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DETERGENTS DERMATITIS
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General considerations Sebum and perspiration combines together on the skin surface forming a protective film (Acid Mantle), which renders the skin less vulnerable to damage and attack by environmental factors (e.g. bacteria, wind and sun) and less liable to hydration. Hydration of the epidermis has an important role on the skin condition. Most detergents are alkaline, but even at neutral pH (7); they remove the surface lipid film and the water-holding substances in the horny layer as well as the vital lipids from the semi-permeable membrane of stratum corneum. They denature protein and damage the cell membranes. Water is hypotonic and acts as a cytotoxic agent on eroded skin. If suitable solvents, including detergents, have removed the surface lipid layer, water may dissolve the hygroscopic substances needed to keep the skin pliable. Lime, magnesium and iron from hard water deposited on the skin fissures may cause mechanical irritation. Irritation of the skin may arise from poorly controlled chlorination or bromination of swimming pools . Alkaline solutions sapoonify the surface lipids and dissolve water-holding substances, break the cross linkages of keratin and cause swelling of cells. Soap, soda, ammonia, potassium and sodium hydroxides, chalk, sodium silicate may cause allergic contact eczema . It should be noted that soda ash (anhydrous sodium carbonate) is three times stronger than washing soda. Soap, detergents and waterless cleansers containing organic solvents are common skin sensitizes. They raise the pH and dissolve lipids. Added silica or sand tends to skin damage by mechanical abrasion. Hand cleansing may be more harmful to the skin. Aromatics in the solvents in ‘waterless cleansers‘ are particularly hazardous. Detergents as surface-active agents, sulphonated oils, wetting agents, and emulsifiers are used for domestic skin cleansing. Washing powders contain detergents, perborates, phosphates, topical bleaches and perfume. Some also have added soap and to prevent precipitation of calcium soap chelating agents are used . The irritant effect is different and that depends on the chemistry of the detergent. Most quaternary ammonium compounds have an irritant effect, causing superficial cracks in dry skin.
Sponges whether the plastic or metal types which are used in cleaning the kitchen utensils , may have an effect on skin eczematization. Contact with vegetables such as tomato, onion, garlic, orange, lemon peel and juice may cause skin sensetization. Plastic gloves used routinely in the kitchen or by the medical staff have an important effect on skin sensitization due to occlusion of the skin surface and to the effect of their plastic contents. Clinical Features Allergic contact dermatitis is of the delayed type. The first contact of skin with a certain sensitizer may have no effect, but with repeated exposure. contact sensitivity manifests. Acute Eczema: affects the skin exposed to the offending detergent. Erythematous localized lesions appear. Papules, vesicles and oozing may devolop accompanied by itching. Chronic Eczema: the skin is dry, thick and fissured. Lichenifecation is the main feature of chronic contact dermatitis. In the early stage, the eczematous reaction is localized to the area in contact with the detergent, but later the eczematous reaction may spread to affect other parts of the skin not exposed to contact with the sensitizer. The most common sites affected by detergents are the hands and due to that,it has been given the name "housewife eczema" . Diagnosis Patch test: may detect the different sensitizers. Treatment The most important line of treatment is to prevent contact of the sensitizer to the skin. All types of treatment will be waste of time and money if this is not fulfilled. The eczematous reaction may improve termporarily on using topical and systemic medications, but recurrence of the eczematous reaction is the rule when there is re-exposure to the sensitizer. Housewives who cannot afford to stop using detergents causing dermatitis will not abide by all the advices to keep away from using them. She will continue to wash , clean, and do her duties towards her family. A simple and effective compromise can be planned. Special types of gloves can be recommended, one is cotton and the other one is plastic (Allerderm). The cotton one is worn first to protect the hands from the plastic glove, whereas the latter is used to protect the cotton gloves from being moist and eliminate any hazardous effect of detergents. Ordinary plastic gloves, and even lined gloves are not allowed. If such gloves are not available similar ones can be easily prepared. A piece of cotton cloth can be put under the hand and fingers and the borders are marked by a pencil. Two pieces of cloth are knitted together to prepare cotton glove to be used under the ordinary kitchen gloves . This is very important and should not by any way to be neglected or overlooked.. The physician should instruct and insist for the use of such protective gloves . This advice may be more effective than the prescription given to the patient. It should be noted that the eczematized skin becomes more sensitive, so that vegetables, orange, lemon juice, garlic and onion juice may act as a primary irritant and should be avoided. This is why that,‘ patients with detergent dermatitis are instructed to use the cotton and plastic gloves when local exposure to these foodstuffs is expected. Active treatment The same as that applied for other types of eczema.
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