Allergic and non-allergic contact eczema – treatment and symptoms

Contact eczema is the most common form of eczema, characterized by skin lesions formed at the site of the action of irritating compounds on the skin or as a result of contact with an allergen with which the patient has been in contact earlier in his professional or everyday life. Due to the mechanism of changes, the following are distinguished: 1. non-allergic contact eczema, 2. allergic contact eczema.

Types of contact eczema

1. Allergic contact eczema (allergic contact dermatitis) (Figures 5.15 and 5.16). It is the most common form of eczema, characterized by superficial inflammatory changes in the skin resulting from contact with an allergen (IV immune mechanism – delayed response).

Frequency of appearance

Allergic contact dermatitis accounts for about 10% of inflammatory skin diseases diagnosed in dermatological clinics. Incidence in the entire population is estimated at 1-10%. Most cases of disease occur in the group of adults. In infants, it is almost absent. The incidence in both sexes is the same (according to some sources, it is dominant in women). In women, the hands are more often affected by lesions.

Figure 5.15. Allergic contact eczema

Figure 5.16. Allergic contact eczema

The causes of allergic contact eczema

The skin lesions are caused by the XNUMXth immunological mechanism, associated with hypersensitivity to small molecule compounds, referred to as haptens. In the first phase, the allergen is presented to the immune system. This triggers a specific immune response. This part of the reaction is called induction phase. The course of the immune response is influenced by:

1. allergen concentration,
2. chemical properties of the allergen,
3. allergen exposure time,
4. skin condition.

The stronger the sensitizing properties, the less important is the individual susceptibility of the patient. The time between the first contact with the allergen and the onset of skin lesions is called the incubation period. The short time is unfavorable, while the long time is indicative of a mild clinical course of skin lesions. The next phase is the disclosure phase, in which re-exposure, even to minimal amounts of the antigen, is capable of inducing a delayed hypersensitivity reaction. This reaction usually appears 24-48 hours after the ingress of the allergen. Often there is a secondary occurrence of hypersensitivity to multiple allergens after initial hypersensitivity to one allergen. More than 2000 chemical compounds that are contact allergens have been described.

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The most important contact allergens:

a. chrom – its main sources are: cement, leather, matches, ash, dyes for materials, water-based paints, oils. This allergy is more common in men;

b. nickel – imitation jewelery is one of the allergenic items. This allergy occurs especially in women. There may be skin changes in places distant from contact with the allergen, the so-called nickel ides;

c. cobalt – it is an allergen that can be found in decorations, buttons, sliders, door handles, and even in bathroom fittings. Hypersensitivity to nickel is often associated with allergy to chromium;

d. gum ingredients – they are present in vulcanization accelerators and in many objects of common use: tires, gloves and shoes;

e. barwniki – found in hair and eyelash dyes, furs, clothes, etc.

f. epoxy resins – they are included in adhesives used for household purposes, they come with gloves or glasses frames;

g. external medications – neomycin, gentamicin, chloramphenicol, Peruvian balm, bee putty;

h. cosmetics – essential oils, preservatives;

i. Agents used as bases for cosmetics – lanolin, eucerin. Industrial dermatitis tends to go into remission on non-working days when the patient is not in contact with allergens. A variation of eczema is kissing dermatitis. kiss eczema, when the patient is allergic to substances on the skin of a healthy person.

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Symptoms of allergic contact eczema

The course of the disease is characterized by involvement of the skin of the hands and fingers; the most severe inflammation is usually on the dorsal side of the hands. Skin changes are usually limited to the place of contact with allergenic objects. The most common locations of skin eruptions are:

1. hands,
2. arms,
3. face,
4. genital organs.

In the case of localization of lesions on the backs of the hands and around the wrists, rubber gloves may be an allergen; when skin lesions are located on the feet – shoes, and on the neck – perfume. Most often, volatile allergens affect the involvement of the eye sockets.

