CONTACT DERMATITIS (CEMENT) PHOTO Reassure and some instruction

32 YEARS OLD MAN CAME TO YOUR SURGERY PRESENTED First of all we would use some corticosteroid cream If
WITH HAND LESION. there is infection I will give you a systemic antibiotic as
TASK: TAKE RELEVANT HISTORY well. (Amoxicillin)
EXPLAIN THE CONDITION TO THE PATIENT Severe cases of contact dermatitis – give oral
GIVE MANAGEMENT corticosteroid for a short time, but gradually withdraw it
(start for 10 days and gradually withdraw it in 10 days)
Differential Diagnosis:
Contact Dermatitis (Cement) Some advices regarding your job
OCD You have to search for another position in your
Herpes Zoster company. Try to speak to your manager or boss
regarding your condition, if you can’t have a change of
work, try to avoid the triggering substance.
How long did you have this problem? We have this barrier cream, zinc oxide, place some in
Any dermatological case: How did it start? your hand, put on cotton gloves and then put on the
Where did it start? rubber gloves. Because the rubber by itself can cause
Does it spread anywhere else? allergy and aggravate your situation.
Is it itchy Mr Smith?
How did it start? Wash your hands after and dry softly.
Ask about pain or disturbance of sensation
Do you notice any other symptoms? Use cortisone cream for 7days to 2 weeks. Apply
Any Fever or lumps? regularly.
Have you tried any cream?
Did you try any medication? Does it help or not? Try to use soap substitutes.

Is it the first time to have this condition? I will refer you to the pathologist to do the Patch Test.
Do you have any type of allergy? Like hav fever, asthma Define which materials/substance you are allergic too.
or skin asthma?
Any other medical condition? I can refer him to the dermatologist if my patient is
concerned. Sometimes they do in the derma clinic
What is your occupation? sometimes in the laboratory.
(Construction, chemist)
Do you wear gloves regularly? +/- maybe from the Serum Allergic Test – new test
gloves itself 1. Dermatitis
How do you wear the gloves? 2. Allergic rhinitis
Do you have contact with any chemicals or construction 3. Asthma
substance?
Do you have any pets at home? 3 panels
Are you living alone?
Do you wash your hands more frequently?
Any family history of allergic condition?

Does this condition affect your daily life or work? Contact dermatitis
Explanation Acute contact (exogenous) dermatitis can be
You have what is called allergic contact dermatitis. This either irritant or allergic.
condition resulted from inflammation caused by an
allergic or irritating that came in contact with your skin.
The reaction can be acute or sudden or can be chronic Features
(and comes slowly)
We have 2 types of contact dermatitis  Itchy, inflamed skin
1. allergic contact dermatitis  Red and swollen
a, acute – sudden onset – within  Papulovesicular
minutes or hour  May be dry and fissured
b. Chronic – slowly (hours, days or
months)
Irritant contact dermatitis
2. non allergic contact dermatitis – delayed
hypersensitivity reaction Caused by primary irritants such as acids, alkalis,
detergents, soaps, oils, solvents. This is irritation, not
allergy.
Allergic contact dermatitis  Refer to a dermatologist for patch testing

Caused by allergens that provoke an allergic reaction in Management

some individuals only—most people can handle the
chemicals without undue effect. It is immunologically
mediated. This allergic group also includes photo-
contact allergens. Contact dermatitis is due to delayed
hypersensitivity, sometimes with a long time of days to
years. It is common in industrial or occupational
situations where it usually affects the hands and
forearms.
Common allergens
 Determine cause with vigor and remove it
 Wash with water (only) and pat dry (avoid soap)
 If acute with blistering, apply Burow's
compresses
 Oral prednisolone for severe cases (start with
25–50 mg daily for adults for 1–2 weeks then
gradually reduce over 1–2 weeks)
 Topical corticosteroid cream
 Oral antibiotics for secondary infection

 Ingredients in cosmetics (e.g. perfumes, Chronic phase

preservatives)
 Topical antibiotics (e.g. neomycin)
Use fragrant-free moisturers regularly, e.g.:
 Topical anaesthetics (e.g. benzocaine)
 Topical antihistamines
 Plants: rhus, grevillea, primula, poison ivy  glycerol 10% in sorbolene cream or
 Metal salts (e.g. nickel sulphate, chromate)  white soft paraffin or
 Dyes  a proprietary emollient handcream
 Perfumes
 Rubber/latex
 Epoxy resins and glues/acrylates
 Coral

Note: The skin of mangoes cross-reacts with rhus and

grevillea.

Clinical features4

 Dermatitis ranges from faint erythema to ‘water

melon’ face oedema
 Worse in periorbital region, genitalia and hairy
skin; least in glabrous skin (e.g. palms and
soles)

Note: Can be delayed onset.

 Think of rhus, grevillea or poison ivy allergy if

puffy eyes

Diagnostic hallmarks4

 Site and shape of lesions suggest contact

 Linear lesions a feature
 Allergic causes may be found by patch testing
 Improvement when off work or on holiday

Diagnosis

 Careful history and examination

 Consider occupation, family history, vacation or
travel history, clothes (e.g. wetsuits, new
clothes, Lycra bras), topical applications (e.g.
medicines, cosmetics)