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Clinical Aspects of Irritant Contact Dermatitis

Abstract

Irritant contact dermatitis (ICD) is more common than allergic contact dermatitis (ACD). It ranges from acute irritant reactions to chronic forms, often morphologically indistinguishable from ACD. Numerous exogenous and endogenous factors are involved in the pathogenesis. Major irritants are water, detergents, acidic and alkaline substances of various nature. Mechanical and thermal influences are important cofactors. Sensitive skin does exist and is frequently associated with previous atopic dermatitis. Chronic ICD is a diagnostic challenge and may be complicated by secondary sensitization to environmental allergens. Therapy and prevention require identification of irritants and reduction of skin contact by gloves or technical measures. Some topical medications and skin care products (e.g., sunscreens) may cause subjective discomfort without clinical signs of irritation: sharp stinging pain or burning of the skin develop several minutes after application in a crescendo pattern. This is considered to be a special form of neurosensory irritation

Keywords

  • Atopic Dermatitis
  • Stratum Corneum
  • Contact Dermatitis
  • Sodium Lauryl Sulfate
  • Allergic Contact Dermatitis

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Malten KE, den Arend JACJ, Wiggers RE (1979) Delayed irritation: hexanediol diacrylate and butanediol diacrylate. Contact Dermatitis 5:178–184

    PubMed  CAS  CrossRef  Google Scholar 

  2. Nethercott JR, Gupta S, Rosen C, Enders LJ, Pilger CW (1984) Tetraethylene glycol diacrylate. A cause of delayed cutaneous irritant reaction and allergic contact dermatitis. J Occup Med 26:513–516

    PubMed  CAS  CrossRef  Google Scholar 

  3. Lovell CR, Rycroft RCG, Williams DMJ, Hamlin J (1985) Contact dermatitis from the irritancy (immediate and delayed) and allergenicity of hydroxypropyl acrylate. Contact Dermatitis 12:117–118

    PubMed  CAS  CrossRef  Google Scholar 

  4. Basketter DA, Marriott M, Gilmour NJ, White IR (2004) Strong irritants masquerading as skin allergens: the case of benzalkonium chloride. Contact Dermatitis 50:213–217

    PubMed  CAS  CrossRef  Google Scholar 

  5. Björnberg A (1968) Skin reactions to primary irritants in patients with hand eczema. Isacsons, Göteborg

    Google Scholar 

  6. Bruynzeel DP, van Ketel WG, Scheper RJ, von Blomberg-van der Feier BME (1982) Delayed time course of irritation by sodium lauryl sulfate: observations on threshold reactions. Contact Dermatitis 8:236–239

    Google Scholar 

  7. Frosch PJ, Rustemeyer T (1999) Contact allergy to calcipotriol does exist. Contact Dermatitis 40:66–71

    PubMed  CAS  CrossRef  Google Scholar 

  8. Kim IH, Seo SH (1999) Occupational chemical burns caused by bromine. Contact Dermatitis 41:43

    PubMed  CAS  CrossRef  Google Scholar 

  9. Agner T, Serup J (1990) Sodium lauryl sulphate for irritant patch testing – a dose-response study using bioengineering methods for determination of skin irritation. J Invest Dermatol 95:543–547

    PubMed  CAS  CrossRef  Google Scholar 

  10. Reiche L, Willis C, Wilkinson J, Shaw S, de Lacharièrre O (1998) Clinical morphology of sodium lauryl sulfate (SLS) and nonanoic acid (NAA) irritant patch test reactions at 48 h and 96 h in 152 subjects. Contact Dermatitis 39:240–243

    PubMed  CAS  CrossRef  Google Scholar 

  11. Atherton DJ (2004) A review of the pathophysiology, prevention and treatment of irritant diaper dermatitis. Curr Med Res Opin 20:645–649

    PubMed  CrossRef  Google Scholar 

  12. Kügler K, Brinkmeier T, Frosch PJ, Uter W (2005) Anogenital dermatoses – allergic and irritative causative factors. Analysis of IVDK data and review of the literature. J Dtsch Dermatol Ges 3:979–986

    Google Scholar 

  13. Dooms-Goossens AE, Debusschere KM, Gevers DM, Dupre KM, Degreef HJ, Loncke JP, Snaauwaert JE (1986) Contact dermatitis caused by airborne agents. J Am Acad Dermatol 15:1–10

    PubMed  CAS  CrossRef  Google Scholar 

  14. Huygens S, Goossens A (2001) An update on airborne contact dermatitis. Contact Dermatitis 44:1–6

    PubMed  CAS  CrossRef  Google Scholar 

  15. Santos R, Goossens A (2007) An update on airborne contact dermatitis: 2001-2006. Contact Dermatitis 57:353–360

    PubMed  CAS  CrossRef  Google Scholar 

  16. Feser A, Plaza T, Vogelsang L, Mahler V (2008) Periorbital dermatitis-a recalcitrant disease: causes and differential diagnoses. Br J Dermatol 159:858–863

    PubMed  CAS  CrossRef  Google Scholar 

  17. Lyon CC, Yell J, Beck MH (1998) Irritant contact dermatitis from pancreatin exacerbating vulvodynia. Contact Dermatitis 38:362

    PubMed  CAS  CrossRef  Google Scholar 

  18. Zimmaro Bliss D, Zehrer C, Savik K, Thayer D, Smith G (2006) Incontinence-associated skin damage in nursing home residents: a secondary analysis of a prospective, multicenter study. Ostomy Wound Manage 52:46–55

    PubMed  Google Scholar 

  19. Timmer-de Mik L, Toonstra J (2008) Allergy to hydrocolloid dressings. Contact Dermatitis 58:124–125

    PubMed  CAS  CrossRef  Google Scholar 

  20. Frosch PJ (1985) Hautirritation und empfindliche Haut. Grosse, Berlin

    Google Scholar 

  21. Jackson EM, Goldner R (eds) (1990) Irritant contact dermatitis. Dekker, New York

    Google Scholar 

  22. Wahlberg JE (1984) Skin irritancy from alkaline solutions assessed by laser Doppler flowmetry. Contact Dermatitis 10:111

    PubMed  CAS  CrossRef  Google Scholar 

  23. Wahlberg JE (1989) Assessment of erythema: a comparison between the naked eye and laser Doppler flowmetry. In: Frosch PJ, Dooms-Goossens A, Lachapelle JM, Rycroft RJG, Scheper RJ (eds) Current topics in contact dermatitis. Springer, Berlin, pp 549–553

    CrossRef  Google Scholar 

  24. Wahlberg JE, Lindberg M (2003) Nonanoic acid – an experimental irritant. Contact Dermatitis 49:117–123

    PubMed  CAS  CrossRef  Google Scholar 

  25. Willis CM, Stephens CJM, Wilkinson JD (1988) Experimentally-induced irritant contact dermatitis. Contact Dermatitis 18:20–24

    PubMed  CAS  CrossRef  Google Scholar 

  26. Tsai TF, Maibach HI (1999) How irritant is water? An overview. Contact Dermatitis 41:311–314

    PubMed  CAS  Google Scholar 

  27. Warner RR, Stone KJ, Boissy YL (2003) Hydration disrupts human stratum corneum ultrastructure. J Invest Dermatol 120:275–284

    PubMed  CAS  CrossRef  Google Scholar 

  28. Warner RR, Boissy YL, Lilly NA, Spears MJ, McKillop K, Marshall JL, Stone KJ (1999) Water disrupts stratum corneum lipid lamellae: damage is similar to surfactants. J Invest Dermatol 113:960–966

    PubMed  CAS  CrossRef  Google Scholar 

  29. Frosch PJ, Rustemeyer T (2000) Hairdresser’s eczema. In: Menné T, Maibach HI (eds) Hand eczema, 2nd edn. CRC Press, Boca Raton, pp 195–207

    Google Scholar 

  30. Gollhausen R, Kligman AM (1985) Effects of pressure on contact dermatitis. Am J lnd Med 8:323–328

    CAS  CrossRef  Google Scholar 

  31. Menné T (1983) Frictional dermatitis in post-office workers. Contact Dermatitis 9:172–173

    PubMed  CrossRef  Google Scholar 

  32. Menné T, Hjorth N (1985) Frictional contact dermatitis. Am J Ind Med 8:401–402

    PubMed  CrossRef  Google Scholar 

  33. McMullen E, Gawkrodger DJ (2006) Physical friction is under-recognized as an irritant that can cause or contribute to contact dermatitis. Br J Dermatol 154:154–156

    PubMed  CAS  CrossRef  Google Scholar 

  34. Mancuso G, Reggiani M, Berdondini RM (1996) Occupational dermatitis in shoemakers. Contact Dermatitis 34:17–22

    PubMed  CAS  CrossRef  Google Scholar 

  35. Bäurle G, Hornstein OP, Diepgen TL (1985) Professionelle Handekzeme und Atopie. Dermatosen 33:161–165

    Google Scholar 

  36. Bäurle G (1986) Handekzeme. Studie zum Einfluß von konstitutionellen und Umweltfaktoren auf die Genese. Schattauer, Stuttgart

    Google Scholar 

  37. Kühner-Piplack B (1987) Klinik und Differentialdiagnose des Handekzems. Eine retrospektive Studie am Krankengut der Universitäts-Hautklinik Heidelberg 1982–1985. Thesis, Ruprecht-Karls-University, Heidelberg

