Etiologi Dki Dka.docx

DKI Etiology Almost any material may be a cutaneous irritant, if the exposure is sufficiently prolonged and/or the concentration of the substance sufficiently high. The likelihood of developing irritant contact dermatitis (ICD) increases with the duration and intensity of exposure to the irritant. [2] Environmental factors may enhance the effect of other irritants. [10, 11, 12]

Dry air and temperature variation Dry air renders the skin more susceptible to cutaneous irritants. Sufficiently dry air alone may provoke irritant contact dermatitis. Most cases of winter itch are a result of dry skin from the drier air found during sustained periods of cold weather. An increase in temperature (up to 43°C from 20°C) increases the cutaneous effect of an irritant. [13]

Water Continual exposure to water may produce maceration or repeated evaporation of water from the skin may produce cutaneous irritation by desiccation of the skin. Even distilled water experimentally provokes increased CD11c+ cells and neutrophils in the epidermis.

Solvents Many individuals are exposed to solvents, particularly at work. Solvents such as alcohol or xylene remove lipids from the skin, producing direct irritant contact dermatitis and rendering the skin more susceptible to other cutaneous irritants, such as soap and water. Irritant contact dermatitis from alcohol most often is cumulative. Manual workers may wash their hands inappropriately with solvents to remove oil, grease, paints, or other materials; thus, they develop irritant contact dermatitis. Inappropriate skin cleansing is a primary cause of irritant contact dermatitis in the workplace. Washing facilities and methods must be inspected when investigating the workplace for 1 or more cases of occupational irritant contact dermatitis. The irritating agents include aromatic, aliphatic, and chlorinated solvents, as well as solvents such as turpentine, alcohol, esters, and ketones. Some organic solvents produce an immediate erythematous reaction on the skin and remove lipids from the stratum corneum.

Metalworking fluids Neat oils most commonly produce folliculitis and acne. They may cause irritant contact dermatitis (as well as allergic dermatitis). Water-based metalworking fluids often cause irritant contact dermatitis in exposed workers; surfactants in these fluids are the main culprit.

Cumulative irritant contact dermatitis This is common in many occupations that often are termed "wet work." Healthcare workers wash their hands 20-40 times a day, producing cumulative irritant contact dermatitis. Similar exposures occur among individuals who wash hair repeatedly or in cleaners or kitchen workers. Multiple skin irritants may be additive or synergistic in their effects. Alcohol-based handcleansing gels cause less skin irritation than hand washing and therefore are preferred for hand hygiene from the dermatological point of view. An alcohol-based hand-cleansing gel may even decrease, rather than increase, skin irritation after a hand wash, owing to a mechanical partial elimination of the detergent. [14]

Microtrauma Fiberglass produces direct damage to the skin, usually manifested by pruritus that may result in excoriation and secondary skin damage. Cutaneous irritation primarily is caused by fiberglass with diameters exceeding 4.5 µm. Most workers with irritant contact dermatitis resulting from fiberglass develop hardening, in which they tolerate further cutaneous exposure to fiberglass. Many plant leaves and stems bear small spicules and barbs that produce direct skin trauma.

Mechanical trauma Pressure produces callus formation. Pounding produces petechia or ecchymosis. Sudden trauma or friction produces blistering in the epidermis. Repeated rubbing or scratching produces lichenification. Sweating and friction appear to be the main cause of dermatitis that appears under soccer shin guards in children. [15]

Rubber gloves Some rubber gloves may provoke direct cutaneous irritation. Many workers complain of irritation from the powder in rubber gloves. Remember that gloves compromised by a hole may allow an irritant to enter; occlusion dramatically increases skin damage from the irritant. Occlusion accentuates the effects, good or bad, of topical agents. Kerosene may produce skin changes similar to that of toxic epidermal necrolysis following occluded cutaneous exposure. Excessive amounts of ethylene oxide in surgical sheets also may produce similar changes.

Sodium lauryl sulfate This chemical is found in some topical medications, particularly acne medications, as well as a range of soaps and shampoos. It is also a classic experimental cutaneous irritant.

Hydrofluoric acid

A hydrofluoric acid burn is a medical emergency. Remember that onset of clinical manifestations may be delayed after the acute exposure (this is crucial to diagnosis). Unfortunately, hydrofluoric acid burns are most frequent on the digits, where the pain is most severe and management is most difficult (see Hydrofluoric Acid Burns).

