Calixtro, Laidelle Jascinth M.
BSN-III
NARRATIVE PATHOPHYSIOLOGY OF CONTACT DERMATITIS
Contact dermatitis happens when the skin becomes irritated or inflamed after coming
in contact with a substance that triggers an allergic reaction. It bears some of the same
symptoms as the six other types of eczema. Contact dermatitis is an inflammatory eczematous
skin disease. It is a type IV delayed hypersensitivity reaction. It can either be an acute or
chronic skin condition caused by contact with an exogenous substance that elicits an allergic
response. It can be classified into four types namely allergic, irritant, phototoxic, and photo
allergic. Majority of the cases are caused by an excessive exposure to or additive effects of
irritants for particularly soaps, detergents, organic solvents. Skin sensitivity may develop after
brief or prolonged periods of exposure, and the clinical picture may appear hours or weeks
after the sensitized skin has been exposed.
Solvent, Rubbing Alcohol, and Airborne substances are the etiological factors of the
irritant contact dermatitis which can lead to either an acute exposure or chronic or repeated
exposure. In acute exposure there would be a direct damage to keratinocytes causing
Perivascular inflammation and vascular dilatation, spongiosos (accumulation of fluid in the
epidermis), vesiculation and erosion and crusting causing shedding of crusts or scaling which
give rise to to necrosis in which the tissue are shed and results to ulceration, and the
stimulation of local nociceptors can cause burning stinging and pruritus and this pruritus can
lead to lichenification (skin is thick and weather). In repeated or chronic exposure there are
damage cell membranes, disrupt skin barrier, protein denaturation, and cellular toxicity this
could lead to penetrating offending agent into the skin elicits chronic non-specific inflammatory
response that can stimulate keratinocyte proliferation which causes epidermal thickening
causing hyperkeratosis (excessive amount formation of keratonicytes) and there is rapid turn
over of stratum corneum leading to fissure and crusting causing pain. Furthermore, in Allergic
contact dermatitis. The first phase is sensitization phase: Haptens (low molecular weight
antigens) penetrate the epidermis and activate Langerhans cells which travels to regional
lymph nodes and activate naive cells. It then proceeded to Elication phase: reexposure to
offending hapten leads to type 4 hypersensitivity reaction. Sensitized T-cells circulate in blood
and arrive at skin sites where antigen is present this leads to an increased production of mast
cells, eosinophils, CD4+ or CD8 T+ cells and inflammatory cytokines. The mast cells release
leukotrienes and can lead to fever (only in severe ACD). The increase also causes
keratinocyte apoptosis, dilation of microvasculature, and stimulation of local nociceptors. The
keratinocyte apoptosis causes spongiosis resulting to papule and vesicles. The dilation of
microvasculature leads to erythema and the stimulation of local nociceptors leads to pruritus
and burning this can lead to chronic findings such as scaling, lichenfication and excoriation.
The prognosis of patients with contact dermatitis depends on the cause and lifestyle.
Isolated cases usually resolve if the offending agent exposure is discontinued. Those who do
not remain compliant and continue to wear jewelry with metal or are exposed to plants
because of lifestyle generally tend to have a chronic course. Relapses are very common. In
healthcare, latex allergy is a very common form of contact dermatitis and can have an impact
on clinical practice. Cases of anaphylaxis are reported all the time.
REFERENCES:
Hinkle, J. L., Brunner, L. S., Suddarth, D. S., & Cheever, K. L. (2018). Brunner & Suddarth's
textbook of medical-surgical nursing. Philadelphia: Wolter Kluwer
Litchman G, Nair PA, Atwater AR, et al. Contact Dermatitis. [Updated 2020 Nov 19]. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK459230/
What is contact dermatitis and how is it treated? (2020, December 04). Retrieved January
25, 2021, from https://nationaleczema.org/eczema/types-of-eczema/contact-dermatitis/