    Google Scholar 

  38. Meding B (1990) Epidemiology of hand eczema in an industrial city. Acta Derm Venerol (Stockh) (suppl) 153:1–43

    Google Scholar 

  39. Rietschel RL (1990) Diagnosing irritant contact dermatitis. In: Jackson EM, Goldner R (eds) irritant contact dermatitis. Dekker, New York, pp 167–171

    Google Scholar 

  40. Menné T, Maibach HI (eds) (2000) Hand eczema, 2nd edn. CRC, Boca Raton, FL

    Google Scholar 

  41. Veien NK, Hattel T, Laurberg G (2008) Hand eczema: Causes, course, and prognosis I. Contact Dermatitis 58:330–334

    PubMed  CrossRef  Google Scholar 

  42. Veien NK, Hattel T, Laurberg G (2008) Hand eczema: Causes, course, and prognosis II. Contact Dermatitis 58:335–339

    PubMed  CrossRef  Google Scholar 

  43. Warshaw EM, Ahmed RL, Belsito DV, DeLeo VA, Fowler JF Jr, Maibach HI, Marks JG Jr, Toby Mathias CG, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Zug KA (2007) Contact dermatitis of the hand: cross-sectional analyses of North American Contact Dermatitis Group Data, 1994-2004. J Am Acad Dermatol 57:301–314

    PubMed  CrossRef  Google Scholar 

  44. Cvetkovski RS, Zachariae R, Jensen H, Olsen J, Johansen JD, Agner T (2006) Prognosis of occupational hand eczema: a follow-up study. Arch Dermatol 142:305–311

    PubMed  CrossRef  Google Scholar 

  45. Hald M, Agner T, Blands J, Veien NK, Laurberg G, Avnstorp C, Menné T, Kaaber K, Kristensen B, Kristensen O, Andersen KE, Paulsen E, Thormann J, Sommerlund M, Nielsen NH, Johansen JD (2009) Clinical severity and prognosis of hand eczema. Br J Dermatol 160:1229–1236

    PubMed  CAS  CrossRef  Google Scholar 

  46. De Boer EM, van Keitel WG, Bruynzeel DP (1989) Dermatoses in metal workers. I. Irritant contact dermatitis. Contact Dermatitis 20:212–218

    PubMed  CrossRef  Google Scholar 

  47. Rycroft RJG, Smith WD (1980) Low humidity occupational dermatoses. Contact Dermatitis 6:488–492

    PubMed  CAS  CrossRef  Google Scholar 

  48. Leggat PA, Smith DR (2006) Dermatitis and aircrew. Contact Dermatitis 54:1–4

    PubMed  CrossRef  Google Scholar 

  49. Morris-Johns R, Robertson SJ, Ross JS et al (2002) Dermatitis caused by physical irritants. Br J Dermatol 147:270–275

    CrossRef  Google Scholar 

  50. Uter W, Gefeller O, Schwanitz HJ (1998) An epidemiological study of the influence of season (cold and dry air) on the occurrence of irritant skin changes of the hands. Br J Dermatol 138:266–272

    PubMed  CAS  CrossRef  Google Scholar 

  51. Agner T, Serup J (1989) Seasonal variation of skin resistance to irritants. Br J Dermatol 121:323–328

    PubMed  CAS  CrossRef  Google Scholar 

  52. Basketter DA, Griffiths HA, Wang XM, Wilhelm KP, McFadden J (1996) Individual, ethnic and seasonal variability in irritant susceptibility of skin: the implications for a predictive human patch test. Contact Dermatitis 35: 208–213

    PubMed  CAS  CrossRef  Google Scholar 

  53. Löffler H, Happle R (2003) Influence of climatic conditions on the irritant patch test with sodium lauryl sulphate. Acta Derm Venereol (Stockh) 83:338–341

    CrossRef  Google Scholar 

  54. Brasch J, Schnuch A, Geier J, Aberer W, Uter W (2004) Iodopropynylbutyl carbamate 0.2% is suggested for patch testing of patients with eczema possibly related to preservatives. Br J Dermatol 151:608–615

    PubMed  CAS  CrossRef  Google Scholar 

  55. Geier J, Uter W, Pirker C, Frosch PJ (2003) Patch testing with the irritant sodium lauryl sulfate (SLS) is useful in interpreting weak reactions to contact allergens as allergic or irritant. Contact Dermatitis 48:99–107

    PubMed  CAS  CrossRef  Google Scholar 

  56. Uter W, Geier J, Land M, Pfahlberg A, Gefeller O, Schnuch A (2001) Another look at seasonal variation in patch test results. A multifactorial analysis of surveillance data of the IVDK. Information Network of Departments of Dermatology. Contact Dermatitis 44:146–152

    PubMed  CAS  CrossRef  Google Scholar 

  57. Uter W, Hegewald J, Pfahlberg A, Pirker C, Frosch PJ, Gefeller O (2003) The association between ambient air conditions (temperature and absolute humidity), irritant sodium lauryl sulfate patch test reactions and patch test reactivity to standard allergens. Contact Dermatitis 49: 97–102

    PubMed  CAS  CrossRef  Google Scholar 

  58. Uter W, Geier J, Becker D, Brasch J, Löffler H (2004) The MOAHLFA index of irritant sodium lauryl sulfate reactions: first results of a multicentre study on routine sodium lauryl sulfate patch testing. Contact Dermatitis 51:259–262

    PubMed  CAS  CrossRef  Google Scholar 

  59. Veien NK, Hattel T, Laurberg G (1997) Low-humidity dermatosis from car heaters. Contact Dermatitis 37:138

    PubMed  CAS  CrossRef  Google Scholar 

  60. Moroni P, Cazzaniga R, Pierini F, Panella V, Zerboni R (1988) Occupational contact psoriasis. Dermatosen 36: 163–164

    Google Scholar 

  61. Hill VA, Ostlere LS (1998) Psoriasis of the hands köbnerizing in contact dermatitis. Contact Dermatitis 39:194

    PubMed  CAS  CrossRef  Google Scholar 

  62. Gawkrodger DJ, Lloyd MH, Hunter JAA (1986) Occupational skin disease in hospital cleaning and kitchen workers. Contact Dermatitis 15:132–135

    PubMed  CAS  CrossRef  Google Scholar 

  63. Ramsing DW, Agner T (1996) Effect of glove occlusion on human skin (II). Long-term experimental exposure. Contact Dermatitis 34:258–262

    PubMed  CAS  CrossRef  Google Scholar 

  64. Wrangsjö K, Osterman K, van Hage-Hamsten M (1994) Glove-related skin symptoms among operating theatre and dental care unit personnel. Contact Dermatitis 30:102–107

    PubMed  CrossRef  Google Scholar 

  65. Kwon S, Campbell LS, Zirwas MJ (2006) Role of protective gloves in the causation and treatment of occupational irritant contact dermatitis. J Am Acad Dermatol 55:891–896

    PubMed  CrossRef  Google Scholar 

  66. John SM (2006) Primary and acquired sensitive skin. In: Berardesca E, Fluhr J, Maibach HI (eds) The sensitive skin syndrome. Taylor & Francis, New York, pp 129–147

    Google Scholar 

  67. Wetzky U, Bock M, Wulfhorst B, John SM (2009) Short- and long-term effects of single and repetitive glove occlusion on the epidermal barrier. Arch Dermatol Res 301: 595–602

    Google Scholar 

  68. Bock U, Dahmer K, Wulfhorst B, John SM (2009) Semipermeable glove membranes. Effects on skin barrier repair following SLS-irritation. Contact Dermatitis 61: 276–280

    Google Scholar 

  69. Zhai H, Maibach HI (2001) Skin occlusion and irritant and allergic contact dermatitis: an overview. Contact Dermatitis 44:201–206

    PubMed  CAS  CrossRef  Google Scholar 

  70. Wulfhorst B, Schwanitz HJ, Bock M (2004) Optimizing skin protection with semipermeable gloves. Dermatitis 15:184–191

    PubMed  CrossRef  Google Scholar 

  71. Kanerva L, Estlander T, Jolanki R (2000) Occupational contact dermatitis caused by personal-computer mouse. Contact Dermatitis 43:362–363

    PubMed  CAS  Google Scholar 

  72. Tanaka M, Fujimoto A, Kobayashi S et al (2001) Keyboard wrist pad. Contact Dermatitis 44:253–254

    PubMed  CAS  Google Scholar 

  73. Capon F, Cambie MP, Clinard F, Bernardeau K, Kalis B (1996) Occupational contact dermatitis caused by computer mice. Contact Dermatitis 35:57–58

    PubMed  CAS  CrossRef  Google Scholar 

  74. Halkier-Sørensen L (1998) Occupational skin disease: reliability and utility of the data in the various registers; the course from notification to compensation and the costs. Contact Dermatitis 39:71–78

    PubMed  CrossRef  Google Scholar 

  75. Eiermann HJ, Larsen W, Maibach HI, Taylor JS (1982) Prospective study of cosmetic reactions: 1977–1980. J Am Acad Dermatol 6:909–917

