Book Review

Irritant Dermatitis

N Engl J Med 2006; 355:106July 6, 2006

Article

Irritant Dermatitis
Edited by Ai-Lean Chew and Howard I. Maibach. 538 pp., illustrated. Berlin, Springer-Verlag, 2006. $179. ISBN: 3-540-00903-5

Contact dermatitis includes two distinct subgroups: allergic contact dermatitis and irritant contact dermatitis. Allergic contact dermatitis has been extensively studied, and methods of determining allergy have been well documented through patch-testing techniques. The term “irritant dermatitis,” in contrast, is often used when the practitioner is unable to demonstrate allergy through patch testing. Irritant dermatitis does not result from an immune reaction, but instead is attributable to direct epidermal-cell damage and inflammation. Many practitioners have been challenged by the patient with persistent hand dermatitis or the infant with nonresponsive diaper dermatitis. Both of these conditions are discussed extensively in Irritant Dermatitis. With regard to diaper dermatitis, many components interact to create the environment in which dermatitis can develop; these include skin pH, urine and feces, and changes in diet. Parents are happy with the advances in disposable diapers; these advances decrease the incidence of diaper rash in infants who are prone to dermatitis.

Occupation-related skin disease is an important cause of morbidity and loss of employment. One common example of this type of disease is irritant dermatitis caused by airborne fibers. With irritation caused by airborne fiberglass, the patient will report stinging or burning sensations on uncovered parts of the body such as the face or neck, but on examination he or she will have no visible dermatitis. Typically the symptoms persist for several days and then abate, only to recur with re-exposure. Often people with these symptoms work in factories where they manufacture fiberglass or handle it for electrical or thermal insulation. The patient is given topical steroid therapy and is instructed to wear protective clothing that is well fitted in the sleeves, trunk, and collar. In the work environment, changes may be made to minimize the release of these fibers into the air.

Irritant dermatitis also plays a role in consumer economics and can lead to a loss of brand usage and to possible litigation. Two common types of products that contribute to irritation are cosmetics and toiletries and hard-surface cleaning products. With regard to the first type of products, personal hygiene habits have changed in the past decade — some people now shower using a scented body wash two or more times each day. This practice can cause a variety of cellular changes in the epidermal barrier that result in damage to the epidermis and the development of irritant dermatitis.

The authors of Irritant Dermatitis have written an exhaustive review of the subject. Early chapters cover common presentations of irritant dermatitis, and later chapters describe occupation-related dermatoses. With each presentation, the authors outline both the physiological and the clinical changes that occur in patients as well as the chemical and physical elements that interplay in each case. The later chapters of the book delve into specific irritants such as corrosive materials, food, and detergents. The authors also describe the methods of measuring skin irritation, the challenges of testing for irritation, and the prevention of irritant dermatitis through barrier creams and gloves. This textbook is essential for the occupational medicine physician and the dermatologist, but it may be overly detailed for the family physician or internist. It will also serve as a resource for scientists and regulators in industry, who are constantly striving to understand skin irritation.

Mary C. Martini, M.D.
Feinberg School of Medicine at Northwestern University, Chicago, IL 60611