CHAPTER 26

 
Irritant and contact dermatitis is more common in the adult age. Although some types of irritants seem to be only used by the adult children nowadays may also share the adults in certain jobs. It is estimated that two hundred and fifty million children in the world are working illegally in different industries and perform the different works of adults. We are faced in our practice with children having contact dermatitis from cement, diesel,

detergents and many other types. This is why such chapters are included. 

    Fig.195.a,b,c,d."The youngest welder"!!! : 10 years old child misused as a metal welder without even the minimal protective safety measures !!.

Different and numerous irritants are available everywhere which have the ability to cause irritant and contact dermatitis. Some of such sensitizers are:

Cutting oils, used as coolants in metal work, , water, emulsifiers, antioxidants, anti-corrosive agents and preservatives. These being aqueous emulsions, have the ability to dry the skin. After repeated exposure the oil tends to be more irritant.

Spindle and lubricating oils replace the normal lipids of the horny layer. Oils, particularly if mixed with metal particles, stick to the skin and tempt the worker to use harmful cleansers. Some oils induce eczematous reaction , acne and follicular hyperkeratosis.

These remove the lipid film and water-holding substances and damage cell membranes. Their irritating capacity depends on their chemical structure. These include aliphatic petroleum solvents such as white spirit.

Other organic solvents include the following: aromatic hydrocarbons such as benzene, toluene and aromatic petroleum solvents; chlorinated hydrocarbons such as trichloroethylene, perchloroethylene, ethylene chloride and chlorobenzene and alcohol .

Thinner is commonly a mixture of alcohol, ketones and esters that is  used in many industrial processes including cleaning textiles and metals, the graphics industries, floor laying (where glue is used), wood-finishing, dyeing, painting and as a solvent.

Organic peroxides such as benzoyl peroxide and cyclohexanone peroxide are used in hardening polyester resins. Some are used in hair bleaching and some for bleaching textiles, oils and flour. They are strong cytotoxic agents and may cause unusual urticarial reactions .

Sodium hypochlorite (bleach) is used for cleaning, by printers and dyers to remove staining from: their hands. Its cytotoxicity makes its medical use like (Eusol) unsuitable to clean wounds and ulcers, which may act as skin sensitizes .

Ethylene oxide is used as a sterilizing agent and may remain on instruments or rubber articles.

The most common sensitizing products are textiles, fur and hair dyes. Such sensitization may sometimes be occupational .

                                                                                                                                                Fig.195 Contact dermatitis

                                                          (This type is usually due to direct contact with shoes, slippers, plastic or carpets)

   (Effective active treatment should be directed to prevent contact of the feet with such factors. Cotton socks should be used even when the child is at home. Without this precaution recurrence of contact dermatitis is usually the rule)

The organic dyes are also present in cosmetics, rubber, plastics, shoes, shoe creams, printers‘ ink, petrol, oil , alcohol for industrial, for domestic use, sanitary paper and ballpoint pens.

These agents are used for the prevention of oxidation, which lead to dryness or rancidity of the products. They occur in rubber, plastics, adhesive tapes, varnishes, oils, glues, etc.

Most fats and waxes used in medications , cosmetics and food have added anti- oxidants.

Alkalis are used in many industries (dyeing, tanning, rubber, plastic, and glass.

Acids are widely used in industry, e.g. chromic acid for rust proofing iron and hydrofluoric acid used in  manufactures of glass, rust stain removal, in the electronics and petroleum industries. Sulfuric, hydrochloric and nitric acids are other common inorganic acids, which may cause skin sensitization.

Hydrochloric acid is used by masons for the cleaning of building stones, but sometimes also for cleaning their hands. Acetic and oxalic acids are the most often used organic acids. Acid anhydrides such as ophthalmic anhydride are stronger irritants than the corresponding acids.

Shoe dermatitis is a common type of dermatitis affecting children and other age groups.

Shoe dermatitis is caused by contact of the foot with  shoes or due to the chemicals used during manufacture and finishing.

Sensitivity is most frequently due to leather from the rubber box toe in shoes which is the main cause. Other allergens such as dyes, chromium and formaldehyde have an important effect. Chromium is gradually liberated from leather collagen by the action of hydroxyl acids in sweat especially when shoes are used without stockings.

The most common site first involved, is the dorsal surface of the big toe and insteps and later spreads by extension to the other toes and the dorsal foot.

