Allergic and Irritant Contact Dermatitis (Allergic Skin Diseases)
Dermatitis is inflammation of the upper layer of the skin. It is the skin's response to a stimulus that is considered harmful. The stimulus need not actually be harmful. This response is given to neutralize the stimulus.
Among adults, the most common type of eczema is contact dermatitis. There are two types of contact dermatitis; These are allergic contact dermatitis and irritant contact dermatitis. Since both occur with direct contact of harmful substances, it is difficult to distinguish them clinically.
In order to overcome contact dermatitis, contact with these harmful substances must be eliminated.
Allergic Contact Dermatitis
It is an immunological reaction (initiated by the immune system) that occurs when the same substance comes into contact with the skin that has previously been sensitized by contact with any allergenic substance. Allergic contact dermatitis constitutes approximately 25-30% of patients diagnosed with contact dermatitis. Allergic contact dermatitis is mostly seen in people prone to allergies. If the skin is traumatized and infected, the penetration of the allergen through the skin increases and sensitivity develops much more easily. There is a high risk of developing allergic contact dermatitis, especially due to locally applied medications. The characteristic red, itchy and sometimes watery eczematous lesions appear after direct contact with certain allergens. Allergic contact dermatitis can be seen at any age. It is slightly more common in women than men due to environmental factors. In women, it consists of cosmetics, and in men, it consists of substances they encounter professionally. In addition, while occupational and cosmetic allergens are more common in young people, topical drugs are in the forefront in the elderly.
The main allergens that cause allergic contact dermatitis are; antiseptic agents, nickel, rubber, fabric dyes, plants (poison ivy), elements, clothes, shoes, cosmetics, rubber, plastic, locally applied drugs, sunscreens and perfumes.
Sensitivity to an allergen can last for weeks or years. In fact, hypersensitivity can last a lifetime. Be contact sensitive Acute exacerbation and healing periods of dermatitis are observed in people with allergies, depending on the frequency of re-contact with the allergen and the duration of contact.
If contact with the causative allergen is completely stopped, dermatitis usually heals within a few weeks. If contact with the allergen continues, dermatitis becomes chronic. The localization and clinical appearance of allergic contact dermatitis to a specific body area can often give clues to the identification of the allergenic substance.
Irritant Contact Dermatitis
External contact with the skin. It is a local inflammatory and non-immunological reaction caused by some irritating substances, that is, not initiated by the immune system. It accounts for an average of 70% of all contact dermatitis cases. It occurs due to the toxic effects of substances. Since sensitization does not have to be acquired beforehand, it can occur even after the first contact with the substance. When an irritating substance contacts the skin for a sufficient amount of time, it causes cell damage and inflammation in the skin. The irritating substance first destroys the structure of the upper layer of the skin, dissolves the oils in the skin and changes the water retention capacity of the skin. For this reason, the skin dries, its protective structure is destroyed and its elasticity is lost. Irritants then cause damage to living cells in the deeper parts of the skin.
Each irritant has a concentration threshold at which it can react. After contact with an irritant substance that exceeds this threshold, irritant contact dermatitis occurs within a few minutes to a few hours. While strong irritants cause dermatitis in almost everyone at first contact, weak irritants usually cause dermatitis after repeated contact. Skin that is damaged by excessive moisture, exposed to heat, cold, pressure and irritation is prone to irritant dermatitis. Dry and thin skin has a greater reaction to irritations.
What are the substances that can cause irritant contact dermatitis?
The most common substances that cause irritant contact dermatitis are water and soap, which are the substances we encounter frequently in daily life. Water is drying and causes cell damage in eroded skin. Substances such as lime and magnesium found in hard water also accumulate in the cracks of the skin and cause mechanical irritation. Soaps make the skin alkaline They degrease (destroy the neutral structure) and cause calcium and magnesium precipitation by removing oil.
The main irritating substances that cause irritant contact dermatitis are; water, soap, detergents, alkalis, acids (sulfuric acid, acetic acid, hydrochloric acid, nitric acid), organic solvents (white spirit, diesel oil, fuel oil, gas, thinner, benzene, acetone), oxidizing agents (benzoyl peroxide, sodium hypochlorite), plants (citrus peel, garlic, spices, onion), physical and mechanical factors (heat, cold, wind, humidity, sunlight), patches and topical (tar, anthralin, potassium permanganate, gentian purple) drugs.< br /> The backs of the hands, the sides of the fingers facing the palm, wrists and forearms are the areas most frequently affected by the disease, as they are the areas most frequently in contact with irritants. In the early stages of this type of dermatitis, dryness is observed in the spaces between the fingers, where irritating substances frequently accumulate. If contact with the irritating substance continues, the entire hand may be affected and pain, sensitivity and limitation of movement develop in the affected skin.