Alkalies Skin surfaces normally have an acidic pH, and alkalies (eg, many soaps) produce more irritation than many acids. The "acid mantle" of the stratum corneum seems to be important for both permeability barrier formation and cutaneous antimicrobial defense. Use of skin cleansing agents, especially synthetic detergents with a pH of approximately 5.5 rather than alkaline pH, may help prevent skin disease. [16]

Etiologi Hampir semua bahan dapat menyebabkan iritasi kulit, jika paparannya cukup lama dan / atau konsentrasi zat tersebut cukup tinggi. Kemungkinan mengembangkan dermatitis kontak iritan (ICD) meningkat dengan durasi dan intensitas paparan iritan. [2] Faktor lingkungan dapat meningkatkan efek iritan lainnya. [10, 11, 12]

Variasi udara dan suhu kering Udara kering membuat kulit lebih rentan terhadap iritasi kulit. Udara yang cukup kering saja dapat memicu dermatitis kontak iritan. Sebagian besar kasus gatal musim dingin adalah akibat dari kulit kering dari udara kering yang ditemukan selama periode cuaca dingin yang berkelanjutan. Peningkatan suhu (hingga 43 ° C dari 20 ° C) meningkatkan efek kulit iritan. [13]

Air Paparan air yang terus-menerus dapat menghasilkan maserasi atau penguapan air yang berulang dari kulit dapat menghasilkan iritasi kulit dengan pengeringan kulit. Bahkan air suling secara eksperimental memprovokasi peningkatan sel CD11c + dan neutrofil di epidermis.

Pelarut Banyak orang yang terpapar pelarut, khususnya di tempat kerja. Pelarut seperti alkohol atau xylene menghilangkan lemak dari kulit, menghasilkan dermatitis kontak iritan langsung dan membuat kulit lebih rentan terhadap iritasi kulit lainnya, seperti sabun dan air. Dermatitis kontak iritan dari alkohol paling sering bersifat kumulatif. Pekerja manual dapat mencuci tangan mereka secara tidak tepat dengan pelarut untuk menghilangkan minyak, minyak, cat, atau bahan lainnya; dengan demikian, mereka mengembangkan dermatitis kontak iritan. Pembersihan kulit yang tidak pantas adalah penyebab utama dermatitis kontak iritan di tempat kerja. Fasilitas dan metode mencuci harus diperiksa ketika menyelidiki tempat kerja untuk 1 atau lebih kasus dermatitis kontak iritan di tempat kerja. Zat pengiritasi meliputi pelarut aromatik, alifatik, dan diklorinasi, serta pelarut seperti terpentin, alkohol, ester, dan

keton. Beberapa pelarut organik menghasilkan reaksi eritematosa segera pada kulit dan menghilangkan lipid dari stratum corneum. Cairan pengerjaan logam Minyak rapi paling sering menghasilkan folikulitis dan jerawat. Mereka dapat menyebabkan dermatitis kontak iritan (dan juga dermatitis alergi). Cairan pengerjaan logam berbasis air sering menyebabkan dermatitis kontak iritan pada pekerja yang terpajan; surfaktan dalam cairan ini adalah penyebab utama. Dermatitis kontak iritan kumulatif Ini umum di banyak pekerjaan yang sering disebut "pekerjaan basah". Petugas kesehatan mencuci tangan mereka 20-40 kali sehari, menghasilkan dermatitis kontak iritan kumulatif. Paparan serupa terjadi di antara individu yang mencuci rambut berulang kali atau di tukang pembersih atau pekerja dapur. Iritasi kulit multipel mungkin bersifat aditif atau sinergis dalam efeknya. Gel pembersih tangan berbasis alkohol menyebabkan iritasi kulit lebih sedikit daripada mencuci tangan dan karenanya lebih disukai untuk kebersihan tangan dari sudut pandang dermatologis. Gel pembersih tangan berbasis alkohol bahkan dapat mengurangi, daripada meningkatkan, iritasi kulit setelah mencuci tangan, karena eliminasi parsial deterjen secara mekanik. [14]

Microtrauma Fiberglass menghasilkan kerusakan langsung pada kulit, biasanya dimanifestasikan oleh pruritus yang dapat menyebabkan eksoriasi dan kerusakan kulit sekunder. Iritasi kulit terutama disebabkan oleh fiberglass dengan diameter melebihi 4,5 μm. Sebagian besar pekerja dengan dermatitis kontak iritan yang dihasilkan dari fiberglass mengalami pengerasan, di mana mereka mentolerir paparan kulit lebih lanjut terhadap fiberglass. Banyak daun dan batang tanaman mengandung spikula kecil dan duri yang menghasilkan trauma kulit langsung.

