Contact Dermatitis

Contact dermatitis is one of the most common problems seen by the dermatologist. Contact dermatitis can be caused by irritation or from an allergy to something in the environment.
Contact Dermatitis (skin allergy) is the medical term for skin irritations resulting from contact with a foreign substance that you are allergic or sensitive to. Contact dermatitis usually takes several days to resolve and only when you are no longer in contact with the irritant. Poison ivy is the most common example of contact dermatitis. Common symptoms are: itching of the skin, skin redness or inflammation, tenderness, localized swelling, warmth or rash at the site of exposure.
Allergic contact dermatitis, the second most common type of contact dermatitis, is caused by exposure to a substance or material to which you have become extra sensitive or allergic. The allergic reaction is often delayed, with the rash appearing 24 - 48 hours after exposure.

Cause

• Irritant contact dermatitis occurs when chemicals or physical agents damage the surface of the skin faster than the skin is able to repair the damage.
• Irritant contact dermatitis can appear differently according to the conditions of exposure.
• Accidental exposure to a strong irritant such as a strong acid or alkali substance may cause an immediate skin reaction resulting in pain, swelling and blistering.
• Contact with mild irritants such as water and soap or detergent may over a period of weeks cause dryness, itching and cracking of the skin. Eventually sores may appear which form crusts and scales.
• Dribble rash around the mouth or on the chin in a baby, or in older children due to licking; the cause is saliva, which is alkaline. Skin bacteria may contribute to the clinical appearance.
• Napkin dermatitis due to urine and faeces. This can affect elderly incontinent patients as well as babies.
• Chemical burns from strong acids (eg. hydrochloric acid) and particularly alkalis (eg. sodium or calcium hydroxide).
• Housewife's eczema is hand dermatitis caused by excessive exposure to water, soaps, detergents, bleaches and polishes.
• Dermatitis on a finger underneath a ring. Soaps, shampoos, detergents and hand creams may accumulate under the ring and cause irritant contact dermatitis.
• Rubber gloves or the powder or sweat or tiny quantities of chemicals that have been occluded inside them may have a direct irritant action on hands (rubber may also result in latex or rubber antioxidant allergy).
• Fiber glass may cause direct mechanical/frictional damage.
• Dry cold air may cause dry irritable skin (winter itch)
• Cosmetics may irritate sensitive facial skin (especially in rosacea) resulting in immediate stinging, burning and redness followed by itching and dryness. Gels and solutions tend to be more irritating than creams and ointments. In time, the skin may develop some tolerance to mild irritants.

Treatment

• Initial treatment includes thorough washing with lots of water to remove any trace of the irritant that may remain on the skin.

• Treatment for allergic contact dermatitis focuses on prevention, by identifying and avoiding the substance responsible for the symptoms. Treatment for the rash caused by allergic contact dermatitis includes gentle skin cleansing, oatmeal baths, oral antihistamines, and topical or oral corticosteroids. In some cases, treatment with corticosteroid injections or ultraviolet light therapy may be required. Treatment for allergic contact dermatitis may require weeks to months of therapy, depending on the cause.

Treatment for contact dermatitis includes:


• Gentle skin cleansing
• Oatmeal baths:
• Oral antihistamines:
• Hydroxyzine
• Diphenhydramine
• Topical corticosteroids:
• Triamcinolone
• Clobetasol 0.05% cream, ointment, or solution
• Hydrocortisone valerate 0.2% cream or ointment
• Oral corticosteroids:
• Prednisone
• Methylprednisolone
• Injectable corticosteroids:
• Triamcinolone
• Immunosuppressive agents: rarely used
• Azathioprine


• Cyclosporine
• Topical immunomodulators:
• Pimecrolimus
• Tacrolimus ointment 0.1% or 0.03%
• Disulfiram:
• Psoralen plus UV-A light therapy

Blepharitis

                  Blepharitis

Blepharitis is a chronic inflammation of the eyelids. A common problem in both children and adults, blepharitis causes swelling, itching and irritation of the eyelids. There are two types of blepharitis: seborrheic and Staphylococcus. The outer layer of the eyelid is composed of skin, while the inside of the eyelid is lined with moist tissue. Muscles and glands are located between the skin and the moist lining. The eyelashes are located on the eyelid margins, the area which come together when the eyelid is closed. Tiny openings from which glands secrete the oily part of tears are also located on the eyelid margin. The eyelid margins are the areas most often affected by blepharitis.

Causes

Blepharitis happens when the minuscule oil glands adjoining the base of the eyelashes stops functioning normally. It is usually a condition that is chronic requiring care that is long-term.

Conditions or diseases that may cause blepharitis consist of:

Bacterial infections,

Dandruff affecting the eyebrows or scalp – known as seborrheic dermatitis,

Rosacea is a condition of the skin categorized by redness in the face,

Oil glands in the eyelids that malfunction,

Eyelash mites.

Allergies such as reactions to eye drugs, contact lens solutions or makeup for the eye.

Blepharitis can also be triggered by a grouping of factors.

If an individual has blepharitis, they can experience:

Problems with eyelash – Cause eyelashes to grow abnormally or fall out.

Skin problems on eyelid – Scarring can happen on the eyelids because of chronic blepharitis.

Stye – This is a contagion which commonly starts adjacent to the base of the eyelashes. It is a lump that is painful located inside of or on the brink of the eyelid. Styes are normally most noticeable on the eyelid surface.

·        Dry or excess tearing eye – Atypical secretions that are oily as well as other debris that falls from the eyelid, for instance flaking related to dandruff, may amass in the tear film – the oil, mucus, water solution that creates tears. A tear film which is abnormal impedes the normal lubrication of a healthy eyelids. This causes irritation to the eyes and causes excessive tearing or dry eyes.

·        Corneal injury – Any continuous irritation from eyelashes which are misdirected or inflamed can cause an ulcer or sore to form on the cornea. Tearing which is insufficient can predispose an individual to corneal infections.

Treatment

The mainstay of treatment is lid hygiene, using cotton buds and solution.

As blepharitis can affect the tears, lubricants can be used to soothe the eyes and relieve irritation. These can be used 3-4 times a day.

There are a variety of artificial tear preparations to choose from, if the drops are required more than 4 times a day then preservative free drops are recommended.

In rare cases, antibiotic tablets may be needed if the blepharitis is particularly difficult to treat.

Treating related conditions such as seborrhoeic dermatitis, which causes bad dandruff and other kind conditions of the face, such as eczema and acne rosacea may help to ease blepharitis.

In a very few people the blepharitis can be severe and damage the eyelids, and treatment can prevent more damage occurring.

The treatment is aimed at :

unblocking the glands in the eyelid, which may be infected and inflamed, like acne on the face or a tiny boil by Lid Cleaning replacing the tears if the eyes are dry with Lubricants

treating any infection present with Antibiotic Cream antibiotic cream

omega 3's...th long chain type that are in oily fish, are very helpful and important. Shorter molecule omega 3s such as flaxseed oil are probably helpful helpful

to treat infection and reduce the inflammation using Antibiotic tablets.

Steroid creams (only to be used by ophthalmologists/expert professionals)

The treatment should make your eyes more comfortable, but there is no magic cure. Even with treatment your eyes may remain a little sore, but no harm will come to them and there is nothing to worry about. 

Start with lid cleaning, use antibiotic cream if this is not helpful. Tablets are for people with very troublesome sore eyes.