It is known that some professions have a high risk of contact dermatitis. Some of the occupational groups at high risk for chronic contact dermatitis are: Bakers, doctors, nurses, hospital workers, butchers, cleaning workers, cooks, construction workers, dental technicians, fishermen, gardeners, hairdressers, metal workers, engine-mechanical workers. (e.g. auto mechanics), printing house workers.
The important thing in both allergic contact dermatitis and irritant contact dermatitis is to identify the substances that cause the event and to avoid contact with these substances. Patients should be educated about its use, and employers should be educated about protective measures such as protective creams, clothing materials and special cleaning practices. In severe cases, a change of profession may be recommended.
What is Atopic Dermatitis (Eczema)?
It is a chronic, recurrent itchy rash. Active lesions may be widespread throughout the body or limited to one area. These may be in the form of pink, watery, itchy lesions. They can become infected as a result of excessive scratching. Skin thickening, lines, peeling and discoloration in periods when lesions constantly recur or do not heal.
The distribution of the lesions in the body varies depending on the age of onset of the disease.
1. Infantile Atopic Dermatitis: It is seen in children between the ages of 2 months and 2 years. Lesions occur especially on the face (often on the cheeks), scalp, neck, back, knee and elbow areas. The disease, which begins in this period, may heal at the age of 3 or continue into later childhood years.
2. Childhood Atopic Dermatitis: It is seen between the ages of 2-12. Skin lesions are often seen in the front of the elbow, behind the knee, neck, wrist and ankle. There is dryness, streaking, watering and itching in the skin areas where the lesions occur.
3. Adult Atopic Dermatitis: Continuation of childhood atopic dermatitis or the skin that first started between the ages of 12-20. may occur as a disease. Skin lesions are often found in front of the elbow and behind the knee. Sometimes it can also occur in the hands. It usually causes lines, thickening and browning of the skin. Sometimes it may be accompanied by dryness and flaking of the skin around the eyes and mouth. It usually has a chronic course.
Findings That May Accompany Atopic Dermatitis:
Different lines on the palms and soles of the feet,
Dark shadows under the eyes,
Pale colored areas with well-defined borders on the cheeks, back, arms and legs.
Babies with atopic dermatitis may develop Asthma or allergic rhinitis in later years.
What are the factors that aggravate the disease?
Soap and Detergents
Soap and detergents eliminate the "natural oiliness" of the skin. It causes the skin to dry out, increase itching, and become sensitive to stimuli. For this reason, alkaline (basic) soaps should not be used while bathing (almost all classical soaps on the market are alkaline). Additionally, soaps containing perfume or dyes should not be used.
When using detergents and similar substances during household chores, special work gloves with cotton inner surface should be used.
Strong detergents and softeners should not be used when washing laundry and clothes. The same goes for bedding. laundry For washing, mild detergents (such as soap powder) that do not contain color and fragrance additives should be used, and the rinsing process should be repeated 2 or 3 times to completely remove chemical residues.
Perfume and cosmetics
Perfume, hair spray, make-up, cologne, shaving lotion, shaving foam and similar substances cause irritation on the skin with atopic dermatitis. Such substances should not be used.
Antibacterial deodorants should also not be preferred.
Clothes
Wool or downy clothing increases itching in patients with atopic dermatitis.
Heat and sweating
Excessive hot and extremely cold weather initiates complaints. Such environments should be avoided.
Sweating should also be prevented. Choosing clothes according to the climate, room temperature, wearing light night clothes when going to bed, not using thick bedding, etc. Precautions such as should be taken.
Stress, scratching habit, vicious cycle of "itching-scratching"
Stress is not a factor that directly causes atopic dermatitis. But it often causes symptoms to worsen. Patients often feel the need to scratch lesion areas in situations of stress. The act of scratching increases itching, and the patient begins to scratch more. This vicious circle continues like this.
This vicious circle can be broken at certain points. One of these is undoubtedly anti-itch medications. But the main point that is wanted to be emphasized here is the duties and practices of the patient and the patient owners; Nails should be cut short and the damage to the skin caused by scratching should be minimized.
Cotton gloves can be worn while sleeping (especially in children) to prevent scratching at night.
Stress-relieving exercises or hobbies can also be tried.
What should not be forgotten is that the better the itching action can be controlled, the more the symptoms of atopic dermatitis will improve.
Foods
Foods affect approximately 10% of children with atopic dermatitis. It appears as a factor that worsens the symptoms of the disease. The main foods that increase complaints are cow's milk, eggs, soy, wheat, tomatoes, fish and snacks such as peanuts.
So what food increases complaints?
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