    PubMed  CAS  CrossRef  Google Scholar 

  76. Berne B, Boström Å, Grahnén AF, Tammela M (1996) Adverse effects of cosmetics and toiletries reported to the Swedish Medical Products Agency 1989–1994. Contact Dermatitis 34:359–362

    PubMed  CAS  CrossRef  Google Scholar 

  77. Kanerva L, Lahtinen A, Toikkanen J, Forss H, Estlander T, Susitaival P, Jolanki R (1999) Increase in occupational skin diseases of dental personnel. Contact Dermatitis 40:104–108

    PubMed  CAS  CrossRef  Google Scholar 

  78. Rustemeyer T, Frosch PJ (1996) Occupational skin diseases in dental laboratory technicians. I. Clinical picture and causative factors. Contact Dermatitis 34:125–133

    PubMed  CAS  CrossRef  Google Scholar 

  79. Paulsen E (1998) Occupational dermatitis in Danish gardeners and greenhouse workers (II.) Etiological factors. Contact Dermatitis 38:14–19

    PubMed  CAS  CrossRef  Google Scholar 

  80. Dickel H, Kuss O, Schmidt A, Kretz J, Diepgen TL (2002) Importance of irritant contact dermatitis in occupational skin disease. Am J Clin Dermatol 3:283–289

    PubMed  CrossRef  Google Scholar 

  81. Dickel H, John SM (2003) Ratio of irritant contact dermatitis in occupational skin disease. J Am Acad Dermatol 49:361–362

    CrossRef  Google Scholar 

  82. Diepgen TL (2003) Occupational skin disease data in Europe. Int Arch Occup Environ Health 76:331–338

    PubMed  CrossRef  Google Scholar 

  83. Kucenic MJ, Belsito DV (2003) Occupational allergic contact dermatitis is more prevalent than irritant contact dermatitis: a 5-year study. J Am Acad Dermatol 49: 360–361, authors’ reply 362

    Google Scholar 

  84. Dickel H, Kuss O, Blesius CR, Schmidt A, Diepgen TL (2001) Occupational skin diseases in Northern Bavaria between 1990 and 1999: a population-based study. Br J Dermatol 145:453–462

    PubMed  CAS  CrossRef  Google Scholar 

  85. Frosch PJ, Pilz B, Peiler D, Dreier B, Rabenhorst S (1997) Die Epikutantestung mit patienten-eigenen Produkten. In: Plewig G, Przybilla B (eds) Fortschritte der praktischen Dermatologie und Venerologie. Springer, Berlin, pp 166–181

    CrossRef  Google Scholar 

  86. Geier J, Uter W, Lessmann H, Frosch PJ (2004) Patch testing with metal-working fluids from the patient’s workplace. Contact Dermatitis 51:172–179

    PubMed  CAS  CrossRef  Google Scholar 

  87. Jolanki R, Estlander T, Alanko K, Kanerva L (2000) Patch testing with a patient’s own material handled at work. In: Kanerva L, Elsner P, Wahlberg JE, Maibach HI (eds) Handbook of occupational dermatology, vol 47. Springer, Berlin, pp 375–383

    CrossRef  Google Scholar 

  88. Menné T, Dooms-Goossens A, Wahlberg JE, White IR, Shaw S (1992) How large a proportion of contact sensitivities are diagnosed with the European Standard series? Contact Dermatitis 26:201–202

    PubMed  CrossRef  Google Scholar 

  89. Uter W, Balzer C, Geier J, Schnuch A, Frosch PJ (2005) Ergebnisse der Epikutantestung mit patienteneigenen Parfums, Deos und Rasierwässern. Dermatol Beruf Umwelt 53:25–36

    Google Scholar 

  90. Belsito DV (2005) Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability. J Am Acad Dermatol 53:303–313

    PubMed  CrossRef  Google Scholar 

  91. Diepgen TL, Andersen KE, Brandao FM, Bruze M, Bruynzeel DP, Frosch P, Goncalo M, Goossens A, Le Coz CJ, Rustemeyer T, White IR, Agner T (2009) European Enviromental and Contact Dermatitis Research Group. Hand eczema classification: a cross-sectional, multicentre study of the aetiology and morphology of hand eczema. Br J Derm 160:353–358

    CAS  CrossRef  Google Scholar 

  92. Meding B, Wrangsjö K, Järvholm B (2005) Fifteen-year follow-up of hand eczema: persistence and consequences. Br J Dermatol 152:975–980

    PubMed  CAS  CrossRef  Google Scholar 

  93. Agner T, Andersen KE, Brandao FM, Bruze M, Bruynzeel DP, Frosch P, Goncalo M, Goossens A, Le Coz CJ, Rustemeyer T, White IR, Diepgen TL (2008) EECDRG. Hand eczema severity and quality of life: a crosssectional, multicentre study of hand eczema patients. Contact Dermatitis 59:43–47

    PubMed  CrossRef  Google Scholar 

  94. Fleming MG, Bergfeld WF (1990) The etiology of irritant contact dermatitis. In: Jackson EM, Goldner R (eds) Initant contact dermatitis. Dekker, New York, pp 41–66

    Google Scholar 

  95. Gehse M, Kändler-Stürmer P, Gloor M (1987) Über die Bedeutung der Irritabilität der Haut für die Entstehung des berufsbedingten allergischen Kontaktekzems. Dermatol Monatsschr 173:400–404

    Google Scholar 

  96. Kligman AM (1979) Cutaneous toxicity: an overview from the underside. Curr Probl Dermatol 7:1–25

    Google Scholar 

  97. Landman G, Farmer ER, Hood AF (1990) The pathophysiology of irritant contact dermatitis. In: Jackson EM, Goldner R (eds) Irritant contact dermatitis. Dekker, New York, pp 67–77

    Google Scholar 

  98. Malten KE (1981) Thoughts on irritant contact dermatitis. Contact Dermatitis 7:238–247

    PubMed  CAS  CrossRef  Google Scholar 

  99. Rietschel RL (1989) Persistent maleic acid irritant dermatitis in the guinea pig. In: Frosch PJ, Dooms-Goossens A, Lachapelle JM, Rycroft RJG, Scheper RJ (eds) Current topics in contact dermatitis. Springer, Berlin, pp 429–434

    CrossRef  Google Scholar 

  100. Agner T, Fullerton A, Broby-Johnson U, Batsberg W (1990) Irritant patch testing: penetration of sodium lauryl sulphate into human skin. Skin Pharmacol 3:213–217

    PubMed  CAS  CrossRef  Google Scholar 

  101. Frosch PJ, Kligman AM (1977) A method for appraising the stinging capacity of topically applied substances. J Soc Cosmet Chem 28:197–209

    Google Scholar 

  102. Frosch PJ, Kligman AM (1979) The soap chamber test: a new method for assessing the irritancy of soaps. J Am Acad Dermatol 1:35–41

    PubMed  CAS  CrossRef  Google Scholar 

  103. Van der Valk PGM, Crijns MC, Nater JP, Bleumink E (1984) Skin irritancy of commercially available soap and detergent bars as measured by water vapour loss. Dermatosen 32:87–90

    Google Scholar 

  104. Van der Valk PGM, Nater JP, Bleumink E (1984) Skin irritancy of surfactants as assessed by water vapor loss measurements. J Invest Dermatol 82:291–293

    PubMed  CrossRef  Google Scholar 

  105. Nangia A, Andersen PH, Berner B, Maibach HI (1996) High dissociation constants (pKa) of basic permeants are associated with in vivo skin irritation in man. Contact Dermatitis 34:237–242

    PubMed  CAS  Google Scholar 

  106. Fischer T, Bjarnason B (1996) Sensitizing and irritant properties of 3 environmental classes of diesel oil and their indicator dyes. Contact Dermatitis 34:309–315

    PubMed  CAS  CrossRef  Google Scholar 

  107. Feldman RJ, Maibach HI (1967) Regional variations in percutaneous absorption of 14 C cortisol in man. J Invest Dermatol 48:181–185

    Google Scholar 

  108. Frosch PJ, Duncan S, Kligman AM (1980) Cutaneous biometrics 1: the DMSO test. Br J Dermatol 102:263–274

    CrossRef  Google Scholar 

  109. Cua AB, Wilhelm KP, Maibach HI (1990) Cutaneous sodium lauryl sulfate irritation potential: age and regional variability. Br J Dermatol 123:607–613

    PubMed  CAS  CrossRef  Google Scholar 

  110. Dahlquist I, Fregert S (1979) Skin irritation in newborns. Contact Dermatitis 5:336

    PubMed  CAS  CrossRef  Google Scholar 

  111. Uter W, Pfahlberg A, Gefeller O, Schwanitz HJ (1998) Hand eczema in a prospectively-followed cohort of office-workers. Contact Dermatitis 38:83–89

    PubMed  CAS  Google Scholar 

  112. Adams RM (1999) Occupational skin disease, 3rd edn. Saunders, Philadelphia

    Google Scholar 

  113. Rycroft RJG (1986) Occupational dermatoses among office personnel. Occup Med State Art Rev 1:323–328

    CAS  Google Scholar 

  114. Rothenborg HW, Menné T, Sjolin KE (1977) Temperature dependent primary irritant dermatitis from lemon perfume. Contact Dermatitis 3:37–48

