Contact dermatitis toxic L24.-

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

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

Definition
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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.

Classification
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"Eczema diseases" after chronic irritative effects (n. Rueff F and Schnuch A 2018)

Localization
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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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Strictly limited to the site of exposure (back of the hand, interdigital spaces between fingers, more rarely palms), flat, scaly and itchy erythema, grouped nodules and plaques. Also erosions, crusts and scratching effects.

Therapy
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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 an aqueous base, in solution or hydrophilic cream, such as 0.1% hydrocortisone butyrate (e.g. Laticort cream) or 0.1% triamcinolone acetonide (e.g. Triamgalen, R259 ). In the weeping or chronic eczema stage medium to strong glucocorticoids in oily 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 case of weeping skin changes, in case of persistent superinfection with antiseptic additives such as quinolinol (e.g. Chinosol 1:1000), R042 or potassium permanganate (light pink). In the vesicular stage lipid-moist treatment with topical glucocorticoids in a fat-rich ointment base (e.g. hydrocortisone 1% in Vasel. alb.(hydrocortisone ointment 1%) and moist compresses, possibly cotton gloves.

In case of strongly scaly hyperkeratotic forms, the application of topical glucocorticoids is also recommended under occlusion.

Omit soaps and detergents, cleaning with oil-containing baths (Balneum Hermal, Balmandol, Linola grease oil bath). Try anti-inflammatory topical preparations such as Ichthyol (e.g. Ichthosin cream). After-treatment with replenishing external agents in a compatible basis (Alfason repair, Excipial repair sensitive, Linola fat, Vaseline alb., Excipial® almond oil ointment), if necessary addition of 2-10% urea R102.

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

In case of occupational reasons: skin protection products, gloves etc. if necessary. S.u. and 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.

Literature
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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

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020