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Irritant Contact Dermatitis and Eczema Therapies by Physicians

  1. Physicians want to find therapies for irritant contact dermatitis and other eczema conditions that would be more effective, long-term, than the current typical treatment with steroids prescribed at the chronic and acute stages. Chronic dermatitis therapy may continue indefinitely. The dry, scaling, thickened skin of chronic dermatitis is better treated with a topical corticosteroid ointment if the patient does not find an ointment too greasy. The frequent use of moisturizers is encouraged. Systemic corticosteroids should be used in chronic contact dermatitis only when other forms of treatment fail, and their use should be stopped as soon as possible to avoid serious side effects. (Marks and DeLeo)
  2. Physicians are seeing exponentially more cases of irritant contact dermatitis caused by new materials and chemicals in common products (such as antibacterial soaps, shampoos, parabens used as preservatives in cosmetics, textiles, detergents, adhesives, food and food packaging, contraceptives, household cleaners, automobile interiors and parts, recycled paper and garden chemicals) and government-dictated universal precautions (such as required use of antibacterial hand cleansers and protective gloves by healthcare, police, and food service workers). Numerous epidemiological studies of the incidence of allergic contact dermatitis (ACD) versus irritant contact dermatitis (ICD) report that the ACD is found in 5-20% of cases when patch tests are performed.(Rietschel and Fowler) In the general population, the incidence of hand eczema varies between 2 and 10%. In high risk occupations such as hairdressing, cleaning, agriculture, construction, and steelworkers, the incidence may occasionally increase to 40%. Dermatological disorders are responsible for 3- to 40% of all occupational diseases. (Henk B. Van der Walle reference Menne)
  3. Physicians, Hospital and LTC organizations are actively looking for better SOLUTIONS to address the problems associated with Contact Dermatitis. A Disease Management approach is of most interest to managed care and group purchasing organizations who constitute over 80% of the market demand for pharmaceutical and medical care products.
  4. A personal or family history of atopy increased the risk of hand eczema. A personal history of childhood eczema was associated with a 3-fold risk of hand eczema, while a personal history of asthma or hay-fever was associated with a 1.6 times increased risk. (van der Valk). Rystedt has extensively studied hand eczema in atopics. She found that of those with childhood atopic dermatitis of either moderate or severe degree (44% and 55% respectively) developed hand eczema even without irritant work exposure, whereas 68 to 81% who worked as house cleaners, nurses, food handlers or hairdressers developed hand eczema.(Ritschel and Fowler)
  5. It is often impossible to distinguish between irritant and allergic contact dermatitis of the hands without performing patch tests. It is the only scientific proof that a contactant is a dermatitis-producing allergen in a particular case. (Ritschel and Fowler)

Problems with current topical cortisteroid treatment are:

Pharmaceutical researchers and dermatologists report serious potential systemic toxic and local side effects of corticosteroids, especially when used for children. Children are more prone to develop systemic reactions to topically applied medication because of their higher ratio of total body surface to body weight. Many side effects of the systemic use of steroids have been noted. Local side effects: Topical application of corticosteroids can cause atrophy; striae [scaring] can occur in children as well as adults. (Maibach and Surber).

References:

Maibach, HI and Surber, C, eds, Topical Corticosteroids, Karger, Basel, 1992.

Menne, T and Maibach, HI, Hand Eczema, CRC Press, Boca Raton, 1994.

Marks, JG, and DeLeo, VA, Contact Occupational Dermatology, Mosby, St. Louis, 1997.

Rietschel, Robert L. and Fowler, Joseph F., Fisher’s Contact Dermatitis, Fourth Edition,
Williams and Wilkins, Baltimore, 1995.

Van der Valk, Pieter and Maibach, Eds, The Irritant Contact Dermatitis Syndrome,
CRC Press, Boca Raton, 1996.

 

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