Irritant Contact Dermatitis
Irritant contact dermatitis (ICD) is more common than allergic contact dermatitis (ACD). The skin injury develops as a result of prolonged pressure and irritation or reaction to chemical or physical agents. Treatment starts by avoidance of irritants such
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19
Tanja Bohl
19.1 Introduction Irritant contact dermatitis (ICD) is the more common of the two types of contact dermatitis in all age groups. The second, less frequent, is allergic contact dermatitis (ACD).
19.2 Pathogenesis and Etiology ICD is the result of skin injury by prolonged pressure and irritation (Fig. 19.1), chemical (Figs. 19.2 and 19.3) or physical agents resulting in inflammation, and a reactive response to produce healing. It occurs and is limited to areas of skin injury and does not involve a delayed immune response. The injury to the skin produces damage faster than the skin can repair itself [1–4]. Vulvar anatomy is conducive to the development of ICD. There are many creases in which perspiration, natural secretions, exfoliated epidermal cells, and feces and urine can collect and irritate the skin. The temperature and humidity in these creases are also increased, stimulating perspiration and reducing epidermal barrier function.
T. Bohl (*) Jean Hailes for Women’s Health, Clayton, VIC, Australia
Fig. 19.1 Red plaque of irritant contact dermatitis resulting from wearing tight synthetic underwear
ICD reduces the integrity of the epidermis increasing the irritancy of both the initiating and additional irritants. The epidermal barrier function is reduced in ability to prevent transepidermal water loss (TEWL) and infection. There are many causes of vulvar ICD that occur more commonly at different times throughout life as part of the “normal” maturation of a female. Some exposures can also produce an allergic response as discussed in the chapter on allergic contact dermatitis.
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_19
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T. Bohl
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Friction from skin rubbing on the skin in obesity and with lack of mobility can cause an inflammatory intertrigo. Similarly, rubbing from snug-fitting gym clothes in conjunction with exercise can produce vulvar ICD. The severity of ICD is determined by the type, strength, and amount of irritant, frequency and duration of exposure in addition to endogenous factors such as atopy, and the presence of a pre- existing vulvar dermatosis. During the reproductive years, a woman is more likely to be exposed to infective agents such as human papilloma virus (HPV) and may require the application of caustic therapeutic agents to her vulva.
19.2.1 Clinical Features
Fig. 19.2 Chronic ICD due to overcleaning the vulva with alkaline soap
Vulvar ICD is usually the result of multiple exposures to irritants causing cumulative changes such as dryness with fine scale, erythema, altered skin color, and texture (Table 19.1). Distinction from ACD is more difficult in this situation and may coexist. Early lesions of ICD are the most typical and can usually be distinguished from those of ACD (Table 19.2). They are confined to the area of contact and produce burning and stinging sensations rather than pruritus.
19.3 Diagnosis As with all vulvar rashes, a careful history
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