    PubMed  CAS  CrossRef  Google Scholar 

  115. Clarys P, Manou I, Barel AO (1997) Influence of temperature on irritation in the hand/forearm immersion test. Contact Dermatitis 36:240–243

    PubMed  CAS  CrossRef  Google Scholar 

  116. Warren R, Ertel KD, Bartolo RG, Levine MJ, Bryant PB, Wong LF (1996) The influence of hard water (calcium) and surfactants on irritant contact dermatitis. Contact Dermatitis 35:337–343

    PubMed  CAS  CrossRef  Google Scholar 

  117. Ramam M, Khaitan BK, Singh MK, Gupta SD (1998) Frictional sweat dermatitis. Contact Dermatitis 38:49

    PubMed  CAS  CrossRef  Google Scholar 

  118. Nilsson E, Mikaelsson B, Andersson S (1985) Atopy, occupation and domestic work as risk factors for hand eczema in hospital workers. Contact Dermatitis 13:216–223

    PubMed  CAS  CrossRef  Google Scholar 

  119. Rystedt I (1985) Atopic background in patients with occupational hand eczema. Contact Dermatitis 12:247–254

    PubMed  CAS  CrossRef  Google Scholar 

  120. Lammintausta K, Kalimo K (1981) Atopy and hand dermatitis in hospital wet work. Contact Dermatitis 7:301–308

    PubMed  CAS  CrossRef  Google Scholar 

  121. Uter W, Pfahlberg A, Gefeller O, Schwanitz HJ (1998) Risk factors for hand dermatitis in hairdressing apprentices. Dermatosen 46:151–158

    Google Scholar 

  122. Löffler H, Effendy I (1999) Skin susceptibility of atopic individuals. Contact Dermatitis 40:239–242

    PubMed  CrossRef  Google Scholar 

  123. Bauer A, Bartsch R, Stadeler M, Schneider W, Grieshaber R, Wollina U, Gebhardt M (1998) Development of occupational skin diseases during vocational training in baker and confectioner apprentices: a follow-up study. Contact Dermatitis 39:307–311

    PubMed  CAS  CrossRef  Google Scholar 

  124. Gallacher G, Maibach HI (1998) Is atopic dermatitis a predisposing factor for experimental acute irritant contact dermatitis? Contact Dermatitis 38:1–4

    PubMed  CAS  CrossRef  Google Scholar 

  125. Tupker R (2003) Prediction of irritancy in the human skin irritancy model and occupational setting. Contact Dermatitis 49:61–69

    PubMed  CAS  CrossRef  Google Scholar 

  126. de Jongh CM, Khrenova L, Verberk MM, Calkoen F, van Dijk FJ, Voss H, John SM Kezic S (2008) Loss of-function poymorphisms in the filaggrin gene are associated with an increased susceptibility to chronic irritant contact dermatitis: a case-control study. Br J Dermatol 159:621–627

    Google Scholar 

  127. Giwercman C, Lerbaek A, Bisgaard H, Menné T (2008) Classification of atopic hand eczema and the filaggrin mutations. Contact Dermatitis 59:257–260

    PubMed  CrossRef  Google Scholar 

  128. de Jongh CM, Khrenova L, Kezic S, Rustemeyer T, Verberk MM, John SM (2008) Polymorphisms in the interleukin-1 gene influence the stratum corneum interleukin-1 α concentration in uninvolved skin of patients with chronic irritant contact dermatitis. Contact Dermatitis 58:263–268

    PubMed  CrossRef  Google Scholar 

  129. Molin S, Vollmer S, Weiss EH, Ruzicka T, Prinz JC (2009) Filaggrin mutations may confer susceptibility to chronic hand eczema characterized by combined allergic and irritant contact dermatitis. Br J Dermatol 161:801–807

    Google Scholar 

  130. de Jongh CM, John SM, Bruynzeel DP, Caloen F, van Duk FJ, Khrenova L, Rustemeyer T, Verberk MM, Kezic S (2008) Cytokine gene polymorphisms and susceptibility to chronic irritant contact dermatitis. Contact Dermatitis 58: 269–277

    PubMed  CrossRef  Google Scholar 

  131. Marriott M, Holmes J, Peters L, Cooper K, Rowson M, Basketter DA (2005) The complex problem of sensitive skin. Contact Dermatitis 53:93–99

    Google Scholar 

  132. Weigand DA, Mershon MM (1970) The cutaneous irritant reaction to agent o- chlorobenzylidene malononitrile (CS). II. Quantitation and racial influence in human subjects. Edgewood Arsenal Technique no 4332

    Google Scholar 

  133. Weigand DA, Haygood C, Gaylor JR (1974) Cell layers and density of negro and caucasian stratum corneum. J Invest Dermatol 62:563–568

    PubMed  CAS  CrossRef  Google Scholar 

  134. Berardesca E, Maibach HI (1988) Racial differences in sodium lauryl sulphate induced cutaneous irritation: black and white. Contact Dermatitis 18:65–70

    PubMed  CAS  CrossRef  Google Scholar 

  135. Berardesca E, Maibach HI (1988) Sodium-lauryl-sulphate-induced cutaneous irritation: comparison of white and hispanic subjects. Contact Dermatitis 19:136–140

    PubMed  CAS  CrossRef  Google Scholar 

  136. Astner S, Burnett N, Rius-Diaz F, Doukas AG, González S, Gonzalez E (2006) Irritant contact dermatitis induced by a common household irritant: a noninvasive evaluation of ethnic variability in skin response. J Am Acad dermatol 54:458–465

    PubMed  CrossRef  Google Scholar 

  137. Frosch PJ, Wissing C (1982) Cutaneous sensitivity to ultraviolet light and chemical irritants. Arch Dermatol Res 272:269–278

    PubMed  CAS  CrossRef  Google Scholar 

  138. John S, Uter W (2005) Meteorological influence on NaOH irritation varies with body site. Arch Derm Res 296:320–326

    PubMed  CAS  CrossRef  Google Scholar 

  139. John SM, Schwanitz HJ (2006) Functional skin testing: the SMART-procedures. In: Chew A-L, Maibach HI (eds) Handbook of irritant dermatitis. Springer, Berlin, pp 211–221

    CrossRef  Google Scholar 

  140. Choi JM, Lee JY, Cho BK (2000) Chronic irritant contact dermatitis: recovery time in man. Contact Dermatitis 42:264–269

    PubMed  CAS  CrossRef  Google Scholar 

  141. Sajjachareonpong P, Cahill J, Keegel T, Saunders H, Nixon R (2004) Persistent post-occupational dermatitis. Contact Dermatitis 51:278–283

    PubMed  CrossRef  Google Scholar 

  142. Apfelbacher CJ, Radulescu M, Diepgen TL, Funke U (2008) Occurrence and prognosis of hand eczema in the car industry: results from the PACO follow-up study (PACO II). Contact Dermatitis 58:322–329

    PubMed  CrossRef  Google Scholar 

  143. Hamami I, Marks R (1988) Structural determinants of the response of the skin to chemical irritants. Contact Dermatitis 18:71–75

    PubMed  CAS  CrossRef  Google Scholar 

  144. Downing DT, Stewart ME, Wertz PW, Colton SW, Abraham W, Strauss JS (1987) Skin lipids: an update. J Invest Dermatol 88:2s–62s

    PubMed  CAS  CrossRef  Google Scholar 

  145. Elias PM, Brown BE, Zoboh VA (1980) The permeability barrier in essential fatty acid deficiency: evidence for a direct role for linoleic acid in barrier function. J Invest Dermatol 74:230–233

    PubMed  CAS  CrossRef  Google Scholar 

  146. Elias PM (1985) The essential fatty acid deficient rodent: evidence for a direct role for intercellular lipid in barrier function. In: Maibach HI, Lowe N (eds) Models in dermatology, vol 1. Karger, Basel, pp 272–285

    Google Scholar 

  147. Landmann L (1985) Permeabilitätsbarriere der Epidermis. Grosse, Berlin (Grosse Scripta 9)

    Google Scholar 

  148. Wertz PW, Miethke MC, Long SA, Strauss JS, Downing DT (1985) The composition of the ceramides from human stratum corneum and from comedones. J Invest Dermatol 84:410–412

    PubMed  CAS  CrossRef  Google Scholar 

  149. Bamford JTM, Gibson RW, Renier CM (1985) Atopic eczema unresponsive to evening primrose oil (linoleic and gammalinolenic acids). J Am Acad Dermatol 13:959–965

    PubMed  CAS  CrossRef  Google Scholar 

  150. Di Nardo A, Sugino K, Wertz P, Ademola J, Maibach HI (1996) Sodium lauryl sulfate (SLS) induced irritant contact dermatitis: a correlation study between ceramides and in vivo parameters of irritation. Contact Dermatitis 35:86–91

    PubMed  CrossRef  Google Scholar 

  151. Willers P (1984) Die Bedeutung der Hornschicht für die Irritabilität der Haut. Thesis, Westfälische Wilhelms University, Münster

    Google Scholar 

  152. Goffin V, Piérard-Franchimont C, Piérard G (1996) Sensitive skin and stratum corneum reactivity to household cleaning products. Contact Dermatitis 34:81–85