Trauma mekanis Tekanan menghasilkan pembentukan kalus. Pound menghasilkan petechia atau ecchymosis. Trauma atau gesekan yang tiba-tiba menghasilkan lepuh di epidermis. Menggosok atau menggaruk berulang kali menghasilkan likenifikasi. Berkeringat dan gesekan tampaknya menjadi penyebab utama dermatitis yang muncul di bawah penjaga tulang kering pada anakanak. [15]

Sarung tangan karet Beberapa sarung tangan karet dapat memicu iritasi kulit langsung. Banyak pekerja mengeluh iritasi dari bubuk di sarung tangan karet. Ingatlah bahwa sarung tangan yang dikompromikan oleh lubang dapat menyebabkan iritasi masuk; oklusi secara dramatis meningkatkan kerusakan kulit akibat iritasi. Penyumbatan menonjolkan efek, baik atau buruk, agen topikal. Minyak tanah dapat menghasilkan perubahan kulit yang mirip dengan nekrolisis epidermis toksik setelah paparan kulit tersumbat. Jumlah etilen oksida dalam lembaran bedah yang berlebihan juga dapat menghasilkan perubahan yang serupa.

Sodium lauryl sulfate Zat kimia ini ditemukan dalam beberapa obat topikal, terutama obat jerawat, serta berbagai sabun dan sampo. Ini juga merupakan iritasi kulit eksperimental klasik.

Asam hidrofluorat Luka bakar asam hidrofluorik adalah keadaan darurat medis. Ingat bahwa timbulnya manifestasi klinis mungkin tertunda setelah paparan akut (ini sangat penting untuk diagnosis). Sayangnya, luka bakar asam hidrofluorik paling sering terjadi pada jari, di mana rasa sakitnya paling parah dan penatalaksanaannya paling sulit (lihat Hydrofluoric Acid Burns).

Alkali Permukaan kulit biasanya memiliki pH asam, dan alkali (misalnya, banyak sabun) menghasilkan lebih banyak iritasi daripada banyak asam. "Mantel asam" dari stratum corneum tampaknya penting untuk pembentukan penghalang permeabilitas dan pertahanan antimikroba kulit. Penggunaan agen pembersih kulit, khususnya deterjen sintetis dengan pH sekitar 5,5 daripada pH basa, dapat membantu mencegah penyakit kulit. [16]

1. [Guideline] Fonacier L, Bernstein DI, Pacheco K, et al. Contact dermatitis: a practice parameter-update 2015. J Allergy Clin Immunol Pract. 2015 May-Jun. 3 (3 Suppl):S139. [Medline]. 2. [Guideline] Brasch J, Becker D, Aberer W, Bircher A, Kränke B, Jung K, et al. Guideline contact dermatitis: S1-Guidelines of the German Contact Allergy Group (DKG) of the German Dermatology Society (DDG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo J Int. 2014. 23 (4):126-138. [Medline]. 3. Lee HY, Stieger M, Yawalkar N, Kakeda M. Cytokines and chemokines in irritant contact dermatitis. Mediators Inflamm. 2013. 2013:916497. [Medline]. 4. Watkins SA, Maibach HI. The hardening phenomenon in irritant contact dermatitis: an interpretative update. Contact Dermatitis. 2009 Mar. 60(3):123-30. [Medline]. 5. Fluhr JW, Akengin A, Bornkessel A, Fuchs S, Praessler J, Norgauer J, et al. Additive impairment of the barrier function by mechanical irritation, occlusion and sodium lauryl sulphate in vivo. Br J Dermatol. 2005 Jul. 153(1):125-31. [Medline]. 6. Jacobs JJ, Lehé CL, Hasegawa H, Elliott GR, Das PK. Skin irritants and contact sensitizers induce Langerhans cell migration and maturation at irritant concentration. Exp Dermatol. 2006 Jun. 15(6):432-40. [Medline]. 7. Heinemann C, Paschold C, Fluhr J, Wigger-Alberti W, Schliemann-Willers S, Farwanah H, et al. Induction of a hardening phenomenon by repeated application of SLS: analysis of lipid changes in the stratum corneum. Acta Derm Venereol. 2005. 85(4):290-5. [Medline]. 8. de Jongh CM, Khrenova L, Verberk MM, Calkoen F, van Dijk FJ, Voss H, et al. Loss-of-function polymorphisms in the filaggrin gene are associated with an increased

