Contact dermatitis

Contact dermatitis as the name implies is a skin inflammation brought about by contact with a substance to which the body reacts. ^[1] It can be classified as allergic or irritant. The latter is the more common type usually caused by chemicals in industrial and household cleaning products. ^[2]

Causes

Irritant dermatitis is typically caused by a substance that comes in direct contact with the skin that brings damage. Dermatitis develops on the initial exposure. Offending substances include cement, hair dyes, shampoos, pesticides, wet diapers and rubber gloves.  In allergic dermatitis, there is an immune response that has developed after a person comes in contact to a substance to which he has a previous exposure to. 24-48 hours usually elapse for the reaction happen. Substances that can trigger the allergic reaction include adhesives, antibiotics, clothing, perfumes, cosmetics, nail polish, hair dye, nickel, metals in jewelry and watch straps, gloves and shoes. ^{[2] [3]}

Signs and Symptoms

In allergic dermatitis, itching is a common finding whereas pain or burning sensation of the affected area is frequent in irritant dermatitis. Contact dermatitis may produce red rashes or skin bumps, blisters, scaly or thickened skin and dry, cracked patches. ^{[3] [4]}   

Differentiating dermatitis from allergy and from irritant may be done roughly by analyzing the skin lesions. In the allergic type, the skin manifestations are commonly confined to the area that directly came in contact with the object and itchy whereas it would be more widespread and more painful than itchy with the irritant type. Moreover, rash is usually immediate with the irritant dermatitis while it may be delayed in allergy. ^[5]

Diagnosis

History of exposure to possible allergen or irritant and physical examination of the skin is usually enough to make a diagnosis. Other exams may include allergy testing or patch testing, skin biopsy and culture. ^[3]

Treatment

Wash the affected area thoroughly to remove irritants. Avoid exposure to allergens in cases of allergic dermatitis. Inflammation may be dealt with by using corticosteroid creams or ointments. When there is severe itching, anti-pruritic lotion or antihistamines may be given.  Antibiotics are prescribed when there is infection. It is always best to avoid the offending substance to prevent it from happening again. ^{[3] [6]}

References:

1.      http://www.patient.co.uk/health/contact-dermatitis

2.      http://www.emedicinehealth.com/contact_dermatitis/page2_em.htm#contact_dermatitis_causes

3.      http://www.nlm.nih.gov/medlineplus/ency/article/000869.htm

4.      http://www.mayoclinic.com/health/contact-dermatitis/DS00985/DSECTION=symptoms

5.      http://www.webmd.com/skin-problems-and-treatments/contact-dermatitis

6.      http://www.patient.co.uk/health/contact-dermatitis

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Mugwort (Artemisa Vulgaris) [1, 7, 8, 9]:

Please note, this management does NOT treat the condition itself. It has been proposed only as a weak supportive symptomatic support, and even then, has been discounted due life-threatening side effects

Recommendation: No recommendation (There is insufficient evidence to support claims that mugwart helps to treat symptoms of dermatitis. More research is needed.)

Grade of Evidence: Very low quality of evidence

Evening Primrose Oil  [1, 4, 5, 6]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation  (Available evidence does not support claims that primrose oil can help with dermatitis. Studies have shown conflicting results)

Grade of Evidence: Low quality of evidence

Chamomile (Matricaria Chamomilla) [1, 2, 3]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (Available evidence does not support claims that Chamomile helps treat contact dermatitis. In addition, allergic reactions and side effects like cramps, itching, rashes and difficulty breathing can be relatively common)

Grade of Evidence: Low quality of evidence

Black Walnut (Juglans Nigra):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (Available evidence does not support claims that Black Walnut helps to treat contact dermatitis)

Grade of Evidence: Low quality of evidence

Arnica Root (Arnica Montana):

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (available evidence shows that Arnica is in no way helpful in the treatment of contact dermatitis)

Grade of Evidence: Moderate quality of evidence

Heat Therapy

Recommendation: Weakly against (there is scant evidence that heat therapy may help speed healing in skin infections, however more research is needed, and there are possible harmful effects to heat therapy being used without supervision by a qualified physician)

Grade of Evidence: Low quality of evidence

Pau Darco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla)

Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.

Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'arco helps to treat dermatitis. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)

Grade of Evidence: Very low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.abchomeopathy.com/r.php/Cham

3. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html

4. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/evening-primrose

5. http://nccam.nih.gov/health/eveningprimrose/

6. http://news.bbc.co.uk/2/hi/health/4395826.stm

7. Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.

8. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/mugwort

9. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.