Case Report

IRRITANT CONTACT DERMATITIS

By:
DARA PURNAMASARI
KHUSNUL AMRA
Supervisor:
FITRIA SALIM

DERMATO-VENEREOLOGY DEPARTMENT
MEDICAL FACULTY OF SYIAH KUALA UNIVERSITY
Dr. ZAINOEL ABIDIN GENERAL HOSPITAL
BANDA ACEH
NOVEMBER 2013
PREFACE

Praise be to Allah SWT, The cherisher and sustainer of the worlds; God who
has been giving His blessing and mercy. Peace and salutation be upon to our
Prophet Muhammad SAW, the greates man in this world.
In finishing this case report entitled Irritant Contact Dermatitis, the authors
really give they regards and thanks to dr. Fitria, M. Sc, Sp. KK who has given
guidance and help.
Finally, the authors realize there are unintended errors in writting this case
report. The authors really allow readers to give their suggestion to improve its
content in order to be made as one of the good examples for the next case report.

Banda Aceh, November 2013

Authors

CONTENTS

17

COVER................i
PREFACE...............................................................................................................ii
CONTENTS..........................................................................................................iii
TABLES LIST.......................................................................................................iv
PICTURES LIST...................................................................................................v
1.

Introduction....................................................................................................1

2.

Case Report...................................................................................................11
2.1 History....................................................................................................11
2.2 Dermatology Status................................................................................12
2.3 Differential Diagnosis.............................................................................12
2.4 Resume...................................................................................................12
2.5 Diagnosis................................................................................................12
2.6 Management...........................................................................................12
2.7 Education................................................................................................13
2.7 Prognosis................................................................................................13

3.

Discussion.....................................................................................................14

REFERENCE.......................................................................................................17

TABLES LIST

17

Table 1.1 Clinical effects of chemical irritants

Table 1.2 Exogenous and endogenous factors influencing the irritant response of
human skin
Table 3.1 Several things which found and relationship with some theory
Table 3.2 Differential diagnosis

PICTURES LIST

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Figure 2.1 Patch erythematous at face

Figure 2.2 Makula erythematous at hand

INTRODUCTION

17

Irritant contact dermatitis is a non allergic inflammatory reaction of the skin

to external agents including chemical, physical or biologic agent that are capable
of irritating the skin, acutely or chronically. Acute irritant contact dermatitis often
result from a single overwhelming exposure or a few brief exposures to strong
irritants or caustic agents, whereas chronic irritant contact dermatitis also known
as cumulative irritant contact dermatitis occurs following repetitive exposure to
weaker irritants either wet, such as detergents, organic solvents, soaps, weak acids
and alkalis, or dry, such as low humidity air, heat, powders and dusts.1,2,3
Irritant dermatitis makes up about 80% of contact dermatitis. The other 20%
is allergic. This disease is significantly more common in women than in men. The
high frequency in women in comparison with men is caused by environmental,
not genetic factors. Irritant contact dermatitis may occur at any age. Almost any
material act as irritants that produce a nonspecific inflammatory reaction of the
skin, if the exposure is sufficiently prolonged and/or the concentration of the
substance sufficiently high. Environmental factors may enhance the effect of other
irritants2,4. The concentration and the type of the toxic agent, the duration of
exposure, and the condition of the skin at the time of exprosure produces the
variation of the severity of the dermatitis from person to person, or from time to
time in the same person. (ANDREWS).
There are several factors that have been identified as being involved in the
cutaneous irritation. These can be divided into endogenous and exogenous factors.
Endogenous (host) factor include: genetic factors, gender, age, ethnicity, skin site
and history of atopy.

