Contact Dermatitis

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Definition

  • Contact dermatitis is an inflammatory reaction of the skin to physical, chemical, or biologic agents.
  • It may be of the primary irritant type, or it may be allergic.
  • The epidermis is damaged by repeated physical and chemical irritation.
  • Common causes of irritant dermatitis are soaps, detergents, scouring compounds, and industrial chemicals.
  • Predisposing factors include extremes of heat and cold, frequent use of soap and water, and a pre existing skin disease.

Other types of dermatitis

  • Contact dermatitis is caused by an allergen or an irritating substance. Irritant contact dermatitis accounts for 80% of all cases of contact dermatitis.
  • Atopic dermatitis is very common worldwide and increasing in prevalence. It affects males and females equally and accounts for 10%–20% of all referrals to dermatologists. Individuals who live in urban areas with low humidity are more prone to develop this type of dermatitis.
  • Dermatitis herpetiformis appears as a result of a gastrointestinal condition, known as celiac disease.
  • Seborrheic dermatitis is more common in infants and in individuals between 30 and 70 years old. It appears to affect primarily men and it occurs in 85% of people suffering from AIDS.
  • Nummular dermatitis is a less common type of dermatitis, with no known cause and which tends to appear more frequently in middle-age people.
  • Stasis dermatitis is an inflammation on the lower legs which is caused by buildups of blood and fluid and it is more likely to occur in people with varicose.
  • Perioral dermatitis is somewhat similar to rosacea; it appears more often in women between 20 and 60 years old.
  • Infective dermatitis is dermatitis secondary to a skin infection

Clinical Manifestations

  • Eruptions when the causative agent contacts the skin.
  • Itching, burning, and erythema are followed by edema, papules, vesicles, and oozing or weeping as first reactions.
  • In the subacute phase, the vesicular changes are less marked and alternate with crusting, drying, fissuring, and peeling.
  • If repeated reactions occur or the patient continually scratches the skin, lichenification and pigmentation occur; secondary bacterial invasion may follow.

Medical Management

  • Soothe and heal the involved skin and protect it from further damage.
  • Determine the distribution pattern of the reaction to differentiate between allergic type and irritant type.
  • Identify and remove the offending irritant; soap is generally not used on site until healed.
  • Use bland, unmedicated lotions for small patches of erythema; apply cool wet dressings over small areas of vesicular dermatitis; a corticosteroid ointment may be used.
  • Medicated baths at room temperature are prescribed for larger areas of dermatitis.
  • In severe, widespread conditions, a short course of systemic steroids may be prescribed.

Nursing Care Plans

Main Article: 4 Dermatitis Nursing Care Plans

Nursing Management

Instruct patient to adhere to the following instructions for at least 4 months, until the skin appears completely healed:

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  • Find out the cause of the problem.
  • Avoid contact with the irritants, or wash skin thoroughly immediately after exposure to the irritants.
  • Avoid heat, soap, and rubbing the skin.
  • Choose bath soaps, detergents, and cosmetics that do not contain fragrance; avoid using a fabric softener dryer sheet.
  • Avoid topical medications, lotions, or ointments, except when prescribed.
  • Make sure gloves are cotton-lined; do not wear for more than 15 to 20 minutes at a time.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.

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