    PubMed  CAS  CrossRef  Google Scholar 

  153. Agner T, Damm P, Skouby SO (1991) Menstrual cycle and skin reactivity. J Am Acad Dermatol 24:566–570

    PubMed  CAS  CrossRef  Google Scholar 

  154. Lammintausta K, Maibach HI (1987) Irritant reactivity in males and females. Contact Dermatitis 17:276–280

    PubMed  CAS  CrossRef  Google Scholar 

  155. Roskos KV, Maibach HI, Guy RH (1989) The effect of aging on percutaneous absorption in man. J Pharmacokinet Biopharm 17:617–630

    PubMed  CAS  CrossRef  Google Scholar 

  156. Rougier A, Lotte C, Corcuff P, Maibach HI (1988) Relationship between skin permeability and corneocyte size according to anatomic site, age, and sex in man. J Soc Cosmet Chem 39:15–26

    Google Scholar 

  157. Coenraads PJ, Bleumink E, Nater JP (1975) Susceptibility to primary irritants. Age dependance and relation of contact allergic reactions. Contact Dermatitis 1:177–181

    CrossRef  Google Scholar 

  158. Wilhelm KP, Maibach HI (1993) The effect of aging on the barrier function of human skin evaluated by in vivo transepidermal water loss measurement. In: Frosch PJ, Kligman AM (eds) Noninvasive methods for the quantification of skin functions. Springer, Berlin, pp 181–189

    CrossRef  Google Scholar 

  159. Grove GL, Duncan S, Kligman AM (1982) Effect of ageing on the blistering of human skin with ammonium hydrxide. Br J Dermatol 107:393–400

    PubMed  CAS  CrossRef  Google Scholar 

  160. Schwindt DA, Wilhelm KP, Miller DL, Maibach HI (1998) Cumulative irritation in older and younger skin: a comparison. Acta Derm Venereol (Stockh) 78:279–283

    CAS  CrossRef  Google Scholar 

  161. Berardesca E, Maibach HI (2003) Ethnic skin: overview of structure and function. J Am Acad Dermatol 48 (suppl):S139–S142

    Google Scholar 

  162. Hicks SP, Swindells KJ, Middelkamp-Hup MA, Sifakis MA, Gonzalez E, Gonzalez S (2003) Confocal histopathology of irritant contact dermatitis in vivo and the impact of skin color (black vs white). J Am Acad Dermatol 48:727–734

    PubMed  CrossRef  Google Scholar 

  163. Robinson MK (1999) Population differences in skin structure and physiology and the susceptibility to irritant and allergic contact dermatitis: implications for skin safety testing and risk assessment. Contact Dermatitis 41:65–79

    PubMed  CAS  CrossRef  Google Scholar 

  164. Swindells K, Burnett N, Ruis-Diaz F, Gonzalez E, Mihm MC, Gonzalez S (2004) Reflectance confocal microscopy may differentiate acute allergic and irritant contact dermatitis in vivo. J Am Acad Dermatol 50:220–228

    PubMed  CrossRef  Google Scholar 

  165. Wulfhorst B (2000) Skin hardening in occupational dermatology. In: Kanerva L, Elsner P, Wahlberg J, Maibach H (eds) Handbook of occupational dermatology. Springer, Berlin, pp 115–121

    CrossRef  Google Scholar 

  166. McOsker DE, Beck LW (1967) Characteristics of accomodated (hardened) skin. J Invest Dermatol 48:372–383

    PubMed  CAS  Google Scholar 

  167. Watkins SA, Maibach HI (2009) The hardening phenomenon in irritant contact dermatitis: an interpretative update. Contact Dermatitis 60:123–130

    PubMed  CrossRef  Google Scholar 

  168. Frosch PJ, Kligman AM (1977) Rapid blister formation in human skin with ammonium hydroxide. Br J Dermatol 96:461–473

    PubMed  CAS  CrossRef  Google Scholar 

  169. Berndt U, Hinnen U, Iliev D, Elsner P (1999) Is occupational irritant contact dermatitis predictable by cutaneous bioengineering methods? Results of the Swiss metalworkers’ eczema study (PROMETES). Dermatology 198:351–354

    PubMed  CAS  CrossRef  Google Scholar 

  170. Kolbe L, Kligman AM, Stoudemayer T (1998) The sodium hydroxide erosion assay: a revision of the alkali resistance test. Arch Derm Res 290:382–387

    PubMed  CAS  CrossRef  Google Scholar 

  171. Wilhelm KP, Pasche F, Surber C, Maibach HI (1990) Sodium hydroxide- induced subclinical irritation. A test for evaluating stratum corneum barrier function. Acta Derm Venereol (Stockh) 70:463–367

    CAS  Google Scholar 

  172. Grunewald AM, Gloor M, Gehring W, Kleesz P (1995) Damage to the skin by repetitive washing. Contact Dermatitis 32:225–232

    PubMed  CAS  CrossRef  Google Scholar 

  173. Hachem J, Crumrine D, Fluhr J (2003) pH directly regulates epidermal permeability barrier homeostasis, and stratum corneum integrity/cohesion. J Invest Dermatol 121:345–353

    PubMed  CAS  CrossRef  Google Scholar 

  174. Held E, Agner T (1999) Comparison between 2 test models in evaluating the effect of a moisturizer on irritated human skin. Contact Dermatitis 40:261–268

    PubMed  CAS  CrossRef  Google Scholar 

  175. McFadden JPP, Wakelin SH, Basketter DA (1998) Acute irritation thresholds in subjects with Type I-Type VI skin. Contact Dermatitis 38:147–149

    PubMed  CAS  CrossRef  Google Scholar 

  176. Basketter DA, Miettinen J, Lahti A (1998) Acute irritant reactivity to sodium lauryl sulfate in atopics and non-atopics. Contact Dermatitis 38:253–256

    PubMed  CAS  CrossRef  Google Scholar 

  177. Robinson MK, Perkins MA, Basketter DA (1998) Application of a 4-h human patch test method for comparative and investigative assessment of skin irritation. Contact Dermatitis 38:194–202

    PubMed  CAS  CrossRef  Google Scholar 

  178. Basketter DA, Whittle E, Chamberlain M (1994) Identification of irritation and corrosion hazards to skin: an alternative strategy to animal testing. Food Chem Toxicol 32:539–542

    PubMed  CAS  CrossRef  Google Scholar 

  179. Basketter DA, Whittle E, Griffiths HA, York M (1994) The identification and classification of skin irritation hazard by human patch test. Food Chem Toxicol 32:769–775

    PubMed  CAS  CrossRef  Google Scholar 

  180. Basketter DA, Chamberlain M, Griffiths HA, York M (1997) The classification of skin irritants by human patch test. Food Chem Toxicol 35:845–852

    PubMed  CAS  CrossRef  Google Scholar 

  181. EC Annex to Commission Directive 92/69/EEC of 31 July 1992 adapting to technical progress for the seventh time Council Directive 67/548/EEC on the approximation of laws, regulations and administrative provisions relating to the classification, packaging and labelling of dangerous substances. Official J Eur Commun L383A:35 (1992)

    Google Scholar 

  182. Judge MR, Griffiths HA, Basketter DA, White IR, Rycroft RJG, McFadden JP (1996) Variation in response of human skin to irritant challenge. Contact Dermatitis 34:115–117

    PubMed  CAS  CrossRef  Google Scholar 

  183. York M, Griffiths HA, Whittle E, Basketter DA (1996) Evaluation of human patch test for the identification and classification of skin irritation potential. Contact Dermatitis 34:204–212

    PubMed  CAS  CrossRef  Google Scholar 

  184. Basketter D, Gerberick F, Kimber I, Willis C (1999) Toxicology of contact dermatitis. Wiley, Chichester

    Google Scholar 

  185. Wilhelm KP, Saunders JC, Maibach HI (1990) Increased stratum corneum turnover induced by subclinical irritant dermatitis. Br J Dermatol 122:793–798

    PubMed  CAS  CrossRef  Google Scholar 

  186. Pinnagoda J, Tupker RA, Coenraads PJ, Nater JP (1989) Prediction of susceptibility to an irritant response by transepidermal water loss. Contact Dermatitis 20:341–346

    PubMed  CAS  CrossRef  Google Scholar 

  187. Wilhelm KP, Maibach HI (1990) Susceptibility to SLS-induced irritant dermatitis: relation to skin pH, TEWL, sebum concentration, and stratum corneum turnover time. J Am Acad Dermatol 23:122–124

    PubMed  CAS  CrossRef  Google Scholar 

  188. Elias PM, Wood LC, Feingold KR (1999) Epidermal pathogenesis of inflammatory dermatoses. Am J Contact Dermat 10:119–126

    PubMed  CAS  CrossRef  Google Scholar 

  189. Willis CM (2002) Variability in responsiveness to irritants: thoughts on possible underlying mechanisms. Contact Dermatitis 47:267–271

    PubMed  CAS  CrossRef  Google Scholar 

  190. Boxman IL, Hensbergen PJ, van der Schors RC, Bruynzeel DP, Tensen CP, Ponec M (2002) Proteomic analysis of skin irritation reveals the induction of HSP27 by sodium lauryl sulphate in human skin. Br J Dermatol 146:777–785

    PubMed  CAS  CrossRef  Google Scholar 

  191. Willis CM, Britton LE, Reiche L, Wilkinson JD (2001) Reduced levels of glutathione S-transferases in patch test reactions to dithranol and sodium lauryl sulphate as demonstrated by quantitative immunocytochemistry: evidence for oxidative stress in acute irritant contact dermatitis. Eur J Dermatol 11:99–104