CASE REPORT

17

Identity of Patient
Name

: Yusna

Sex

: Female

Age

: 39 years old

Address

: Desa Lampakuk, Kecamatan Kuta Cot Glie, Aceh Besar

Hospitalized

: November 13th, 2013

Examination day

: November 13th, 2013

History
Chief Complaint
Present of swelling, redness patches and burning sensation, painful on the skin
face and hand since 4 days ago.
Present illness history
Patient came to hospital complaining the appearance of swelling, redness patches,
burning and painful feeling on the skin face and hand since 4 days ago. At first,
patient found redness around her face, neck and her hand followed by burning and
painful feeling after using a facial soap. And then, after about 9 hours patient
found her face swelling. This is the first time for the patient using the soap. Patient
got the facial soap from her sister who use it everyday. Unlike her, her sister has
no skin problem after using the soap.
Past illness history
Patient has a history of soliter nodule beside her left eye when she was child and
has taken operating procedures to cure it.
Family disease history
None of her family had this kind of disease.
Medicine history
Patient did not take any medication before going to hospital.
Status of Dermatology

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Figure 2.1 Patch erythematous at face

Figure 2.2 Makula erythematous at

hand

Differential Diagnosis
1.
2.
3.
4.

Irritant contact dermatitis

Erisepelas
Selulitis
Allergic contact dermatitis

Planning Diagnostic
1. Patch Test
2. Prick Test
3. Gram staining

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Resume
A 39 years old woman came to hospital complaining of the presence of swelling,
redness patches, burning and painfull feeling on the skin face and hand since 4
days ago. On dermatological status was found patch eritematous with diffuse and
regular edge at her face and macula eritematous at both her hand.
Diagnosis
Irritant contact dermatitis
Management
1. Metylprednisolon
2. Cetirizin 10 mg 1 x 1 tab
3. Thyamicin + Inerson oint (morning and night)
Education
Avoid irritant that potential effect to induce skin problem. If contact does occur,
wash with water as soon as possible and come to hospital to take medication if
needed.
Prognosis
Quo ad Vitam

: dubia ad bonam

Quo ad Functionam

: dubia ad bonam

Quo ad Sanactionam : dubia ad bonam

DISCUSSION
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Irritant contact dermatitis is an acute or chronic inflammatory reactions to

substances that come in contact with the skin such as chemical or other physical
agents that are capable of irritating the skin. Irritant contact responses of the skin
include: subjective irritancy, transient irritant reactions, persistent irritant
reactions, toxic burn. Irritant contact responses of the skin appendages and
pigmentary system include: follicular and acneform eruptions, miliaria,
pigmentary changes (hypo- and hyperpigmentation), granulomatous reactions and
alopecia. In some individuals, subjective symptoms (burning, stinging, smarting)
may be the only manifestations. Painful sensations can occur within seconds after
exposure (immediate-type stinging), e.g., exposure to acids, chloroform, and
methanol. Delayed-type stinging occurs within 1 to 2 min, peaking at 5 to 10 min,
fading by 30 min, and is caused by agents such as aluminum chloride, phenol,
propylene glycol, and others. The changing of skin appearance may occur within
minutes after exposure or may be delayed up to 24 hours. The spectrum of
changes range from erythema to vesiculation and caustic burn with necrosis.
Acute ICD represents sharply demarcated erythema and superficial edema,
corresponding to the application site of the toxic substance. Lesion do not spread
beyond the site of the contact. In more severe reactions cesicles and blisters arise
within the erythema often bizarre or linear 1. In this case, some symptoms appears
same as what has been mentioned in the theory, as shown in the table below:
Table 3.1 Several things which found and relationship with some theory
Definition

CASE
This patient
complain some
skin problem
including
swelling,
redness, burning
and painful
sensation after

THEORY
Irritant contact
dermatitis is an acute or
chronic inflammatory
reactions to substances
that come in contact
with the skin such as
chemical or other
physical agents that are

COMMENT
There are
similarities
between the case
and the theory
which states that
ICD is an
inflammatory
reactions to

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Age of Onset

Clinical
Features

using a facial
soap that
potentially
contain irritant
substances.
Patient suffering
the disease at 39
years old.

