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__NOTOC__
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{{Contact dermatitis}}
{{Contact dermatitis}}
{{CMG}} {{AE}} [[Ogechukwu Hannah Nnabude, MD]]
==Pathophysiology==


'''Irritant contact dermatitis'''  
'''Irritant contact dermatitis'''  
   
   
It is due to sufficient inflammation arising from the release of proinflammatory cytokines from keratinocytes, usually in response to chemical stimuli. It mainly causes skin barrier disruption, epidermal cellular changes, and cytokine release.
Irritant contact dermatitis arises from sufficient inflammation due to the release of proinflammatory cytokines from keratinocytes, in response to chemical stimuli. This causes skin barrier disruption, epidermal cellular changes, and cytokine release <ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020. </ref>


Irritants can be classified as cumulatively toxic (e.g., hand soap causing irritant dermatitis in a hospital employee), subtoxic, degenerative, or toxic (e.g., hydrofluoric acid exposure at a chemical plant).
Irritants can be classified as <ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020. </ref>
*Cumulatively toxic (e.g., hand soap causing irritant dermatitis in a hospital employee)
*Subtoxic
*Degenerative
*Toxic (e.g., hydrofluoric acid exposure at a chemical plant).


'''Allergic contact dermatitis'''
'''Allergic contact dermatitis'''


It is T-cell mediated inflammation of the skin caused by repeated skin exposure to haptens in a sensitized individual.
Allergic contact dermatitis is T-cell mediated inflammation of the skin due to repeated skin exposure to haptens in a sensitized individual.<ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> ... </ref>


Allergic contact dermatitis has two phases. The sensitization phase in which antigen-specific effector T cells are induced in the draining lymph nodes by antigen captured cutaneous dendritic cells that migrate from the skin. The elicitation phase includes effector T cells that are activated in the skin by antigen captured cutaneous dendritic cells and produce various chemical mediators, which create antigen-specific inflammation.
Allergic contact dermatitis has two phases.<ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020. </ref>
*The sensitization phase; antigen-specific effector T cells are induced in the draining lymph nodes by antigen captured cutaneous dendritic cells that migrate from the skin.  
*The elicitation phase; effector T cells that are activated in the skin by antigen captured cutaneous dendritic cells and produce various chemical mediators, which create antigen-specific inflammation.


Photo contact dermatitis occurs when an allergen becomes an irritant in the presence of light.
Photo contact dermatitis occurs when an allergen becomes an irritant in the presence of light.<ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020. </ref>


Contact urticaria usually presents with a 'wheal and flare' reaction after exposure to the offending topical agent. While most cases are mild, anaphylactic reactions can occur. Some common types of contact urticaria include exposure to cold, dermatographism, pressure, exercise, solar, heat and cholinergic.
Contact urticaria usually presents with as a 'wheal and flare' reaction after exposure to the offending topical agent. While most cases are mild, anaphylactic reactions can occur.  
Some common types of contact urticaria include <ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020. </ref>
*Exposure to cold
*Dermatographism
*Pressure
*Exercise
*Solar
*Heat
*Cholinergic.


Contact dermatitis can also occur after exposure to plants of the Urticaceae family.
Contact dermatitis can also occur after exposure to plants of the Urticaceae family.<ref name="Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020."> Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020. </ref>


=='''References'''==
=='''References'''==
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Latest revision as of 21:08, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Ogechukwu Hannah Nnabude, MD

Pathophysiology

Irritant contact dermatitis

Irritant contact dermatitis arises from sufficient inflammation due to the release of proinflammatory cytokines from keratinocytes, in response to chemical stimuli. This causes skin barrier disruption, epidermal cellular changes, and cytokine release [1]

Irritants can be classified as [1]

  • Cumulatively toxic (e.g., hand soap causing irritant dermatitis in a hospital employee)
  • Subtoxic
  • Degenerative
  • Toxic (e.g., hydrofluoric acid exposure at a chemical plant).

Allergic contact dermatitis

Allergic contact dermatitis is T-cell mediated inflammation of the skin due to repeated skin exposure to haptens in a sensitized individual.[1]

Allergic contact dermatitis has two phases.[1]

  • The sensitization phase; antigen-specific effector T cells are induced in the draining lymph nodes by antigen captured cutaneous dendritic cells that migrate from the skin.
  • The elicitation phase; effector T cells that are activated in the skin by antigen captured cutaneous dendritic cells and produce various chemical mediators, which create antigen-specific inflammation.

Photo contact dermatitis occurs when an allergen becomes an irritant in the presence of light.[1]

Contact urticaria usually presents with as a 'wheal and flare' reaction after exposure to the offending topical agent. While most cases are mild, anaphylactic reactions can occur. Some common types of contact urticaria include [1]

  • Exposure to cold
  • Dermatographism
  • Pressure
  • Exercise
  • Solar
  • Heat
  • Cholinergic.

Contact dermatitis can also occur after exposure to plants of the Urticaceae family.[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Graham Litchman; Pragya A. Nair; Amber R. Atwater; Beenish S. Bhutta. Contact Dermatitis. StatPearls Publishing LLC. May 12, 2020.

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