Irritant contact dermatitis is the most common form of contact dermatitis, and yet is often overlooked. Recent progress in understanding the pathogenesis has reignited the interest of clinicians in this area of dermatology. Irritant contact dermatitis is not a homogenous entity, but rather a number of subtypes contributing to different clinical presentations. The diagnosis of irritant contact dermatitis is often clinical, and may only be possible after the exclusion of allergic contact dermatitis with patch testing. There is no readily available diagnostic test. There is an incomplete understanding of the factors which lead to the development of cumulative irritant contact dermatitis and persistent postoccupational dermatitis. We have used the experience from our tertiary referral occupational dermatology clinic to illustrate various aspects of irritant contact dermatitis, and to highlight the difficulty sometimes encountered in making this diagnosis. We believe that increased awareness of the often pivotal role of irritant contact dermatitis, as well as all the other factors contributing to occupational dermatitis, will lead to improvement in outcomes for patients.
Hairdressers belong to an occupational group that is commonly affected by occupational skin disease, specifically contact dermatitis, which may be allergic or irritant and, less commonly, contact urticaria. Occupational contact dermatitis predominantly affects apprentices, and atopy is a recognized risk factor associated with a poor prognosis. Repetitive wet work leading to irritant contact dermatitis, followed by exposure to allergens and the development of allergic contact dermatitis, are the main factors contributing to occupational contact dermatitis. Once developed, it is often difficult to manage and is a cause of significant morbidity. Early education, training and prevention is the best approach to the management of this disorder that is endemic among hairdressers.
The ODDI is a valid and reliable instrument to assess the severity and functional limitations caused by OCD, in patients who have had treatment or modified work duties, associated with some improvement of their dermatitis.
These data demonstrate for the first time that MI is an emerging, important allergen in both cosmetic and occupational settings in Australia. An important source of exposure was baby wipes, which was predominantly associated with hand dermatitis in parents. We believe that it is important to test for MI, not just MCI/MI, in the baseline series.
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