Presence of
swelling,
redness patches,
burning and
painfull feeling
on the skin face
and hand.

capable of irritating the

skin1.

substances that
come in contact
with the skin that
are capable of
irritating skin
Irritant contact
There are
dermatitis may occur at similarities
any age. Many cases of between the case
diaper dermatitis are
and the theory
irritant contact
which states that
dermatitis resulting
ICD may occur at
from direct skin irritants any age and older
present in urine and,
persons have drier
especially, feces. Older and thinner skin
persons have drier and
that does not
thinner skin that does
tolerate soaps and
not tolerate soaps and
solvents as well as
solvents as well as
younger
younger individuals.
individuals.
Occupational hand
eczema often is
associated with
persistent dermatitis and
prolonged sick leave,
with substantially
greater severity among
those with occupational
irritant contact
dermatitis and atopic
dermatitis and age older
than 50 years5.
The spectrum of
There are
changes ranges from
similarities
erythema to
between the case
vesiculation and caustic and the theory.
burn with necrosis.
Acute ICD represents
sharply demarcated
erythema and
superficial edema,
corresponding to the
application site of the

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toxic substance. Lesion

do not spread beyond
the site of the contact.
There are also some
subjective symptoms
such as burning,
stinging and smarting
sensation1.
In the acute stage of
irritant contact
dermatitis,
topical corticosteroids
are indicated. If there is
deep tissue destruction
or signs of bacterial
infection,
systemic corticosteroids
and antimicrobial
agents
should be
administered2.

Treatment

There are
similarities
between the case
and the theory.

The differential diagnosis for irritant contact dermatitis includes other

diasease that presents swelling, redness, burning and painful sensation such as
erisepelas, selulitis and allergic contact dermatitis.
Table 3.2 Differential diagnosis
Irritant Contact

Erisepelas

Selulitis

Dermatitis
Symptoms are
stinging, smarting,
burning and
painful sensation.
Skin lesion forms
erythema, edema,
sometimes there
are also vesicle,
erosion, crust and
scaling. The
margination of the

Allergic Contact
Dermatitis

Usually starts by
prodromal
symptoms such as
fever, headache,
vomiting. Skin
lesion forms local
and painful
erythema with
clear cut border
and higher edge.
There are also

Skin lesion forms

local and painful
erythema that
become more red
in short time with
diffuse border and
has flat edge.
Sometimes there
are nodules or
vesicles in the
center area of the

Symptoms are
itching and painful
sensation. Skin
lesion forms
erythema, papul,
vesicle, erosion,
crust, scaling and
plaques with sharp
margination,
confined to the
side of exposure
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lesion is sharp,
strictly confined to
site of exposure.

burning and
painful sensation.
The predilection
area are face and
lower extremity.

lession, produce
exudate if broken.
Can also followed
by fever and
malaise.

but spreading in
the periphery.

REFERENCE
1. Goldsmith L, Katz S, Gilchrest B, Paller A, Leffel D, Wolff K. Fitzpatricks
Dermatology in General Medicine. Eighth Edition. 2008. McGraw-Hill:
New York. P.395-400
2. Frosch PJ, John SM. Clinical Aspects of Irritant Contact Dermatitis. 2006.
Available at http://www.springer.com/978-3-540-24471-4 (November 16th,
2013).
3. Bourke J, Coulson I, English J. 2008. Guidelines for The Management of
Contact Dermatitis: An Update. British Journal of Dermatology. St Johns
Institue of Dermatology, Kings College: London.
4. Wolff K, Johnson RA, Suurmond D. Fitzpatricks Color Atlas and Synopsis
of Clinical Dermatology. 2005. McGraw-Hill: New York. P.18-23
5. Health and Safety Authority. Guidelines on Occupational Dermatitis. 2009.
The Metropolitan Building, James Joyce Street, Dublin.
6. Hogan DJ. Irritant Contact Dermatitis Medication. Available at
http://emedicine.medscape.com/article/1049353-medication#showall
(November 16th, 2013).

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