DR.

BHUIYAN, Ma YOUSUF
MBBS. MSc ( Sweden)
Physician, dermatology

A. Difference between irritant and allergic contact dermatitis:

Difference between allergic and irritant contact dermatitis may pose considerable problem in clinical
practice since both inflammatory disease have clinical, histological and immunohistological similarities,
which have been cited in this table.

Events Irritable contact dermatitis (ICD) Allergic contact dermatitis (ACD)

Definition Irritation refers to the direct injurious Contact allergy is an action by the
action by a substance when in contact immune system of the body on
with the skin. The resultant injury recognizing an allergen that has gained
causes an inflammation, called entry into the skin. The resultant
appropriately irritant contact inflammation is called an allergic
dermatitis. contact dermatitis.
Development of lesions When chemicals or physical agents An allergic reaction to material in
to skin damage the surface of the skin faster contact with the skin
than the skin is able to repair the
damage.
Local inflammatory Non immunological; cytotoxic effect Immunological; Type IV delayed
reaction on the cell of the epidermis hypersensitivity reaction
frequency of exposure short heavy exposure or The first contact does not result in
repeated/prolonged low exposure allergy. Only people who have been
exposed to the substance, and have
acquired an allergy
Duration Most cases of ICD are acute in onset, Lesions appear with in 24-48 hrs
in which symptoms develop within
seconds of exposure. Mild irritants
require prolonged or repeated exposure
and Strong irritants (e.g., strong acids,
alkalis) can produce immediate
reactions.
Brutality Severity of the reaction is related to Repeated exposures to an ACD-
the amount and duration of exposure to inducing allergen tend to cause
the irritant. incrementally more severe reactions.
Age Most common during adulthood Common in infants

Contributing factor The risk of developing irritant contact Contributing factors include allergen
dermatitis is particularly high in concentration, duration of exposure,
individuals with atopic dermatitis. and presence of other skin diseases.

Investigation There are no specific tests that can Patch tests are used to confirm allergic
reliably show what the effect of an contact dermatitis and identify the
irritant will be in each individual case. allergen(s).
 B. Similarities between irritant and allergic contact dermatitis:

Allergic contact dermatitis may look similar to irritant contact dermatitis, but it is caused by an
immune response following skin contact with an allergenic substance. Tiny quantities may be
sufficient to cause allergy, whereas a certain minimum exposure is necessary for irritant contact
dermatitis. Irritant and allergic contact dermatitis may coexist.

1. The morphologic changes, time course to the development of dermatitis, and histological
changes have long been known to overlap for both allergic and irritant contact dermatitis
reactions. Studies of the behavior of Langerhans cells, cytokines, and adhesion
molecules have found more similarities than differences between irritant and allergic
reactions. At present, the difference between irritants and allergens is more conceptual
than demonstrable.
2. The epidermal and dermal cell activity that produces the cascade of inflammation
appears to be similar in both cases.
3. Most cases of contact dermatitis have a similar appearance regardless of the mechanism
or cause of inflammation. Inflammatory responses can be categorized into acute, sub
acute, and chronic phases. In all phases, a key feature is localization to the area of
contact all most similar.
4. The affected skin may be red, swollen and blistered or dry and bumpy in case of allergic
contact dermatitis, which is a similar skin condition is caused by excessive contact with
irritants. Irritants include water, soaps, detergents, solvents, acids, alkalis, and friction.
5. In case of irritant contact dermatitis, accidental exposure to a strong irritant such as a
strong acid or alkali substance may cause an immediate skin reaction resulting in pain,
swelling and blistering which symptoms also found in case of acute allergic contact
dermatitis.
6. Contact with mild irritants such as water and soap or detergent may over a period of
weeks cause dryness, itching and cracking of the skin. Eventually sores may appear
which form crusts and scales similar to allergic contact dermatitis.