    PubMed  CAS  Google Scholar 

  192. Barr RM, Brain SC, Camp RD, Cilliers J, Greaves MW, Al M, Misch K (1984) Levels of arachidonic acid and its metabolites in the skin in human allergic and irritant contact dermatitis. Br J Dermatol 111:23–28

    PubMed  CAS  CrossRef  Google Scholar 

  193. Cumberbatch M, Dearman RJ, Groves RW, Antanopoulos C, Kimber I (2002) Differential regulation of epidermal Langerhans cell migration by interleukins (IL)-1alpha and IL-1beta during irritant and allergen-induced cutaneous immune responses. Toxicol Appl Pharmacol 182:126–135

    PubMed  CAS  CrossRef  Google Scholar 

  194. Frosch PJ, Czarnetzki BM (1987) Surfactants cause in vitro chemotaxis and chemokinesis of human neutrophils. J Invest Dermatol 88:52s–55s

    PubMed  CAS  CrossRef  Google Scholar 

  195. Imokawa G, Mishima Y (1981) Cumulative effect of surfactants on cutaneous horny layers. Contact Dermatitis 7:65–71

    PubMed  CAS  CrossRef  Google Scholar 

  196. Kucharekova M, Hornix M, Ashikaga T et al (2003) The effect of the PDE-4 inhibitor (cipamfylline) in two human models of irritant contact dermatitis. Arch Dermatol Res 295:29–32

    PubMed  CAS  Google Scholar 

  197. Larsen CG, Ternowitz T, Larsen EG, Thestrup-Pedersen K (1989) ETAF/interleukin 1 and epidermal lymphocyte chemotactic factor in epidermis overlying an irritant patch test. Contact Dermatitis 20:335–340

    CrossRef  Google Scholar 

  198. Li LF, Fiedler VC, Kumar R (1998) Down-regulation of protein kinase C isoforms in irritant contact dermatitis. Contact Dermatitis 38:319–324

    PubMed  CAS  CrossRef  Google Scholar 

  199. Nickoloff BJ (1988) The role of gamma interferon in cutaneous trafficking of lymphocytes with emphasis on molecular and cellular adhesion events. Arch Dermatol 124:1835–1843

    PubMed  CAS  CrossRef  Google Scholar 

  200. Oxholm AM, Oxholm P, Avnstorp C, Bendtzen K (1991) Keratinocyte-expression of interleukin-6 but not of tumour necrosis factor-alpha is increased in the allergic and the irritant patch test reaction. Acta Derm Venereol (Stockh) 71:93–98

    CAS  Google Scholar 

  201. Patrick E, Burkhalter A, Maibach HI (1987) Recent investigations of mechanisms of chemically induced skin irritation in laboratory mice. J Invest Dermatol 88:24s–31s

    PubMed  CAS  CrossRef  Google Scholar 

  202. Prottey C (1978) The molecular basis of skin irritation. In: Breuer MM (ed) Cosmetic science, vol 1. Academic, London, pp 275–349

    Google Scholar 

  203. Reilly DM, Green MR (1999) Eicosanoid and cytokine levels in acute skin irritation in response to tape strip-ping and capsicain. Acta Derm Venereol (Stockh) 79:187–190

    CAS  CrossRef  Google Scholar 

  204. Smith HR, Basketter DA, McFadden JP (2002) Irritant dermatitis, irritancy and its role in allergic contact dermatitis. Exp Dermatol 27:138–146

    CrossRef  Google Scholar 

  205. Van der Valk PGM, Maibach HI (eds) (1996) The irritant contact dermatitis syndrome. CRC Press, Boca Raton

    Google Scholar 

  206. Wallengren J, Larsson B (2001) Nitric oxide participates in prick test and irritant patch test reactions in human skin. Arch Derm Res 293:121–125

    PubMed  CAS  CrossRef  Google Scholar 

  207. Carter EL, O’Herrin S, Woolery C, Jack Longley B (2008) Epidermal stem cell factor augments the inflammatory response in irritant and allergic contact dermatitis. J Invest Dermatol 128:1861–1863

    PubMed  CAS  CrossRef  Google Scholar 

  208. Törmä H, Lindberg M, Berne B (2008) Skin barrier disruption by sodium lauryl sulfate-exposure alters the expressions of involucrin, trasglutaminase 1, profilaggrin, and kallikreins during the repair phase in human skin in vivo. J Invest Dermatol 128:1212–1219

    PubMed  CrossRef  CAS  Google Scholar 

  209. de Jongh CM, Lutter R, Verberk MM, Kezic S (2008) Differential cytokine expression in skin after single and repeated irritation by sodium lauryl sulfate. Exp Dermatol 16:1032–1040

    CrossRef  CAS  Google Scholar 

  210. Meller S, Lauerma AI, Kopp FM, Winterberg F, Anthoni M, Müller A, Gombert M, Haahtela A, Alenius H, Rieker J, Dieu-Nosjean MC, Kubitza RC, Gleichmann E, Ruzicka T, Zlotnik A, Homey B (2007) inflammation: memory T cells make the difference. J Allergy Clin Immunol 119:1470–1480

    PubMed  CAS  CrossRef  Google Scholar 

  211. Bonneville M, Chavagnac C, Vocanson M, Rozieres A, Benetiere J, Pernet I, Denis A, Nicolas JF, Hennino A (2007) Skin contact irritation conditions the development and severity of allergic contact dermatitis. J Invest Dermatol 127:1430–1435

    PubMed  CAS  CrossRef  Google Scholar 

  212. Blanken R, van der Valk PGM, Nater JP (1986) Laser-Doppler flowmetry in the investigation of irritant compounds on human skin. Dermatosen 34:5–9

    CAS  Google Scholar 

  213. Nilsson GE, Otto U, Wahlberg JE (1982) Assessment of skin irritancy in man by laser Doppler flowmetry. Contact Dermatitis 8:401–406

    PubMed  CAS  CrossRef  Google Scholar 

  214. Fluhr JW, Bankova L, Fuchs S, Kelterer D, Schliemann-Willers S, Norgauer J, Kleesz P, Grieshaber R, Elsner P (2004) Fruit acids and sodium hydroxide in the food industry and their combined effect with sodium lauryl suphate: controlled in vivo tandem irritation study. Br J Dermatol 151:1039–1048

    PubMed  CAS  CrossRef  Google Scholar 

  215. Kappes UP, Goritz N, Wigger-Alberti W, Heinemann C, Elsner P (2001) Tandem application of sodium lauryl sulfate and n-propanol does not lead to enhancement of cumulative skin irritation. Acta Derm Venereol (Stockh) 81:403–405

    CAS  CrossRef  Google Scholar 

  216. Wigger-Alberti W, Krebs A, Elsner P (2000) Experimental irritant contact dermatitis due to cumulative epicutaneous exposure to sodium lauryl sulphate and toluene: single and concurrent application. Br J Dermatol 143:551–556

    PubMed  CAS  CrossRef  Google Scholar 

  217. Wigger-Alberti W, Spoo J, Schliemann-Willers S, Klotz A, Elsner P (2002) The tandem repeated irritation test: a new method to assess prevention of irritant combination damage to the skin. Acta Derm Venereol (Stockh) 82:94–97

    CAS  CrossRef  Google Scholar 

  218. Elsner P, Wigger-Alberti W (2003) Skin-conditioning products in occupational dermatology. Int Arch Occup Environ Health 76:351–354

    PubMed  CAS  CrossRef  Google Scholar 

  219. Frosch PJ, Kurte A, Pilz B (1993) Biophysical techniques for the evaluation of skin protective creams In: Frosch PJ, Kligman AM (eds) Noninvasive methods for the quantification of skin functions. Springer, Berlin, pp 214–222

    Google Scholar 

  220. Frosch PJ, Kurte A (1994) Efficacy of skin barrier creams. IV. The repetitive irritation test (RIT) with a set of four standard irritants. Contact Dermatitis 31:161–168

    PubMed  CAS  CrossRef  Google Scholar 

  221. Schliemann-Willers S, Wigger-Alberti W, Elsner P (2001) Efficacy of a new class of perfluoropolyethers in the prevention of irritant contact dermatitis. Acta Derm Venereol (Stockh) 81:392–394

    CAS  CrossRef  Google Scholar 

  222. Schliemann-Willers S, Wigger-Alberti W, Kleesz P, Grieshaber R, Elsner P (2002) Natural vegetable fats in the prevention of irritant contact dermatitis. Contact Dermatitis 46:6–12

    PubMed  CAS  CrossRef  Google Scholar 

  223. Schnetz E, Diepgen TL, Elsner P, Frosch PJ, Klotz AJ, Kresken J, Kuss O, Merk H, Schwanitz HJ, Wigger-Alberti W, Fartasch M (2000) Multi-centre study for the development of an in vivo model to evaluate the influence of topical formulations on irritation. Contact Dermatitis 42:336–343

    PubMed  CAS  CrossRef  Google Scholar 

  224. Spoo J, Wigger-Alberti W, Berndt U, Fischer T, Elsner P (2002) Skin cleansers: three test protocols for the assessment of irritancy ranking. Acta Derm Venereol (Stockh) 82:13–17