It is the primary bloom exudative papule and vesicle. Contact eczema, depending on the severity of inflammatory changes, may be acute or sub-acute.

In acute and subacute lesions there is intense erythema, a large number of papules and vesicles, exudative changes and erosions. Symptoms of lichenification dominate in chronic disease lesions. Skin lesions are usually not clearly demarcated from the environment, they disappear without leaving a trace. Often, the eruptions are accompanied by itching. In the case of acute eczema located in the area of ​​the eye sockets and genitals, edema and inflammatory symptoms predominate.

The duration of skin eruptions depends primarily on contact with the allergen. In some people, the skin lesions are observed for a short period (several weeks), while in others it may recur for many years. The course of contact eczema depends on the type of allergen, the time of its detection, the possibility of its avoidance and contact with other sensitizing or irritating stimuli.

Skin prone to allergies must be especially cared for. It is worth reaching for cosmetics with a soothing effect, eg HYDRA ESSENCE moisturizing gel-sorbet Moisturizing and protecting Sensilis. We also recommend Bioherba Raspberry Peeling Soap, which gently cleanses and smoothes sensitive skin with a tendency to allergic reactions.

How is allergic contact eczema diagnosed?

The basis for the diagnosis of contact eczema is the detection of an allergen. The diagnosis should always be confirmed with positive results patch tests. There is a pool of the most common 30 allergens. The tested chemicals are soaked in special flakes, which are then applied to the skin of the patient’s back, and then done after 24 and another 72 hours. It is also important to evaluate any irritation reactions that may occur, however, this reaction is not evident in the second control.

Contact allergic eczema – treatment

In the treatment of contact eczema, it is important to select a topical preparation and its form depends on the clinical stage of eczema. In the case of acute eczema (oozing changes and swelling predominate) it should be used preparations with anti-swelling and disinfecting properties in the form of solutions, e.g. compresses with 3% boric acid, baths in a weak solution of potassium permanganate.

In turn, in the case of chronic eczema with the presence of hyperkeratosis and lichenification, it should be used exfoliating agents. For this purpose, 5-10% of salicylic acid on a paraffin base or urea in a concentration of 5-10% on a base of lipophilic cream or ointment is most often used.

W topical treatment they are the means of choice corticosteroid preparationswhich cause vasoconstriction, have anti-inflammatory and anti-proliferative properties. In the case of lichenization, corticosteroids in ointments and less in cream penetrate the skin. Drugs with a strong and very strong effect are indicated in the first phase of treatment of severe, active eczema lesions.

In turn, in general treatment the basic preparations are antihistamines which have a beneficial antipruritic effect. In more severe cases, corticosteroids are generally used: starting with 30-40 mg of prednisolone daily, then – every 7 days – the dose is reduced by 5 mg. Systemic antibiotics should be considered in the event of severe bacterial superinfection. Irradiation with UVB and PUVA rays is also used in the treatment.

2. Non-allergic contact eczema (irritation contact eczema) (Figure 5.17). It is a primary inflammatory skin reaction that results from exposure to exogenous irritants. The incidence of this type of eczema is much greater than that of allergic contact dermatitis, and skin lesions can occur in anyone exposed to the irritant. Non-allergic contact eczema is most common in the population of young women. It is much more common in children than in adults. An example in infants is diaper rash.

Exposure to irritants is possible both at work and at home. Professionals such as:

1. hairdresser,
2. male nurse,
3. Cook,
4. mechanics.

In some cases, it coexists with allergic contact eczema, e.g. when patients with irritable contact eczema become secondary allergic to external medications.

Figure 5.17. Contact dermatitis. Nickel allergy in the place where the nickel-plated button on the trousers adjoins.

Non-allergic contact eczema – causes

Non-allergic skin changes occur in a non-specific way, as a result of irritating substances, which does not require preliminary sensitization. Eczema changes can occur in every human being, and their occurrence depends on the duration of action, the concentration of a given irritating factor, as well as individual predispositions.