susceptibility to chronic irritant contact dermatitis: a case-control study. Br J Dermatol. 2008 Sep. 159(3):621-7. [Medline]. 9. Visser MJ, Landeck L, Campbell LE, McLean WH, Weidinger S, Calkoen F, et al. Impact of atopic dermatitis and loss-of-function mutations in the filaggrin gene on the development of occupational irritant contact dermatitis. Br J Dermatol. 2013 Feb. 168 (2):326-32. [Medline]. 10. Pelletier JL, Perez C, Jacob SE. Contact Dermatitis in Pediatrics. Pediatr Ann. 2016 Aug 1. 45 (8):e287-92. [Medline]. 11. Robinson AJ, Foster RS, Halbert AR, King E, Orchard D. Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids. Australas J Dermatol. 2016 Sep 19. [Medline]. 12. Higgins CL, Palmer AM, Cahill JL, Nixon RL. Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014. Contact Dermatitis. 2016 Oct. 75 (4):213-22. [Medline]. 13. Kartono F, Maibach HI. Irritants in combination with a synergistic or additive effect on the skin response: an overview of tandem irritation studies. Contact Dermatitis. 2006 Jun. 54(6):303-12. [Medline]. 14. Löffler H, Kampf G, Schmermund D, Maibach HI. How irritant is alcohol?. Br J Dermatol. 2007 Jul. 157(1):74-81. [Medline]. 15. Weston WL, Morelli JG. Dermatitis under soccer shin guards: allergy or contact irritant reaction?. Pediatr Dermatol. 2006 Jan-Feb. 23(1):19-20. [Medline]. 16. Schmid-Wendtner MH, Korting HC. The pH of the skin surface and its impact on the barrier function. Skin Pharmacol Physiol. 2006. 19(6):296-302. [Medline]. 17. Deleo VA, Alexis A, Warshaw EM, Sasseville D, Maibach HI, DeKoven J, et al. The Association of Race/Ethnicity and Patch Test Results: North American Contact Dermatitis Group, 1998-2006. Dermatitis. 2016 Sep-Oct. 27 (5):288-292. [Medline]. 18. Callahan A, Baron E, Fekedulegn D, Kashon M, Yucesoy B, Johnson VJ, et al. Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers. Dermatitis. 2013 Jul-Aug. 24 (4):170-5. [Medline]. 19. Forrester BG, Roth VS. Hand dermatitis in intensive care units. J Occup Environ Med. 1998 Oct. 40(10):881-5. [Medline]. 20. Cvetkovski RS, Rothman KJ, Olsen J, Mathiesen B, Iversen L, Johansen JD, et al. Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol. 2005 Jan. 152(1):93-8. [Medline]. 21. Dickel H, Kuss O, Schmidt A, Kretz J, Diepgen TL. Importance of irritant contact dermatitis in occupational skin disease. Am J Clin Dermatol. 2002. 3(4):283-9. [Medline]. 22. Mangion SM, Beulke SH, Braitberg G. Hydrofluoric acid burn from a household rust remover. Med J Aust. 2001 Sep 3. 175(5):270-1. [Medline]. 23. Basketter DA, Marriott M, Gilmour NJ, White IR. Strong irritants masquerading as skin allergens: the case of benzalkonium chloride. Contact Dermatitis. 2004 Apr. 50(4):213-7. [Medline]. 24. Rietschel RL, Fowler JF Jr. Fisher's Contact Dermatitis. 4th ed. Baltimore, Md: Lippincott Williams & Wilkins; 1995. 25. Lakshmi C, Srinivas CR, Anand CV, Mathew AC. Irritancy ranking of 31 cleansers in the Indian market in a 24-h patch test. Int J Cosmet Sci. 2008 Aug. 30(4):277-83. [Medline].

