Patient complains of irritation on the skin initially which turns  into eruptions resembling vesicles with a lot of itching. Irritability of the skin, dryness, cracking and redness, increasing slowly until an eczematous breakdown occurs. Irregular acute relapses indicate allergic reactions. It is a case of CONTACT DERMATITIS.

A detailed history is necessary to identify the responsible substance. This variety of dermatitis may arise from primary chemical irritation or a type IV hypersensivity reaction. Strong acids or alkalis cause primary irritation of every skin, and therefore are relatively easy to recognize . chemicals vary in their sensitizing potentiality and individuals vary in their susceptibility.

Substances, initially touched or handled by hand invariably in time get transferred to the face and external genitals where they may produce contact dermatitis. Most simple chemical substances may produce contact dermatitis but some do it more readily than others. Friction from tight clothes or footwear, degreasing of the skin by frequent use of detergents and causing damage to the keratin from dehydration due to prolonged immersion of hands in water.

SYMPTOMS OF CONTACT DERMATITIS

Contact dermatitis usually occurs on  those areas of body that have been directly exposed to the reaction-causing substance ; for example, along a calf that brushed against poison ivy or under a watchband. The rash usually develops within minutes to hours of exposure and can last two to four weeks.

Signs and symptoms of contact dermatitis include:

• A red rash
• Itching, which may be severe
• Dry, cracked, scaly skin
• Bumps and blisters, sometimes with oozing and crusting
• Swelling, burning or tenderness

CAUSES OF CONTACT DERMATITIS

Contact dermatitis is caused by a the substance that could be one of thousands of known allergens and irritants. Some of these substances may cause both irritant contact dermatitis and allergic contact dermatitis.

Irritant contact dermatitis is the most common type. This nonallergic skin reaction occurs when a substance damages the skin's outer protective layer.

Some people react to strong irritants after a single exposure. Others may develop signs and symptoms after repeated exposures to even mild irritants. And some people develop a tolerance to the substance over time.

Common irritants include:

• Solvents
• Rubbing alcohol
• Bleach and detergents
• Shampoos, permanent wave solutions
• Airborne substances, such as sawdust or wool dust
• Plants
• Fertilizers and pesticides

Allergic contact dermatitis occurs when a substance to which we're sensitive (allergen) triggers an immune reaction in our skin. It usually affects only the area that came into contact with the allergen. But it may be triggered by something that enters our body through foods, flavorings, medicine, or medical or dental procedures (systemic contact dermatitis).

Common allergens include:

• Nickel, which is used in jewelry, buckles and many other items
• Medications, such as antibiotic creams and oral antihistamines
• Balsam of Peru, which is used in many products, such as perfumes, cosmetics, mouth rinses and flavorings
• Formaldehyde, which is in preservatives, disinfectants and clothing
• Personal care products, such as deodorants, body washes, hair dyes, cosmetics and nail polish
• Plants such as poison ivy and mango, which contain a highly allergenic substance called urushiol
• Airborne substances, such as ragweed pollen and spray insecticides
• Products that cause a reaction when you're in the sun (photoallergic contact dermatitis), such as some sunscreens and oral medications

Children develop the condition from the usual offenders and also from exposure to diapers, baby wipes, sunscreens, clothing with snaps or dyes, and so on.

RISK FACTORS OF CONTACT DERMATITIS

• Health care and dental employees
• Metalworkers
• Construction workers
• Hairdressers and cosmetologists
• Auto mechanics
• Scuba divers or swimmers, due to the rubber in face masks or goggles
• Cleaners
• Gardeners and agricultural workers
• Cooks and others who work with food

COMPLICATIONS OF CONTACT DERMATITIS

Contact dermatitis can lead to an infection if there is repeatedly scratch the affected area, causing it to become wet and oozing. This creates a good place for bacteria or fungi to grow and may cause an infection.

PREVENTION OF CONTACT DERMATITIS

General prevention steps include the following:

• Avoid irritants and allergens. Try to identify and avoid substances that irritate the skin or cause an allergic reaction.
• Wash your skin.  wash skin, Use a mild, fragrance-free soap and warm water. Rinse completely. Also wash any clothing or other items that may have come into contact with a plant allergen, such as poison ivy.
• Wear protective clothing or gloves. Face masks, goggles, gloves and other protective items can shield  from irritating substances, including household cleansers.
• Use moisturizer. Regularly applying moisturizing lotions can help restore the skin's outermost layer and keep skin supple.
• Take care around pets. Allergens from plants, such as poison ivy, can cling to pets and then be spread to people.

HOMOEOPATHIC TREATMENT FOR CONTACT DERMATITIS

Once the contact substance is identified, it will be necessary to avoid the same for some time and treat the condition on the lines of the signs and symptoms in case of dermatitis. The substance can gradually be reintroduced to see whether there has been any response to the treatment.

Usually patch test is performed. Take care that this is not performed during the acute phase. Skin usually returns to normal if further exposure is avoided, but sensitization to the offending substance may persist for life if these cannot substances cannot be identified.

Remedies are same as in the case of dermatitis.

HOMEOPATHIC MEDICINE FOR CONTACT DERMATITIS

Sepia - It is particularly helpful for long-standing eczema affecting the nose, chin, behind the ears, and the genitals with very dry skin

Natrum Muriaticum -It is used for eczema which is worse at the seaside, appearing in the joints, genitals and around the hair and mouth. The Natrum mur type is naturally emotional, feeling-orientated and sensitive

Lycopodium -   is used for eczema that is bleeding, moist or discharging; affecting the scalp, armpits, limbs, back and neck and in eczema accompanied by liver complaints.

Cicuta virosa -It is used for eczema formig thick hard lemo-coloured crust on chin,cheek and scalp.

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