Irritant prognosis

Early diagnosis of skin cancer is the key to improved prognosis. Diagnostic accuracy and clinical skills are two essential factors in the appropriate management of skin cancer. On presentation to a clinician s office, patients may offer a history of a new growth or an area of irritation. Conversely, the skin cancer may have been present for years undetected by the patient. The definitive diagnosis of any suspected cutaneous malignancy should be confirmed by a biopsy prior to treatment. 

Ocular damaging and irritant agents can be identified and evaluated by the Draize rabbit test [114]. However, more recently this test has been criticized on the basis of ethical considerations and unreliable prognosis of human response. Alternative methods such as the evaluation of toxicity on ocular cell cultures have been recommended and are being indicated as promising prognostic tools [115-120]. Direct confocal microscopic analysis [121], hydration level of isolated corneas [122], and various other tests on isolated corneas or animal eyes have also been proposed for evaluation of ocular toxic effects. 

At least 12 cases of perforation of the colon by barium enema, with four deaths, were reported in a series of publications (SED-12,1165) (6-8). The incidence of perforation was about 1 in 6000 examinations. Even sterile barium sulfate can cause marked peritoneal irritation, with considerable fluid loss into the peritoneal cavity, but in practice it is usually a mixture of barium and feces that escapes and this, not surprisingly, produces severe peritonitis and dense adhesions. Mortality has been reported to be 58% with conservative treatment, and as high as 47% with surgical intervention (9). Early operation is indicated, and large volumes of intravenous fluids improve the prognosis. Patients who recover can... 

Hogan DJ (1996) The prognosis of irritant contact dermatitis. In van der Va PGM, Maibach HI (eds) The irritant contact dermatitis syndrome. CRC, New York, pp 9-15 Hogan DJ, Dannaker CJ, Maibach HI (1990) The prognosis of contact dermatitis. J Am Acad Dermatol 23 300-307 Hurwitz RM, Rivera HP, Guin JD (1984) Black-spot poison ivy dermatitis. An acute irritant contact dermatitis superimposed upon an allergic contact dermatitis. Am J Dermatopathol 6 319-322... 

This chapter reviews reports on the prognosis of occupational contact dermatitis. Factors that may affect the prognosis of occupational contact dermatitis include atopy, job change, the age of the patient, the nature of irritants and allergens, and the nature of the occupation. 

Prognosis of Occupational Irritant Versus Allergic Contact Dermatitis... 

Most reports indicate that irritant contact dermatitis tends to have a poorer prognosis than allergic contact dermatitis. Some occupational irritants - for example. 

Chia et al. observed that occupational irritant dermatitis from cement and acids/alkali tends to have a relatively better prognosis than other irritants, with all workers experiencing complete clearance of their dermatitis when they ceased contact with the irritant (Chia and Goh 1991). 

Workers who continued with exposure to occupational irritants tend to have a poorer prognosis than those who cease exposure. For example, Chia et al. reported that about 60% of patients with occupational irritant dermatitis from solvents had persistent dermatitis when they continued to work with the solvents (Chia and Goh 1991). Some occupational irritants appear to cause less chronicity, e.g. irritant contact dermatitis from acids/alkali and cement appear to clear when proper preventive measures are introduced (Chia and Goh 1991). The report from Singapore showed that all workers with irritant contact dermatitis from cement had complete clearance of their dermatitis despite continuing to work with the irritant. Similarly, in Denmark, occupational irritant dermatitis from cement cleared in 80% of their workers despite the fact that they continued working at the same job (Avnstorp 1989). 

Hairdressers with irritant contact dermatitis appeared to have good prognosis when they changed jobs. Matsunaga reported a 70% clearance rate for workers who ceased working as hairdressers (Matsunaga et al. 1998). 

In Singapore, the prognosis of occupational allergic and irritant contact dermatitis for patients who ceased to be exposed was better then those who continued exposure to the contactants. The overall clearance rates for patients who ceased exposure and continued exposure were 73% and 69%, respectively. The clearance rates for allergic contact dermatitis were 71% (ceased exposure) and 74% (continued exposure), respectively, and for irritant contact dermatitis were 74% and 68%, respectively (Chia and Goh 1991). 

The causes of chronicity from occupational contact dermatitis are usually multifactorial. Most studies indicated that allergic contact dermatitis is less likely to lead to chronicity than irritant contact dermatitis. The risk factor for chronicity of dermatitis in patients with contact dermatitis appears to be determined by the type or causes of contact dermatitis, the presence of atopy, and job change. The prognosis of contact dermatitis appears to be better in recent years. This improvement could be due to better understanding of the nature and causes of occupational contact dermatitis, availability of better diagnostic procedures and better health education, and preventive measures against occupational contact dermatitis. 

Hannuksela A, Kinnunen T (1992) Moisturizers prevent irritant dermatitis. Acta Derm Venereol 72 42-44 Hogan DJ (1993) The prognosis of hand eczema. In Menne T, Maibach HI (eds) Hand eczema. CRC Press, Boca Raton, pp 285-292... 

Many mild cases of nickel dermatitis will clear when exposure to the causative object(s) is avoided and a topical treatment is applied. Hand eczema in nickel-sensitive patients is, however, considered to have a poor prognosis and may in some cases be resistant to treatment and persist for years (Fregert 1975 Christensen 1982). Nickel dermatitis in Denmark is the second most common dermatological disease, after irritant contact dermatitis, giving rise to compensation... 

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