26. Menne T, Johansen JD, Sommerlund M, Veien NK. Hand eczema guidelines based on the Danish guidelines for the diagnosis and treatment of hand eczema. Contact Dermatitis. 2011 Jul. 65(1):3-12. [Medline]. 27. Levin C, Zhai H, Bashir S, Chew AL, Anigbogu A, Stern R, et al. Efficacy of corticosteroids in acute experimental irritant contact dermatitis?. Skin Res Technol. 2001 Nov. 7(4):214-8. [Medline]. 28. Fuchs M, Schliemann-Willers S, Heinemann C, Elsner P. Tacrolimus enhances irritation in a 5-day human irritancy in vivo model. Contact Dermatitis. 2002 May. 46(5):290-4. [Medline].

DKA Etiology Approximately 25 chemicals appear to be responsible for as many as one half of all cases of allergic contact dermatitis. These include nickel, preservatives, dyes, and fragrances.

Poison ivy Poison ivy (Toxicodendron radicans) is the classic example of acute allergic contact dermatitis in North America. Allergic contact dermatitis from poison ivy is characterized by linear streaks of acute dermatitis that develop where plant parts have been in direct contact with the skin.

Nickel Nickel is the leading cause of allergic contact dermatitis in the world. The incidence of nickel allergic contact dermatitis in North America is increasing; in contrast, new regulations in Europe have resulted in a decreasing prevalence of nickel allergy in young and middle-aged women. [2, 3] Allergic contact dermatitis to nickel typically is manifested by dermatitis at the sites where earrings or necklaces (see the image below) containing nickel are worn or where metal objects (including the keypads of some cell phones [4] ) containing nickel are in contact with the skin. Nickel may be considered a possible occupational allergen. Workers in whom nickel may be an occupational allergen primarily include hairdressers, retail clerks, caterers, domestic cleaners, and metalworkers. Individuals allergic to nickel occasionally may develop vesicles on the sides of the fingers (dyshidrotic hand eczema or pompholyx) from nickel in the diet.

Allergic contact dermatitis to nickel in a necklace. View Media Gallery

Rubber gloves

[5]

Allergy to 1 or more chemicals in rubber gloves is suggested in any individual with chronic hand dermatitis who wears them, unless patch testing demonstrates otherwise. Allergic contact dermatitis to chemicals in rubber gloves typically occurs maximally on the dorsal aspects of the hand. Usually, a cutoff of dermatitis occurs on the forearms where skin is no longer in contact with the gloves. Individuals allergic to chemicals in rubber gloves may develop dermatitis from other exposures to the chemicals (eg, under elastic waistbands).

Hair dye and temporary tattoos p-Phenylenediamine (PPD) is a frequent component of and sensitizer in permanent hair dye products and temporary henna tattoos [6] ; exposure in to it in hair dye products may cause acute dermatitis with severe facial edema. Severe local reactions from PPD may occur in black henna tattoos in adults and children. Epidemiologic data indicate that the median prevalence of positive patch test reactions to PPD among dermatitis patients is 4.3% (increasing) in Asia, 4% (plateau) in Europe, and 6.2% (decreasing) in North America. [7]

Textiles Individuals allergic to dyes and permanent press and wash-and-wear chemicals added to textiles typically develop dermatitis on the trunk, which occurs maximally on the lateral sides of the trunk but spares the vault of the axillae. Primary lesions may be small follicular papules or may be extensive plaques. Individuals in whom this allergic contact dermatitis is suspected should be tested with a series of textile chemicals, particularly if routine patch testing reveals no allergy to formaldehyde. New clothing is most likely to provoke allergic contact dermatitis, since most allergens decrease in concentration in clothing following repeated washings.

Preservatives

Preservative chemicals added to cosmetics, moisturizers, and topical medications are major causes of allergic contact dermatitis (see the image below). The risk of allergic contact dermatitis appears to be highest to quaternium-15, followed by allergic contact dermatitis to isothiazolinones. Methylisothiazolinone is used as an individual preservative and may be a significant allergen. [8] Kathon CG is methylchloroisothiazolinone in combination with methylisothiazolinone. Although parabens are among the most widely used preservatives, they are not a frequent cause of allergic contact dermatitis.

