Dermatitis is an acute inflammatory skin disease that develops under the influence of certain irritants.
Development reasons
Dermatitis most often develops as a result of skin contact with chemicals: acids, alkalis, chromium salts, nickel, mercury.
In addition, drugs, physical, biological, climatic and other effects can cause manifestations of dermatitis.
The peculiarities of the course of dermatitis and the severity of its clinical manifestations depend on the properties of the irritating factor itself, the duration of its effect and the state of the body’s reactivity. A characteristic feature of dermatitis is a rather rapid reverse development after the removal of the irritant.
There are several types of dermatitis: simple (contact), allergic contact and toxic-allergic.
Clinic
Simple (contact) dermatitis. The causes of contact dermatitis are often direct long-term or repeated exposure to the skin of chemicals (acids, alkalis in high concentrations, etc.), mechanical (abrasion, friction of tight clothing, shoes, plaster casts, pressure of instruments, etc.), physical (high and low temperature, ultraviolet (actinic dermatitis), X-rays, radioactive isotopes and other factors, as well as contact with biological irritants and plants (such as buttercup, euphorbia, coastal grasses, primrose, etc.).
In everyday life, simple (contact) dermatitis in children can be triggered by shampoos, caustic soaps, cosmetics, detergents, citrus juice and a number of topical medications. Saliva is one of the common causes of dermatitis on the face and in the cervical folds in young and mentally retarded children. Dermatitis, localized around the mouth, occurs in older children who have a habit of licking their lips.
This type of dermatitis occurs at the site of exposure to the irritant and, as a rule, does not spread beyond it. The predisposition to the development of contact dermatitis in children is different. So, in some children, the disease occurs with minimal exposure to the stimulus.
With simple (contact) dermatitis, erythema, swelling appears on the patient’s skin first, and then vesicles, papules and pustules. Skin changes are accompanied by burning and soreness in the lesions.
With the development of contact dermatitis from exposure to X-rays, high temperatures and some other irritants, the lesions subsequently ulcerate and scar.
Simple (contact) dermatitis resolves fairly quickly (within a few days) after contact with the irritant is eliminated.
In pediatric practice, two forms of this disease are most common: diaper dermatitis and juvenile plantar dermatitis.
Diaper dermatitis. It occurs as a result of skin reaction to pressure and prolonged contact with urine and feces, soap residues.
It manifests itself in the form of erythema, cracks and erosions at the points of contact of the skin with the irritant, while the genitocrural folds are never affected. Skin manifestations are accompanied by itching, burning.
Diaper dermatitis usually resolves quickly after systematic washing with warm water and mild soap and frequent diaper changes. During this period, the use of diapers is not recommended; it is better to use ordinary diapers. It is possible to apply emollient protective agents (zinc oxide and petrolatum paste) to the affected areas after changing the diapers, use the Drapolen cream.
In rare cases, children have a particular predisposition to contact dermatitis, making it difficult to treat.
Treatment of such children is carried out with the use of anti-inflammatory hormonal ointments in a short course, but only after being prescribed by the attending physician.
Juvenile plantar dermatitis. Juvenile plantar dermatitis is caused by wearing tight synthetic shoes. The disease occurs mainly in the prepubertal period.
The lesions are localized on the supporting surfaces and have a glassy appearance. Cracks may appear. Skin changes are accompanied by soreness.
To treat this condition, a change of footwear with temporary local applications of emollients is sufficient.
Allergic contact dermatitis. Allergic contact dermatitis also occurs as a result of external stimuli, however, unlike simple contact dermatitis, it is based on allergic restructuring of the body.
Allergic dermatitis can be caused by substances such as chromium salts, formalin, phenol-formaldehyde and other artificial resins that are part of varnishes, adhesives, plastics, etc. Also, pronounced allergenic properties are inherent in penicillin and its derivatives, mercury salts.
Some children are extremely sensitive to nickel. Allergic dermatitis in this case can occur upon contact with nickel-containing fasteners on clothes or jewelry. Nickel dermatitis is often localized to the earlobes.
Dermatitis from shoes can be caused by antioxidants in shoe lubricant or tanning agents and chromium salts in the leather from which the shoes are made. When you sweat profusely, these substances are usually leached out.
Allergic dermatitis from shoes usually develops on the back of the foot and toes without affecting the interdigital spaces. Unlike simple contact dermatitis, it rarely affects the palmar and plantar surfaces. In typical cases, the lesions are symmetrical.
Dermatitis from clothes develops upon contact with the following allergens: factory dyes, elastic fibers of fabrics, resins, fabric stains. Dyes, resins, and fabric stains can be poorly set and leach out later on while wearing clothing.
All types of cosmetics (especially on the eyelids) can cause allergic dermatitis on the face.
Unexpectedly, allergic dermatitis can develop with the use of topical treatments, especially when used to treat preexisting dermatitis. These allergens include topical anti-histamines, anesthetics, neomycin, merthiolate, and ethylenediamide, which is present in many ointments.
Allergic contact dermatitis can occur in two forms – acute and chronic, prone to exacerbations. Hypersensitivity to a particular allergen that occurs once usually persists for many years.
Skin manifestations in allergic contact dermatitis resemble morphological elements of simple contact dermatitis, with the difference that in allergic dermatitis, the inflammatory process extends beyond the lesion and manifests itself as oozing like eczema.
Diagnosis of this disease is carried out by setting skin tests with minimal concentrations of the corresponding allergens.
Toxic-allergic dermatitis. The most common toxic-allergic dermatitis of drug origin that occurs when taking Elenium and drugs like it.
The disease is caused by both allergic and toxic components of the drug’s action.
Medicinal toxic-allergic dermatitis develops with prolonged repeated, less often – short-term intake of the medication by mouth or with its introduction parenterally.
A combination of allergic and toxic effects of an irritant, different in severity and strength, causes the development of a so-called drug disease, in which, in addition to lesions of the skin and mucous membranes, the tissues of the nervous, vascular systems and internal organs are involved in the inflammatory process.
The prognosis of toxic-allergic dermatitis of drug origin depends on the severity of general clinical and allergic reactions. The most severe consequences, often leading to death, are observed in Lyell’s syndrome.
Treatment
When planning the treatment of all types of contact dermatitis, it is necessary to take into account the degree and prevalence of cutaneous and general clinical manifestations.
For simple (contact) dermatitis, symptoms reverse after elimination of the irritant. For the treatment of acute inflammatory phenomena, water-zinc paste, lanolin cream, and cooling anti-inflammatory lotions are recommended.
With allergic dermatitis, not only local, but also general therapy is required to reduce the allergization of the body, which is achieved by the appointment of calcium preparations, sodium hyposulfite.
In case of a complicated course, only after the appointment by the attending physician, low doses of corticosteroid hormones (prednisolone, triamcinolone and dexamethasone) are used in appropriate age doses for 10-12 days, followed by a gradual dose reduction in combination with antihistamines (suprastin, diazolin, tavegil , pipolfen, etc.). If allergic dermatitis is complicated by a purulent infection, local treatment with ointments such as oxycort, dermozolone, lo-cacorten brings favorable results.
Toxic-allergic dermatitis of drug origin is treated in a similar way. A prerequisite for a favorable outcome of drug toxidermia is the abolition of the medication, which is its causative factor.