1. Epidemiology
1.1. Occupational Hazard
1.1.1. repeated handwashing
1.1.2. repeated exposure of skin to irritants
1.2. Prevalence
1.2.1. 55.6% in 2 intensive care units
1.2.2. 69.7% in the most highly exposed workers
1.3. Environmental factors
1.3.1. Amount and strength of the irritant
1.3.2. Length and frequency of exposure
1.3.3. Skin susceptibility (eg. thick, thin, oily, dry, very fair, previously damaged skin or pre-existing atopic tendency)
1.3.4. high or low temperature or humidity
2. Pathophysiology
2.1. Skin Barrier Disruption
2.1.1. patients with altered barrier function are more prone to developing ICD
2.2. Epidural Cellular Changes
2.3. Cytokin Release hones naïve T-lymphocytes to the skin
2.3.1. Released from the keratinocytes which expresses tumor necrosis factor-α (TNF-α) causing inflammation
3. Risk Factors
3.1. Occupational Hazard of workers who handle irritants
3.1.1. Textile workers
3.1.2. Painters
3.1.3. Nurses
3.1.4. Printers
3.1.5. Agricultural workers
3.1.6. Dry Cleaners
3.1.7. Coal Miners
3.1.8. Hair Dressers
3.1.9. Mechanics
3.1.10. Artists
3.1.11. Cleaners
3.1.12. Construction workers
4. Clinical Presentation
4.1. Redness
4.2. Cracking of skin
4.3. Dryness
4.4. inflamed
4.5. thickened
5. Diagnosis
5.1. No specific tests are necessary because ICD can be diagnosed by clinical examination
6. Adaptive Responses to alterations
6.1. Hardening or accommodation has been defined as the adaptation of the skin from altered local expression of multiple cytokines and inflammatory mediators with repeated irritation from skin irritants. Accommodated skin has a relatively thicker layer of stratum granulosum versus normal skin. Accommodated skin may exhibit a slight sheen and glossy appearance with a mild scale. On manipulation, there may also be a slight loss of elasticity
7. Etiology
7.1. Common cutaneous irritants
7.1.1. Solvents
7.1.1.1. Organic Solvents- Alcohol, turpentine, hair products, ketones, chlorine, esters, paint, acids Diluted Alkalis- Soap and soda Detergents- washing detergents
7.1.2. Microtrauma
7.1.2.1. Fiberglass
7.1.3. Mechanical Irritants
7.1.3.1. Friction