Severe allergic contact dermatitis resulting from preservatives in sunscreen. Patch testing was negative to the active ingredients in the sunscreen. View Media Gallery

Schnuch et al estimated that preservatives found in leave-on topical products varied over 2 orders of magnitude in relative sensitization risk. [9] Formaldehyde is a major cause of allergic contact dermatitis (see the image below). Certain preservative chemicals widely used in shampoos, lotions, other moisturizers, and cosmetics are termed formaldehyde releasers (ie, quaternium-15 [Dowicil 200], imidazolidinyl urea [Germall 115], and isothiazolinones [9] ). They are, in themselves, allergenic or may produce cross-sensitization to formaldehyde.

Onycholysis developing from allergic contact dermatitis to formaldehyde used to harden nails. View Media Gallery

Fragrances

[10, 11]

Individuals may develop allergy to fragrances. Fragrances are found not only in perfumes, colognes, aftershaves, deodorants, and soaps, but also in numerous other products, often as a mask to camouflage an unpleasant odor. Unscented products may contain fragrance chemicals used as a component of the product and not labeled as fragrance. Individuals allergic to fragrances should use fragrance-free products. Unfortunately, the exact chemicals responsible for a fragrance in a product are not labeled. Four thousand different fragrance molecules are available to formulate perfumes. The fragrance industry is not required to release the names of ingredients used to compose a fragrance in the United States, even when individuals develop allergic contact dermatitis to fragrances found in topical medications. Deodorants may be the most common cause of allergic contact dermatitis to fragrances because they are applied to occlude skin that is often abraded by shaving in women. Massage and physical therapists and geriatric nurses are at higher risk of occupational allergic contact dermatitis to fragrances.

Corticosteroids In the last decade, it has become clear that some individuals with chronic dermatitis develop allergy to topical corticosteroids. Most affected individuals can be treated with some topical corticosteroids, but an individual can be allergic to all topical and systemic corticosteroids.

Budesonide and tixocortol pivalate are useful patch test corticosteroids for identifying individuals allergic to topical corticosteroids.

Neomycin The risk of allergy to neomycin is related directly to the extent of its use in a population. The risk of allergy to neomycin is much higher when it is used to treat chronic stasis dermatitis and venous ulcers than when it is used as a topical antibiotic on cuts and abrasions in children. Assume that individuals allergic to neomycin are allergic to chemically related aminoglycoside antibiotics (eg, gentamicin, tobramycin). [12] Avoid these drugs both topically and systemically in individuals allergic to neomycin.

Benzocaine Avoid topical use of benzocaine. Benzocaine is included in most standard patch test trays. Individuals allergic to benzocaine may safely use or be injected with lidocaine (Xylocaine), which does not cross-react with benzocaine.

Sunscreens Many individuals complain of adverse reactions to sunscreens, but many of these individuals are not allergic to the sunscreen materials. They may be allergic to preservatives in these products or may have nonspecific cutaneous irritation from these products.

Photoallergy Occasionally, individuals develop photoallergic contact dermatitis. Allergic contact dermatitis may be accentuated by ultraviolet (UV) light, or patients may develop an allergic reaction only when a chemical is present on the skin and when the skin is exposed sufficiently to ultraviolet light A (UV-A; 320-400 nm). Acrylates and methacrylates

[13, 14]

These agents are used in manufacturing, nail acrylics, and wound dressings, among other uses.

DKA Etiologi Sekitar 25 bahan kimia tampaknya bertanggung jawab atas sebanyak setengah dari semua kasus dermatitis kontak alergi. Ini termasuk nikel, pengawet, pewarna, dan wewangian. Poison ivy Poison ivy (Toxicodendron radicans) adalah contoh klasik dari dermatitis kontak alergi akut di Amerika Utara. Dermatitis kontak alergi dari poison ivy ditandai oleh garis-garis linier

