves
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PHARMACOLOGY
Systemic:
Corticosteroid: metilprednisolon 16 mg/day(5 days)
Anti-histamin : cetirizine 1 x 10 mg
Topical:
Corticosteroid : Betametason cream 2 dd ueUrea cream 10% 2 dd ue
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PLANS
Patch test
Prognosis
Ad vitam :bonamAd sanam :bonamAd fungsionam :bonam
Ad Kosmetikum :bonam
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THANK YOU