    CAS  CrossRef  Google Scholar 

  225. Löffler H, Pirker C, Aramaki J, Frosch PJ, Happle R, Effendy I (2001) Evaluation of skin susceptibility to irritancy by routine patch testing with sodium lauryl sulfate. Eur J Dermatol 11:416–419

    PubMed  Google Scholar 

  226. Lammintausta K, Maibach HI, Wilson D (1988) Mechanisms of subjective (sensory) irritation. Dermatosen 36:45–49

    CAS  Google Scholar 

  227. Wilhelm KP, Surber C, Maibach HI (1989) Quantification of sodium lauryl sulfate irritant dermatitis in man: comparison of four techniques: skin color reflectance, transepidermal water loss, laser Doppler flow measurement and visual scores. Arch Dermatol Res 281:293–295

    PubMed  CAS  CrossRef  Google Scholar 

  228. John SM, Uter W, Schwanitz HJ (2000) Relevance of multiparametric skin bioengineering in a prospectively-followed cohort of junior hairdressers. Contact Dermatitis 43:161–168

    PubMed  CAS  CrossRef  Google Scholar 

  229. Smit HA, van Rijssen A, Vandenbrouke JP, Coenrads PJ (1994) Susceptibility to and incidence of hand dermatitis in a cohort of apprentice hairdressers and nurses. Scand J Work Environ Health 20:113–121

    PubMed  CAS  CrossRef  Google Scholar 

  230. Smith HR, Armstrong DK, Holloway D, Whittam L, Basketter DA, McFadden JP (2002) Skin irritation thresholds in hairdressers: implications for the development of hand dermatitis. Br J Dermatol 146:849–852

    PubMed  CAS  CrossRef  Google Scholar 

  231. Uter W (1999) Epidemiologie und Prävention von Handekzemen in Feuchtberufen am Beispiel des Friseurhandwerks. Universitätsverlag Rasch, Osnabrück

    Google Scholar 

  232. Frosch PJ (1985) Human models for quantification of corticosteroid adverse effects. In: Maibach HI, Lowe NJ (eds) Models in dermatology, vol 2. Karger, Basel, pp 5–15

    Google Scholar 

  233. Anveden I, Kindberg M, Andersen KE, Bruze M, Isaksson M, Lidén C, Sommerlund M, Wahlberg JE, Wilkinson JD, Willis CM (2004) Oral prednisone suppresses allergic but not irritant patch test reactions in individuals hypersensitive to nickel. Contact Dermatitis 50:298–303

    PubMed  CAS  CrossRef  Google Scholar 

  234. Levin C, Zhai H, Bashir S, Chew AL, Anigbogu A, Stern R, Maibach H (2001) Efficacy of corticosteroids in acute experimental irritant contact dermatitis? Skin Res Technol 7:214–218

    PubMed  CAS  CrossRef  Google Scholar 

  235. Ramsing DW, Agner T (1995) Efficacy of topical corticosteroids on irritant skin reactions. Contact Dermatitis 32:293–297

    PubMed  CAS  CrossRef  Google Scholar 

  236. Kao JS, Fluhr JW, Man M-Q, Fowler AJ, Hachem J-P, Crumrine D, Ahn SK, Brown BE, Elias PM, Feingold KR (2003) Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: inhibition of epidermal lipid synthesis accounts for functional abnormalities. J Invest Dermatol 120:456–464

    PubMed  CAS  CrossRef  Google Scholar 

  237. Kolbe L, Kligman AM, Schreiner V, Stoudemayer T (2001) Corticosteroid-induced atrophy and barrier impairment measured by non-invasive methods in human skin. Skin Res Technol 7:73–77

    PubMed  CAS  CrossRef  Google Scholar 

  238. Schliemann S, Kelterer D, Bauer A, John SM, Schindera I, Wehrmann W, Elsner P (2008) Tacrolimus in the treatment of occupationally-induced chronic hand dermatitis. Contact Dermatitis 58:299–306

    PubMed  CAS  CrossRef  Google Scholar 

  239. Peiler D, Rustemeyer T, Pflug B, Frosch PJ (2000) Allergic contact dermatitis in dental laboratory technicians. II. Major allergens and their clinical relevance. Dermatosen 48:48–54

    Google Scholar 

  240. Frosch PJ, Peiler D, Grunert V (2003) Wirksamkeit von Hautschutzprodukten im Vergleich zu Hautpflegeprodukten bei Zahntechnikern – eine kontrollierte Feldstudie. JDDG 1:547–557

    PubMed  CrossRef  Google Scholar 

  241. Jungbauer FHW, van der Harst JJ, Groothoff JW, Coenraads PJ (2004) Skin protection in nursing work: promoting the use of gloves and hand alcohol. Contact Dermatitis 51:135–140

    PubMed  CAS  CrossRef  Google Scholar 

  242. Löffler H, Kampf G, Schmermund D, Maibach HI (2007) How irritant is alcohol? Br J Dermatol 157:74–81

    PubMed  CrossRef  CAS  Google Scholar 

  243. Slotosch CM, Kampf G, Löffler H (2007) Effects of disinfectants and detergents on skin irritation. Contact Dermatitis 57:235–241

    PubMed  CAS  CrossRef  Google Scholar 

  244. Stutz N, Becker D, Jappe U, John SM, Ladwig A, Spornraft-Ragaller P, Uter W, Löffler H (2009) Nurses’ perceptions of the benefits and adverse effects of hand disinfection: alcohol-based hand rubs vs. hygienic handwashing: a multicentre questionnaire study with additional patch testing bei the German Contact Dermatitis Research Group. Br J Dermatol 160:565–572

    PubMed  CAS  CrossRef  Google Scholar 

  245. English JSC, Ratcliffe J, Williams HC (1999) Irritancy of industrial hand cleansers tested by repeated open application on human skin. Contact Dermatitis 40:84–88

    PubMed  CAS  CrossRef  Google Scholar 

  246. Paye M, Gomes G, Zerweck CR, Piérard GD, Grove GL (1999) A hand immersion test under laboratory-controlled usage conditions: the need for sensitive and controlled assessment methods. Contact Dermatitis 40: 133–138

    PubMed  CAS  CrossRef  Google Scholar 

  247. Tupker RA, Bunte EE, Fidler V, Wiechers JW, Coenraads PJ (1999) Irritancy ranking of anionic detergents using one-time occlusive, repeated occlusive and repeated open tests. Contact Dermatitis 40:316–322

    PubMed  CAS  CrossRef  Google Scholar 

  248. Wigger-Alberti W, Fischer T, Greif C, Maddern P, Elsner P (1999) Effects of various grit-containing cleansers on skin barrier function. Contact Dermatitis 41:136–140

    PubMed  CAS  CrossRef  Google Scholar 

  249. Piérard GE, Goffin V, Herrmanns-Lê T, Arrese JE, Piérard-Franchimont C (1995) Surfactant induced dermatitis. A comparison of corneosurfametry with predicitve testing on human and reconstructed skin. J Am Acad Dermatol 33:462–469

    PubMed  CrossRef  Google Scholar 

  250. Bock M, Schürer NY, Schwanitz HJ (2004) Effects of CO2-enriched water on barrier recovery. Arch Derm Res 296:163–168

    PubMed  Google Scholar 

  251. Yoshizawa Y, Kitamura K, Kawana S, Maibach HI (2003) Water, salts and skin barrier of normal skin. Skin Res Technol 9:31–33

    PubMed  CrossRef  Google Scholar 

  252. Halkier-Sørensen L, Thestrup-Pedersen K (1993) The efficacy of a moisturizer (Locobase) among cleaners and kitchen assistants during everyday exposure to water and detergents. Contact Dermatitis 29:1–6

    CrossRef  Google Scholar 

  253. Lodén M (1997) Barrier recovery and influence of irritant stimuli in skin treated with a moisturizing cream. Contact Dermatitis 36:256–260

    PubMed  CrossRef  Google Scholar 

  254. Hannuksela A, Hannuksela M (1996) Irritant effects of a detergent in wash, chamber and repeated open application tests. Contact Dermatitis 34:134–137

    PubMed  CAS  CrossRef  Google Scholar 

  255. Held E (2002) Prevention of irritant skin reactions in relation to wet work. Thesis, University of Copenhagen

    Google Scholar 

  256. Zhai H, Maibach HI (1998) Moisturizers in preventing irritant contact dermatitis: an overview. Contact Dermatitis 38:241–244

    PubMed  CAS  CrossRef  Google Scholar 

  257. Goh CL, Gan SL (1994) Efficacies of a barrier cream and an afterwork emollient cream against cutting fluid dermatitis in metal workers. A prospective study. Contact Dermatitis 31:176–180

    PubMed  CAS  CrossRef  Google Scholar 

  258. Frosch PJ, Pilz B (1994) Hautschutz für Friseure – die Wirksamkeit von zwei Hautschutzprodukten gegenüber Detergentien im repetitiven Irritationstest. Dermatosen 42:199–202

    Google Scholar 

  259. Zhai H, Willard P, Maibach HI (1999) Putative skin-protective formulations in preventing and/or inhibiting experimentally-produced irritant and allergic contact dermatitis. Contact Dermatitis 41:190–192