dermatitis akut yang berkembang di mana bagian tanaman telah bersentuhan langsung dengan kulit. Nikel Nikel adalah penyebab utama dermatitis kontak alergi di dunia. Insiden dermatitis kontak alergi nikel di Amerika Utara meningkat; sebaliknya, peraturan baru di Eropa telah mengakibatkan penurunan prevalensi alergi nikel pada wanita muda dan setengah baya. [2, 3] Dermatitis kontak alergi terhadap nikel biasanya dimanifestasikan oleh dermatitis di lokasi di mana anting-anting atau kalung (lihat gambar di bawah) yang mengandung nikel dipakai atau di mana benda-benda logam (termasuk keypad dari beberapa ponsel [4]) yang mengandung nikel berada dalam kontak dengan kulit. Nikel dapat dianggap sebagai alergen kerja yang mungkin. Pekerja di mana nikel mungkin merupakan alergen kerja terutama meliputi penata rambut, pegawai ritel, katering, pembersih rumah tangga, dan pekerja logam. Orang-orang yang alergi terhadap nikel kadang-kadang dapat mengembangkan vesikel pada sisi jari (eksim tangan dishidrotik atau pompholyx) dari nikel dalam makanan.

Allergic contact dermatitis to nickel in a necklace.

Sarung tangan karet [5] Alergi terhadap 1 atau lebih bahan kimia dalam sarung tangan karet disarankan pada setiap individu dengan dermatitis tangan kronis yang memakainya, kecuali pengujian patch menunjukkan sebaliknya. Dermatitis kontak alergi terhadap bahan kimia dalam sarung tangan karet biasanya terjadi secara maksimal pada aspek punggung tangan. Biasanya, potongan dermatitis terjadi pada lengan bawah di mana kulit tidak lagi bersentuhan dengan sarung tangan. Individu yang alergi terhadap bahan kimia dalam sarung tangan karet dapat mengembangkan dermatitis dari paparan lain terhadap bahan kimia (misalnya, di bawah ikat pinggang elastis). Pewarna rambut dan tato temporer

p-Phenylenediamine (PPD) adalah komponen yang sering dan peka pada produk pewarna rambut permanen dan tato henna sementara [6]; paparan dalam produk pewarna rambut dapat menyebabkan dermatitis akut dengan edema wajah yang parah. Reaksi lokal yang parah dari PPD dapat terjadi pada tato pacar hitam pada orang dewasa dan anak-anak. Data epidemiologis menunjukkan bahwa prevalensi median dari reaksi uji tempel positif terhadap PPD di antara pasien dermatitis adalah 4,3% (meningkat) di Asia, 4% (dataran tinggi) di Eropa, dan 6,2% (menurun) di Amerika Utara. [7] Tekstil Individu yang alergi terhadap pewarna dan bahan kimia pers dan pencuci permanen yang ditambahkan ke tekstil biasanya mengalami dermatitis pada batang tubuh, yang terjadi secara maksimal pada sisi lateral batang tubuh tetapi tidak menggunakan kubah aksila. Lesi primer bisa berupa papula folikel kecil atau bisa berupa plak yang luas. Orang-orang yang dicurigai menderita dermatitis kontak alergi ini harus diuji dengan serangkaian bahan kimia tekstil, terutama jika uji tempel rutin menunjukkan tidak ada alergi terhadap formaldehida. Pakaian baru kemungkinan besar akan memicu dermatitis kontak alergi, karena sebagian besar alergen menurunkan konsentrasi pakaian setelah dicuci berulang kali. Pengawet Bahan kimia pengawet yang ditambahkan ke kosmetik, pelembab, dan obat topikal adalah penyebab utama dermatitis kontak alergi (lihat gambar di bawah). Risiko dermatitis kontak alergi tampaknya paling tinggi dibanding quaternium-15, diikuti oleh dermatitis kontak alergi terhadap isothiazolinones. Methylisothiazolinone digunakan sebagai pengawet individu dan mungkin merupakan alergen yang signifikan. [8] Kathon CG adalah methylchloroisothiazolinone dalam kombinasi dengan methylisothiazolinone. Meskipun paraben adalah salah satu pengawet yang paling banyak digunakan, mereka tidak sering menjadi penyebab dermatitis kontak alergi.

Severe allergic contact dermatitis resulting from preservatives in sunscreen. Patch testing was negative to the active ingredients in the sunscreen.