Skin lesions may be acute presenting with erythematous, or vesiculation and oozing.

Secondary infection is common.

Chronic lesions are dry and lichenified.

The presence of normal skin not in contact with the shoes between the eczematous areas is usually important in the diagnosis of shoe dermatitis.

Detection of the type of skin sensitizer of shoe dermatitis is by patch test.

1. Avoid using redyed shoes. It should be noted that linings of shoes are protected against mildew by impregnation in phenols and organic mercury. These may cause severe toxic reaction especially in infants and young children.

2. Patients with shoe dermatitis can use special types of shoes prepared from non-sensitizing substances such as Bloom‘s shoe.

3. Use always stockings made of absorbent cotton

4. Treatment of hyperhidrosis

Active treatment is the same as that of other types of contact dermatitis.

Azodyes in nylon stockings are the main cause of contact dermatitis. Azo dyes cross sensitize with paraphenylamine diamine derivatives and other related rubber chemicals. Nylon fabrics of the stocking may also cause contact dermatitis.

The distal part of the feet, popliteal region are the most commonly affected. In females using long nylon stockings, the middle of the thighs are commonly affected. In males, using short stockings containing rubber plastic at the upper end of the leg may cause contact dermatitis corresponding to the upper stretch part of the stockings due to the rubber content of the stretched part of the stocking.

By patch testing for the suspected sensitizers.

Rubber is a common cause of shoe dermatitis especially with preservative antioxidants as monobenzyl hydroquinone that may also cause hypopigmentation of the skin.

Finish materials used in rubber manufacture may cause contact dermatitis especially when there is hyperhidrosis.

Rubber components are used also for preparation of gloves, rubber bands, adhesive tapes as Sterri Strip , Dermacil and Band Aid plaster .

1. Raesaenen L, Lehto M, Reunala T. Decreased monocyte production of interleukin-1 and impaired lymphocyte proliferation in atopic dermatitis. Arch Dermatol Res 1987; 279: 215-18.

2. Zesch A. Adverse reactions of externally applied drugs and inert substances. Dermatosen 1988; 36: 128-33.

3. Hezemans-Boer M, Toonstra J, Meulenbelt J et al. Skin lesions due to exposure to methyl bromide. Arch Dermatol 1988; 124: 917-21.

4. Hostynek JJ, Patrick E, Younger B et al. Hypochlorite sensitivity in man. Contact Derm 1989; 20: 32-7.

5. Jackson EM, Goldner R, eds. Irritant Contact Dermatitis. New York: Marcel Dekker, 1990.

6. Middleton JD. The mechanism of action of surfactants on the isolated stratum corneum. J Soc Cosmet Chem 1969; 20:399-412.

7. Pryce DW, White J, English JSC et al. Soluble oil dermatitis: a review. J Soc Occup Med 1989; 39: 93-8.

8. Rycroft RJG. Soluble Oil as a Major Cause of Occupational Dermatitis. Cambridge: University of Cambridge, 1982 (dissertation).

9. Verbeck SJA, Buise-van Unnik EMM, Malten KE. Itching in office workers from glass fibres. Contact Derm 1981; 7: 354.

10. Fisher AA. Contact Dermatitis, 3rd edn. Philadelphia: Lea and Febiger, 1986.

11. Foussereau J, Benezra C, Maibach HI. Occupational Contact Dermatitis. Copenhagen: Munksgaard, 1982.

12. Fregert S. Manual of Contact Dermatitis, 2nd edn. Copenhagen: Munksgaard, 1981.

13. Caron GA, Calnan CD. Studies in contact dermatitis XIV. Resorcin. Trans St John‘s Hosp Dermatol Soc 1962; 48: 149-56.

14. Correia S, Menezes Brand?o F. Contact dermatitis of the feet. Dermatosen 1986; 34: 102-5.

15. Sugai T, Yamamoto S. Decrease in the incidence of contact sensitivity to formaldehyde. Contact Derm 1980; 6: 154.

16. Cronin E. Studies in contact dermatitis: XIX. Nylon stocking dyes. Trans St John‘s Hosp Derm Soc 1968; 54: 165-9.

17. Dahl MV. Allergic dermatitis from footwear. Minnesota Med 1975; 58: 871-4.

18. Fisher AA. How to obtain shoes free of common sensitizers. Cutis 1973; 12: 678.

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