    PubMed  CAS  CrossRef  Google Scholar 

  260. Bayerl C, Garbea A, Peiler D, Rzany B, Allgäuer T, Kleesz P, Jung EG, Frosch PJ (1999) Pilotstudie zur Therapie des beruflich bedingten Handekzems mit einer neuen tragbaren UVB-Bestrahlungseinheit. Aktuel Dermatol 25:302–305

    Google Scholar 

  261. Sjövall P, Christensen OB (1994) Treatment of chronic hand eczema with UV- B Handylux in the clinic and at home. Contact Dermatitis 31:5–8

    PubMed  CrossRef  Google Scholar 

  262. Agner T, Johansen JD, Overgaard L, Volund A, Basketter D, Menné T (2002) Combined effects of irritants and allergens. Contact Dermatitis 47:21–26

    PubMed  CAS  CrossRef  Google Scholar 

  263. Pedersen LK, Johansen JD, Held E, Agner T (2004) Augmentation of skin response by exposure to a combination of allergens and irritants – a review. Contact Dermatitis 50:265–273

    PubMed  CAS  CrossRef  Google Scholar 

  264. Agner T, Held E (2002) Skin protection programmes. Contact Dermatitis 46:253–256

    CrossRef  Google Scholar 

  265. Weisshaar E, Radulescu M, Bock M et al (2005) Hautschutzseminare zur sekundären Individualprävention bei Beschäftigten in Gesundheitsberufen: erste Ergebnisse nach über 2-jähriger Durchführung. JDDG 3:33–38

    PubMed  CrossRef  Google Scholar 

  266. Funke U, Diepgen T, Fartasch M (1996) Risk-group-related prevention of hand eczema at the workplace. Curr Probl Dermatol 25:123–132

    PubMed  CAS  Google Scholar 

  267. Itschner L, Hinnen U, Elsner P (1996) Prevention of hand eczema in the metal-working industry. Risk awareness and behaviour of metal worker apprentices. Dermatology 193:226–229

    PubMed  CAS  CrossRef  Google Scholar 

  268. Kalimo K, Kautiainen H, Niskanen T, Niemi L (1999) “Eczema school” to improve compliance in an occupational dermatology clinic. Contact Dermatitis 41:315–319

    PubMed  CAS  CrossRef  Google Scholar 

  269. Schwanitz HJ, Uter W, Wulfhorst B (eds) (1996) Neue Wege zur Prävention – Paradigma Friseurekzem. Rasch, Osnabrück

    Google Scholar 

  270. John SM (2008) Occupational skin diseases: options for multidisciplinary networking in preventive medicine. GMS Ger Med Sci 6:Doc07 (Online-Publikation: http://www.egms.de/en/gms/2008-6/000052.shtml)

  271. Jungbauer FHW, van der Vleuten P, Groothoff JW, Coenraads PJ (2004) Irritant hand dermatitis: severity of disease, occupational exposure to skin irritants and preventive measures 5 years after initial diagnosis. Contact Dermatitis 50:245–251

    PubMed  CAS  CrossRef  Google Scholar 

  272. Klaschka F (1979) Arbeitsphysiologie der Hornschicht in Grundzügen. In: Marchionini A (ed) Jadassohns Handbuch der Haut- und Geschlechtskrankheiten. Ergänzungswerk, vol 1, part 4A. Springer, Berlin, pp 153–261

    Google Scholar 

  273. Parrish JA, Pathak MA, Fitzpatrick TB (1975) Facial irritation due to sunscreen products (letter to the editor). Arch Dermatol 111:525

    PubMed  CAS  CrossRef  Google Scholar 

  274. Soschin D, Kligman AM (1982) Adverse subjective reactions. In: Kligman AM, Leyden JJ (eds) Safety and efficacy of topical drugs and cosmetics. Grune and Stratton, New York, pp 377–388

    Google Scholar 

  275. Kerr AC, Niklasson B, Dawe RS, Escoffier AM, Krasteva M, Sanderson B, Ferguson J (2009) A double-blind, randomized assessment of the irritant potential of sunscreen chemical dilutions used in photopatch testing. Contact Dermatitis 60:203–209

    PubMed  CAS  CrossRef  Google Scholar 

  276. Agin PP, Ruble K, Hermansky SJ, McCarthy TJ (2008) Rates of allergic sensitization and irritation to oxybenzone-containing suscreen products: a quantitative meta-analysis of 64 exaggerated use studies. Photodermatol Photoimmunol Photomed 24:211–217

    Google Scholar 

  277. Lee E, An S, Choi D, Moon S, Chang I (2007) Comparison of objective and sensory skin irritations of several cosmetic preservatives. Contact Dermatitis 56:131–136

    PubMed  CrossRef  Google Scholar 

  278. Issachar N, Gall Y, Borrel MT, Poelman MC (1998) Correlation between percutaneous penetration of methyl nicotinate and sensitive skin, using laser Doppler imaging. Contact Dermatitis 39:182–186

    PubMed  CAS  CrossRef  Google Scholar 

  279. Coverly J, Peters L, Whittle E, Basketter DA (1998) Susceptibility to skin stinging, non-immunologic contact urticaria and acute skin irritation; is there a relationship? Contact Dermatitis 38:90–95

    PubMed  CAS  CrossRef  Google Scholar 

  280. Basketter DA, Wilhelm KP (1996) Studies on non-immune contact reactions in an unselected population. Contact Dermatitis 35:237–240

    PubMed  CAS  CrossRef  Google Scholar 

  281. Issachar N, Gall Y, Borell MT, Poelman MC (1997) pH measurements during lactic acid stinging test in normal and sensitive skin. Contact Dermatitis 36:152–155

    PubMed  CAS  CrossRef  Google Scholar 

  282. Seidenari S, Francomano M, Mantovani L (1998) Baseline biophysical parameters in subjects with sensitive skin. Contact Dermatitis 38:311–315

    PubMed  CAS  CrossRef  Google Scholar 

  283. Wu Y, Wang X, Zhou Y, Tan Y, Chen D, Chen Y, Ye M (2003) Correlation between stinging, TEWL and capacitance. Skin Res Technol 9:90–93

    PubMed  CrossRef  Google Scholar 

  284. Lonne-Rahm S, Berg M, Mrin P, Nordlind K (2004) Atopic dermatitis, stinging, and effects of chronic stress: a pathocausal study. J Am Acad Dermatol 51:899–905

    PubMed  CrossRef  Google Scholar 

  285. Laden K (1973) Studies on irritancy and stinging potential. J Soc Cosmet Chem 24:385–393

    CAS  Google Scholar 

  286. Villarama C, Maibach HI (2005) Sensitive skin and transepidermal water loss. In: Fluhr J, Elsner P, Berardesca E, Maibach HI (eds) Bioengineering and the skin. CRC Press, Boca Raton, pp 135–141

    Google Scholar 

  287. Pilz B, Löffler T, Frosch PJ (1994) Toxische Dermatitis durch Dimethylsulfoxid (DMSO) als Antidot gegen Epirubicin. Dermatosen 42:204–209

    Google Scholar 

  288. Bruze M, Emmett EA (1990) Occupational exposures to irritants. In: Jackson EM, Goldner R (eds) Irritant contact dermatitis. Dekker, New York, pp 81–106

    Google Scholar 

  289. Fregert S (1981) Manual of contact dermatitis, 2nd edn. Munksgaard, Copenhagen

    Google Scholar 

  290. Rycroft RJG (1998) The principal irritants and sensitizers. In: Rook A, Wilkinson DS, Ebling FJG, Champion RH, Burton JL, Burns DA, Breathnach SM (eds) Textbook of dermatology, 6th edn. Blackwell, Oxford, pp 821–860

    Google Scholar 

  291. Epstein WL (1990) House and garden plants. In: Jackson EM, Goldner R (eds) lrritant contact dermatitis. Dekker, New York, pp 127–165

    Google Scholar 

  292. Lachapelle JM, Mahmoud G, Vanherle R (1984) Anhy-drite dermatitis in coal miners. Contact Dermatitis 11:188–189

    PubMed  CAS  CrossRef  Google Scholar 

  293. Lensen G, Jungbauer F, Goncalo M, Coenraads PJ (2007) Airborne irritant contact dermatitis and conjunctivitis after occupational exposure to chlorothalonil in textiles. Contact Dermatitis 57:181–186

    Google Scholar 

  294. Ermertcan AT, Oztürkcan S, Sahin MT, Bilaç C, Bilaç DB (2007) Acute irritant contact dermatitis due to ‘apium graveolens. Contact Dermatitis 57:122–123

    PubMed  CrossRef  Google Scholar 

  295. Cronin E (1980) Contact dermatitis. Churchill Livingston, Edinburgh

    Google Scholar 

  296. Aramaki J, Effendy I, Happle R, Kawana S, Löffler C, Löffler H (2001) Which bioengineering assay is appropriate for irritant patch testing with sodium lauryl sulfate? Contact Dermatitis 45:286–290

    PubMed  CAS  CrossRef  Google Scholar 

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Frosch, P.J., John, S.M. (2011). Clinical Aspects of Irritant Contact Dermatitis. In: Johansen, J., Frosch, P., Lepoittevin, JP. (eds) Contact Dermatitis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-03827-3_16

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