Irritant Contact Dermatitis

Recommendations

Identify and Treat the Cause
1 Take a careful history and determine exposure to irritating chemicals in patients with suspected irritant contact dermatitis. Level of Evidence
Not Assessed


Address Patient-centered Concerns
2 Provide information and advice on prevention and treatment options. Level of Evidence
Not Assessed


Provide Local Care
3 Prevent development of irritant contact dermatitis by identifying and managing risk factors in incontinent patients, ostomates, and patients with chronic wounds. Level of Evidence
Not Assessed
4 Prevent further exposure to irritant. Level of Evidence
Not Assessed
5 Treat affected skin to reduce inflammation and restore barrier function Level of Evidence
Not Assessed


Provide Organizational Support
6 Facilitate healthcare professionals to gain relevant knowledge and skills to offer appropriate advice and information. Level of Evidence
Not Assessed


Background

Skin contact with irritating chemicals causes acute inflammation, disrupts the natural skin barrier and causes irritant contact dermatitis. Inflammation is usually evident within a few hours and peaks within 24 hours. Brief contact with strong irritants may produce blisters whereas prolonged low-level exposure to milder irritants may cause redness and small lesions.

The irritant properties of a compound are associated with its chemical properties, amount and concentration of the compound, and the length and frequency of exposure. The region of the affected skin also plays a role, as skin thickness varies. Skin trauma, including cuts, abrasions and exposure to friction, may increase irritation. Environmental factors, such as heat and humidity, may also play a role.

Excreted bodily fluids are a common cause of irritant contact dermatitis, especially among patients with chronic wounds, ostomates, and incontinent individuals. Fecal material contains hundreds of organisms, many of which produce contact irritants. Wound exudate contains various enzymes that may damage normal periwound skin. Urinary incontinence is associated with elevated skin pH and barrier function impairment, which then allows skin breakdown and incontinent dermatitis to occur. When both urinary and fecal incontinence are present, the alkaline urine reactivates digestive enzymes, significantly increasing the risk of skin breakdown and bacterial infection. Many chemicals routinely used in the home and workplace are also associated with irritant contact dermatitis.

Management relies on protecting skin from further exposure using skin barriers and protectants, reducing inflammation and restoring skin integrity. Prevention relies on thoroughly assessing patients with risk factors for skin breakdown, developing and implementing an individualized skin care strategy, and reassessing and modifying the approach as necessary.

References

Essential Publications
1 Irritant dermatitis Quality Indicator
 Type:
Wakashin K. Sanatary napkin contact dermatitis of the vulva: Location-dependent differences in skin surface conditions may play a role in negative patch test results. Journal of Dermatology 2007;34:834-837.
This recent case series describes six Japanese patients who developed irritant dermatitis when wearing sanitary napkins, but had negative results when a patch test was applied to the flexor side of their arms. The author makes the point that the wet conditions and friction caused irritant dermatitis of the genital skin that has thinner stratum corneum than the arm. This study may have implications for patients wearing protection for wet conditions created by incontinence.


Enablers for practice

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