dermatitis is most common in adult females and thus has the name
" housewife eczema". Due to increased occurrence of such
types of dermatitis in children especially young females who are
assigned as house helpers, this type of eczema is included briefly in
perspiration combines together on the skin surface forming a
protective film (Acid Mantle), which renders the skin less
vulnerable to damage and attack by environmental factors (e.g.
bacteria, wind and sun) and less liable to hydration. Hydration of
the epidermis has an important role on the skin condition.
Most detergents are
alkaline, but even at neutral pH (7); they remove the surface lipid
film and the water-holding substances in the horny layer as well as
the vital lipids from the semi-permeable membrane of stratum
corneum. They denature protein and damage the cell membranes.
Water is hypotonic
and acts as a cytotoxic agent on eroded skin. If suitable solvents,
including detergents, have removed the surface lipid layer, water
may dissolve the hygroscopic substances needed to keep the skin
Lime, magnesium and
iron from hard water deposited on the skin fissures may cause
mechanical irritation. Irritation of the skin may arise from poorly
controlled chlorination or bromination of swimming pools .
sapoonify the surface lipids and dissolve water-holding substances,
break the cross linkages of keratin and cause swelling of cells.
Soap, soda, ammonia, potassium and sodium hydroxides, chalk, sodium
silicate may cause allergic contact eczema .
It should be noted
that soda ash (anhydrous sodium carbonate) is three times stronger
than washing soda.
and waterless cleansers containing organic solvents are common skin
sensitizes. They raise the pH and dissolve lipids. Added silica or
sand tends to skin damage by mechanical abrasion.
Hand cleansing may
be more harmful to the skin.
Aromatics in the
solvents in ‘waterless cleansers‘ are particularly hazardous.
surface-active agents, sulphonated oils, wetting agents, and
emulsifiers are used for domestic skin cleansing.
contain detergents, perborates, phosphates, topical bleaches and
perfume. Some also have added soap and to prevent precipitation of
calcium soap chelating agents are used . The irritant effect is
different and that depends on the chemistry of the detergent.
ammonium compounds have an irritant effect, causing superficial
cracks in dry skin.
Fig. 187. Detergent dermatitis
Fig. 188. Chronic contact dermatitis
Fig. 189. Chronic contact dermatitis
plastic or metal types which are used in cleaning the kitchen
utensils , may have an effect on skin eczematization.
vegetables such as tomato, onion, garlic, orange, lemon peel and
juice may cause skin sensetization.
Plastic gloves used
routinely in the kitchen or by the medical staff have an important
effect on skin sensitization due to occlusion of the skin surface
and to the effect of their plastic contents.
dermatitis is of the delayed type. The first contact of skin with a
certain sensitizer may have no effect, but with repeated exposure.
contact sensitivity manifests.
affects the skin exposed to the offending detergent. Erythematous
localized lesions appear. Papules, vesicles and oozing may devolop
accompanied by itching.
Chronic Eczema: the
skin is dry, thick and fissured. Lichenifecation is the main feature
of chronic contact dermatitis.
In the early stage,
the eczematous reaction is localized to the area in contact with the
detergent, but later the eczematous reaction may spread to affect
other parts of the skin not exposed to contact with the sensitizer.
affected by detergents are the hands and due to that,it has been
given the name
"housewife eczema" .
Patch test: may
detect the different sensitizers.
The most important
line of treatment is to prevent contact of the sensitizer to the skin. All types of
treatment will be waste of time and money if this is not fulfilled.
The eczematous reaction may improve termporarily on using topical
and systemic medications, but recurrence of the eczematous reaction
is the rule when there is re-exposure to the sensitizer.
cannot afford to stop using detergents causing dermatitis will not abide by all
the advices to keep away from using them. She will continue to wash
, clean, and do her duties towards her family. A simple and
effective compromise can be planned. Special types of gloves can be
recommended, one is cotton and the other one is plastic (Allerderm).
The cotton one is worn first to protect the hands from the plastic glove,
whereas the latter is used to protect the cotton gloves from being
moist and eliminate any hazardous effect of detergents. Ordinary
plastic gloves, and even lined gloves are not allowed.
If such gloves are
not available similar ones can be easily prepared. A piece of cotton
cloth can be put under the hand and fingers and the borders are
marked by a pencil.
Two pieces of cloth
are knitted together to prepare cotton glove to be used under the
ordinary kitchen gloves . This is very important and should not by
any way to be neglected or overlooked..
physician should instruct and insist for the use of such protective
gloves . This advice may be more effective than the prescription
given to the patient.
It should be noted
that the eczematized skin becomes more sensitive, so that
vegetables, orange, lemon juice, garlic and onion juice may act as a
primary irritant and should be avoided. This is why that,‘
patients with detergent dermatitis are instructed to use the cotton
and plastic gloves when local exposure to these foodstuffs is
The same as that
applied for other types of eczema.
Gilje 0. Allergic contact dermatitis from a dishwashing liquid
containing laurel ether sulphate. Acta DermVenereol 1973; 53:
Lewis J, El Alami A. Possible adverse reactions to an
enzyme-containing washing powder. Contact Derm 1985;13: 175-9.
Bandmann H-J, Calnan CD et al. The role of contact allergy in hand
eczema. Trans St John‘s Hosp Derm Soc 1970; 56: 19-25.
Nursing and Management of Skin Diseases 4th edn. London, Faber
& Faber, 1977.
Nickel dermatitis. Br J Dermatol 1956; 60: 229-36.
OB, Moller H. Nickel allergy and hand eczema. Contact Derm 1975;
Clinical prediction of patch test results. Trans St John‘s Hosp
Derm Soc 1972; 58: 153-62.
Edman B. Sites
of contact dermatitis in relationship to particular allergens.
Contact Derm 1985; 13: 129-35.
Metal dermatitis - some questions and answers. Cutis 1977; 19:
156, 158, 164, 165 and 169.
Occupational dermatitis in a 10-year material. Contact Derm 1975;
Contact dermatitis in the West of Scotland. Contact Derm 1977; 3:
Brandrup F, Thestrup-Pedersen K et al. Patch test reactivity to
nickel alloys. Contact Derm 1987; 16: 255-9.
Intradermal testing in doubtful cases of contact allergy to
metals. Contact Derm 1989; 20: 120-3.