Due to the strength of action, the following are distinguished:

1. strong (absolute) irritants,
2. mild (relative) irritants.

Attention! An example of the most severe toxic reaction is tissue necrosis, which occurs within minutes of exposure to concentrated acids or bases. The mechanism of action is mainly based on the coagulation of skin proteins and tissue dehydration.

Mild irritants cause changes typical of eczema, usually after prolonged, sometimes several years of contact with these compounds. The most common irritants include:

1. water
2. soaps,
3. detergents,
4. oils and solvents,
5. citrus peel,
6. flower bulbs,
7. onions,
8. Garlic,
9. pineapple,
10. geranium,
11. tars,
12. Potassium permanganate,
13. gentian violet,
14. mercury compounds.

The exogenous factors influencing the course of the toxic reaction include: type of irritant, amount of irritating substance penetrating the skin, area of ​​the body exposed to contact with the irritant, body temperature, mechanical and climatic factors (dry air, cold wind). The endogenous factors include: individual susceptibility to the action of an irritating factor, skin sensitivity, racial factors, susceptibility to UV radiation and age.

An important predisposition factor is the history of atopic dermatitis. The non-specific reduction of the threshold of sensitivity to physical and chemical stimuli, called the ectodermal defect, is emphasized. A variety more common in infants, the so-called diaper dermatitis occurs as a result of hygienic negligence when changing diapers is not frequent enough. In atopic children, the foci of this form of eczema may develop into lesions of the type of atopic dermatitis with a less characteristic location.

Non-allergic contact eczema – symptoms

Skin changes in the course of non-allergic contact eczema are limited to the place of contact with the irritating factor. Eczema appears most often where the wedding ring is worn. Symptoms are pale to dark red erythema, which may be accompanied by the appearance of erosions, scabs, blisters and urticarial eruptions. The efflorescence is asymmetrical and clearly delimited. Depending on the severity of the reaction, itching, burning and pain may occur.

Diagnosis of non-allergic contact eczema

Histopathological examination shows spongiform degeneration with intra-epidermal vesicles and blisters within the epidermis. In more advanced cases, epidermal necrosis occurs. In addition, there are perivascular infiltrates within the dermis. Differentiate non-allergic contact eczema with the following conditions:

1. allergic dermatitis,
2. atopic dermatitis,
3. neurodermit,
4. psoriasis,
5. dermatomyositis,
6. systemic lupus erythematosus.

How to treat non-allergic contact eczema?

When treating ailments, avoid contact with water and other irritants. Systemic glucocorticoid therapy is not as effective as for allergic contact dermatitis. Typically, local treatment is implemented analogous to allergic dermatitis.

What’s the prognosis?

The disease may be chronic and recurrent. Typically, nonallergic contact eczema develops flare-ups, usually improving over the weekend or vacation. When it is impossible to avoid the effects of a harmful factor, the symptoms persist. In rare cases, allergic dermatitis may develop.

Long-term complications resulting from non-allergic contact eczema include post-inflammatory hypo- and hyperpigmentation.

LITERATURE:

1. Braun-Falco O., Plewig G., Wolff HH, Burgdorf WHC: Dermatology, eds. half. Gliński W., Wolska H., Wydawnictwo Czelej, Lublin 2004.

2. Jabłońska S., Chorzelski T .: Skin diseases, PZWL, Warsaw 2002.

3. du Vivier A .: Atlas of clinical dermatology, ed. half. Majewski S., Elsevier Urban & Partner, Wrocław 2005.

Source: Dermatology Doctor’s Guide,

4. Langner A. (ed.): Contemporary treatment of selected skin diseases, OIN Polfa, Warsaw 2002.

5. Błaszczyk-Kostanecka M., Wolska H. (eds.): Dermatology in practice, PZWL, Warsaw 2005.

6. Gliński W., Rudzki E .: Allergology for dermatologists, Czelej Publishing House, Lublin 2002.

Czelej Publishing House