Schnuch et al memperkirakan bahwa bahan pengawet yang ditemukan dalam produk topikal yang dibiarkan bervariasi lebih dari 2 kali lipat dalam risiko kepekaan relatif. [9] Formaldehyde adalah penyebab utama dermatitis kontak alergi (lihat gambar di bawah). Bahan kimia pengawet tertentu yang banyak digunakan dalam shampo, lotion, pelembab lainnya, dan kosmetik disebut pelepas formaldehida (yaitu, quaternium-15 [Dowicil 200], imidazolidinyl urea [Germall 115], dan isothiazolinones [9]). Mereka, dalam dirinya sendiri, alergi atau dapat menghasilkan sensitisasi silang terhadap formaldehida.

Onycholysis developing from allergic contact dermatitis to formaldehyde used to harden nails.

Parfum [10, 11] Individu dapat mengembangkan alergi terhadap wewangian. Wewangian tidak hanya ditemukan dalam parfum, cologne, aftershave, deodoran, dan sabun, tetapi juga di banyak produk lainnya, seringkali sebagai masker untuk menyamarkan aroma yang tidak sedap. Produk yang tidak berbau mungkin mengandung bahan kimia pewangi yang digunakan sebagai komponen produk dan tidak diberi label sebagai pewangi. Orang yang alergi terhadap wewangian harus menggunakan produk bebas pewangi. Sayangnya, bahan kimia yang tepat yang menyebabkan aroma dalam suatu produk tidak diberi label. Tersedia empat ribu molekul aroma berbeda untuk merumuskan parfum. Industri wewangian tidak diharuskan untuk merilis nama bahan yang digunakan untuk membuat wewangian di Amerika Serikat, bahkan ketika individu mengembangkan dermatitis kontak alergi terhadap wewangian yang ditemukan dalam obat topikal. Deodoran dapat menjadi penyebab paling umum dari dermatitis kontak alergi terhadap wewangian karena mereka digunakan untuk menyumbat kulit yang sering diabrasi dengan mencukur pada wanita.

Pijat dan terapis fisik dan perawat geriatri berisiko lebih tinggi terkena dermatitis kontak alergi terhadap wewangian. Kortikosteroid Dalam dekade terakhir, telah menjadi jelas bahwa beberapa individu dengan dermatitis kronis mengembangkan alergi terhadap kortikosteroid topikal. Kebanyakan individu yang terkena dapat diobati dengan beberapa kortikosteroid topikal, tetapi seorang individu dapat alergi terhadap semua kortikosteroid topikal dan sistemik. Budesonide dan tixocortol pivalate adalah kortikosteroid uji tempel yang berguna untuk mengidentifikasi individu yang alergi terhadap kortikosteroid topikal. Neomisin Risiko alergi terhadap neomisin terkait langsung dengan tingkat penggunaannya dalam suatu populasi. Risiko alergi terhadap neomisin jauh lebih tinggi ketika digunakan untuk mengobati dermatitis stasis kronis dan borok vena dibandingkan ketika digunakan sebagai antibiotik topikal pada luka dan lecet pada anak-anak. Asumsikan bahwa individu yang alergi terhadap neomycin alergi terhadap antibiotik aminoglikosida yang terkait secara kimiawi (misalnya, gentamisin, tobramycin). [12] Hindari obat-obatan ini baik secara topikal maupun sistemik pada orang yang alergi terhadap neomycin. Benzocaine Hindari penggunaan benzocaine secara topikal. Benzocaine termasuk dalam sebagian besar baki uji tempel. Orang yang alergi terhadap benzocaine dapat dengan aman menggunakan atau disuntik dengan lidocaine (Xylocaine), yang tidak bereaksi silang dengan benzocaine. Tabir surya Banyak orang mengeluh reaksi buruk terhadap tabir surya, tetapi banyak dari orang-orang ini tidak alergi terhadap bahan tabir surya. Mereka mungkin alergi terhadap bahan pengawet dalam produk ini atau mungkin memiliki iritasi kulit spesifik dari produk ini. Fotoalergi Kadang-kadang, individu mengembangkan dermatitis kontak fotoalergi. Dermatitis kontak alergi dapat ditekankan oleh sinar ultraviolet (UV), atau pasien dapat mengembangkan reaksi alergi hanya ketika bahan kimia ada pada kulit dan ketika kulit terpapar secukupnya pada sinar ultraviolet A (UVA; 320-400 nm) . Acrylates dan methacrylates [13, 14] Agen ini digunakan dalam pembuatan, akrilik kuku, dan pembalut luka, di antara kegunaan lain.

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