Contact dermatitis toxic L24.-

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 04.12.2023

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Acute irritant contact dermatitis; Cumulatively toxic hand eczema; Dermatitis degenerative; dermatitis toxica; Eczema Cumulative toxic contact dermatitis; Eczema toxic degenerative; Eczema traumiterative; Hand eczema cumulative toxic; irritant dermatitis; Irritative contact dermatitis; Toxic contact dermatitis; Toxic contact eczema; toxic dermatitis; Toxic dermatitis; Wear and tear dermatosis

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Exogenously triggered, acute or chronic inflammation of the skin which, in contrast to allergic (contact allergic) contact dermatitis, is not triggered by prior sensitization and is generally strictly limited to the site of exposure. In the case of chronic hand dermatitis and patients who are predisposed to it, an occupational disease must be clarified.

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"Dermatitis " after acute or chronic toxic effects (according to Rueff F and Schnuch A 2018) - See also under eczema term

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In most cases the hands are affected (90%); less frequently the feet or other covered parts of the body.

Clinical features
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Erythema strictly limited to the site of exposure (back of the hand, interdigital spaces, rarely palms), two-dimensional, scaly and itchy erythema, grouped nodules and plaques, depending on the acuity also vesicles or blisters. In addition, erosions, crusts and scratching effects.

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Avoidance or reduction of the acting contact noxae. Depending on the degree of severity and acuteity, purely external or internal therapy.

External therapy
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Phase-appropriate therapy of dermatitis, see below. Eczema.

Initially, medium to strong glucocorticoids, in aqueous base, solution or hydrophilic cream, such as 0.1% hydrocortisone butyrate (e.g., Laticort cream) or 0.1% triamcinolone acetonide (e.g., Triamgalen, altetnative: Rp:triamcinolone acetonide cream hydrophilic 0.025/0.05/0.1% (NRF 11.38.) . In the weeping or chronic eczema stage, medium to strong glucocorticoids in greasy bases such as Laticort ointment, 0.25% prednicarbate (e.g. Dermatop® cream/ointment), 0.1% mometasone furoate (e.g. Ecural® cream/ointment). In addition, moist compresses with NaCl solution, especially in the case of weeping skin lesions, with antiseptic additives such as quinolinol (e.g., Chinosol 1:1000), or potassium permanganate (light pink) if there is evidence of superinfection. In the vesicular stage, fat-moist treatment with topical glucocorticoids in a high-fat ointment base (e.g., hydrocortisone 1% in Vasel. alb. (Hydrocortisone ointment 1%) and moist compresses, cotton glove if necessary.

In severely scaling-hyperkeratotic forms, the application of topical glucocorticoids is also recommended under occlusion.

Omit soaps and detergents, cleanse with oil-containing baths (Balneum Hermal, Balmandol, Linola fat oil bath). Try antiphlogistic externals such as ichthyol (e.g. Ichthosin cream). Follow-up treatment with refatting externals in a compatible base (Alfason repair, Excipial repair sensitiv, Linola Fett, Vaseline alb., Excipial® almond oil ointment) if necessary addition of 2-10% urea (Rp: urea cream hydrophilic 5 or 10% (NRF 11.71.) .

If necessary, apply Zarzenda cream (internationally known as Atopiclair®). This is a steroid-free, topical multicomponent cream with a strong antipruritic, anti-inflammatory effect (apply 2 times/day).

In case of occupational conditions: skin protection preparations, gloves, etc., if necessary. See below Occupational dermatoses.

Internal therapy
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Glucocorticoids (100-150 mg prednisolone equivalent/day) p.o., possibly antihistamines such as desloratadine (e.g. Aerius 1-2 bl./day) or levocetirizine (e.g. Xusal 1-2 filmtbl./day).S.a. Eczema.

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  1. Crowson AN et al (2003) Progress in the understanding of the pathology and pathogenesis of cutaneous drug eruptions: implications for management. At J Clin Dermatol 4: 407-428
  2. Rueff F (2018) Toxic and allergic contact dermatitis. In: Plewig G et al. Braun-Falco`s Dermatology, Venerology and Allergology. Springer Reference Medicine, Springer Publishing House S 512
  3. Rustemeyer T et al (1994) Contact allergies in medical occupations. dermatologist 45: 834-844


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Last updated on: 04.12.2023