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Management of Contact Dermititis

Updated on July 3, 2017

Introduction

Contact dermatitis is a skin inflammation which happens when one has contact with a particular substance. The main causes of the condition include allergens which are systems which makes the immune to react in a way that impacts the skin and irritants which refers to substances that damages the outer layer of the skin. However, irritants are the most common causes, contributing to 8 out of 10 causes. In this paper, the author explains the pathophysiology and epidemiology of contact dermatitis alongside the diagnosis, clinical management and follow-up of the condition. The paper also discusses the impact of the culture on clinical care and management of the specific condition.

Pathophysiology and Epidemiology of Contact Dermatitis

Contact dermatitis is the outcome of sufficient inflammation which emanates when proinflammatory cytokines are released from the skin cells which are normally identified as keratinocytes. The release of keratinocytes occurs as a response to the chemical stimuli. Contact dermititis has three essential pathophysiological changes which include the release of cytokine, cellular changes that are epidermal in nature and the disruption of the skin barrier (Menne et al, 2011).

The period of exposure and level of concentration triggers some chemicals, solvents and microtrauma to behave as irritants. Draelos (2012) established that frequent hand washing was highly associated with hand determatitis among workers based at the intensive care. In the same way, the study also noted that contact dermatitis resulted from consistent skin exposure to frequent use of low level cutaneous irritants which includes water, soap, and detergents. Frequent skin irritation makes the skin to be vulnerable to sensitization by topical agents. Further, this irritation which could be due to allergenic or nonallergic compounds stirs maturation and migration of Langerhans cell. Circumstances that may lead to heightening of contact dermatitis include but not limited to rubber gloves, medications and topical creams.

Contact dermatitis pathogenesis involves dermal fibroblasts, endothelial cells, epidermal and different types of leukocytes which interact with one another under the control of lipid mediators and a network of cytokines. Keratinocytes has a critical role in perpetuating and initiating reactions that causes skin inflammation by responding to cytokines. Consequently, resting keratinocutes generates some form of cytokines (Menne et al, 2011).

Diagnosis, Management, and Follow-up of Contact Dermititis

Contact dermatitis and its related symptoms have an adverse impact on the quality of life, relationships and day to day activities. On the other hand, there is very poor long term prognosis particularly when workplace exposures are not addressed accordingly. In most cases, the case is dealt with dermatologists, GPs, and physicians who are mandated with managing workplace issues when occupational health services are not availed (College of Physicians, 2011).

When a patient presents himself/herself with the clinical features of contact dermatitis. The physician is required to take an occupational history of the patient. Among the questions they should be asked for include the kind of job they do, the materials they use in such a job, the state of their relationships at the work place, and where they are affected. A full diagnosis should involve taking of prick tests and patch tests in a clinic that specializes in contact dermatitis (Johansen et al, 2011).

For this condition, a physician is mandated to make proper diagnosis, educate the caregivers and initiate treatment plans to alleviate the untreated rash. Established symptoms should be treated with soap substitutes, topic steroids and emollients. Further, patients should be advised against risks of exposure to irritants as well as agents that sensitize these agents. In light of these, patients should be counseled to use gloves to protect their skin, avoid excessive exposure to irritants, utilize emollients during and after work and using soap substitutes Royal (College of Physicians, 2011).

The Impact of Culture on Care of Patients with Contact Dermatitis

Some patients, especially the elderly do have the notion that the doctor “knows the best” and, hence will be in charge of the situation (Coutts, 2005). This means that they do not take an active role in matters pertaining to their care as, well as in managing their health condition. This may pose as a challenge to physicians since effective management of the condition entails a direct involvement of the patients in decision making and care programs.

Conclusion

Contact dermatitis is a condition that occurs as a result of too much exposure and contact with skin irritants. These irritants may include dichromates, chromates, chromic acid or external agents that are common in the workplaces such as friction or heat. Clinicians and physicians ought to be aware on how to manage the condition, as well as advise the patients on the best way of managing the condition. Communication between the stakeholders, which is patients, physicians and caregivers, is important for effective care pathway.

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