DKI

Etiology
Almost any material may be a cutaneous irritant, if the exposure is sufficiently prolonged
and/or the concentration of the substance sufficiently high. The likelihood of developing
irritant contact dermatitis (ICD) increases with the duration and intensity of exposure to the
irritant. [2] Environmental factors may enhance the effect of other irritants. [10, 11, 12]

Dry air and temperature variation

Dry air renders the skin more susceptible to cutaneous irritants. Sufficiently dry air alone may
provoke irritant contact dermatitis. Most cases of winter itch are a result of dry skin from the
drier air found during sustained periods of cold weather.

An increase in temperature (up to 43°C from 20°C) increases the cutaneous effect of an
irritant. [13]

Water

Continual exposure to water may produce maceration or repeated evaporation of water from
the skin may produce cutaneous irritation by desiccation of the skin. Even distilled water
experimentally provokes increased CD11c+ cells and neutrophils in the epidermis.

Solvents

Many individuals are exposed to solvents, particularly at work. Solvents such as alcohol or
xylene remove lipids from the skin, producing direct irritant contact dermatitis and rendering
the skin more susceptible to other cutaneous irritants, such as soap and water.

Irritant contact dermatitis from alcohol most often is cumulative. Manual workers may wash
their hands inappropriately with solvents to remove oil, grease, paints, or other materials;
thus, they develop irritant contact dermatitis.

Inappropriate skin cleansing is a primary cause of irritant contact dermatitis in the workplace.
Washing facilities and methods must be inspected when investigating the workplace for 1 or
more cases of occupational irritant contact dermatitis. The irritating agents include aromatic,
aliphatic, and chlorinated solvents, as well as solvents such as turpentine, alcohol, esters, and
ketones. Some organic solvents produce an immediate erythematous reaction on the skin and
remove lipids from the stratum corneum.

Metalworking fluids

Neat oils most commonly produce folliculitis and acne. They may cause irritant contact
dermatitis (as well as allergic dermatitis). Water-based metalworking fluids often cause
irritant contact dermatitis in exposed workers; surfactants in these fluids are the main culprit.
Cumulative irritant contact dermatitis

This is common in many occupations that often are termed "wet work." Healthcare workers
wash their hands 20-40 times a day, producing cumulative irritant contact dermatitis. Similar
exposures occur among individuals who wash hair repeatedly or in cleaners or kitchen
workers.

Multiple skin irritants may be additive or synergistic in their effects. Alcohol-based hand-
cleansing gels cause less skin irritation than hand washing and therefore are preferred for
hand hygiene from the dermatological point of view. An alcohol-based hand-cleansing gel
may even decrease, rather than increase, skin irritation after a hand wash, owing to a
mechanical partial elimination of the detergent. [14]

Microtrauma

Fiberglass produces direct damage to the skin, usually manifested by pruritus that may result
in excoriation and secondary skin damage. Cutaneous irritation primarily is caused by
fiberglass with diameters exceeding 4.5 µm.

Most workers with irritant contact dermatitis resulting from fiberglass develop hardening, in
which they tolerate further cutaneous exposure to fiberglass.

Many plant leaves and stems bear small spicules and barbs that produce direct skin trauma.

Mechanical trauma

Pressure produces callus formation. Pounding produces petechia or ecchymosis. Sudden

trauma or friction produces blistering in the epidermis. Repeated rubbing or scratching
produces lichenification. Sweating and friction appear to be the main cause of dermatitis that
appears under soccer shin guards in children. [15]

Rubber gloves

Some rubber gloves may provoke direct cutaneous irritation. Many workers complain of
irritation from the powder in rubber gloves.

Remember that gloves compromised by a hole may allow an irritant to enter; occlusion
dramatically increases skin damage from the irritant. Occlusion accentuates the effects, good
or bad, of topical agents. Kerosene may produce skin changes similar to that of toxic
epidermal necrolysis following occluded cutaneous exposure. Excessive amounts of ethylene
oxide in surgical sheets also may produce similar changes.

Sodium lauryl sulfate

This chemical is found in some topical medications, particularly acne medications, as well as
a range of soaps and shampoos. It is also a classic experimental cutaneous irritant.

Hydrofluoric acid
A hydrofluoric acid burn is a medical emergency. Remember that onset of clinical
manifestations may be delayed after the acute exposure (this is crucial to diagnosis).
Unfortunately, hydrofluoric acid burns are most frequent on the digits, where the pain is most
severe and management is most difficult (see Hydrofluoric Acid Burns).

Alkalies

Skin surfaces normally have an acidic pH, and alkalies (eg, many soaps) produce more
irritation than many acids. The "acid mantle" of the stratum corneum seems to be important
for both permeability barrier formation and cutaneous antimicrobial defense. Use of skin
cleansing agents, especially synthetic detergents with a pH of approximately 5.5 rather than
alkaline pH, may help prevent skin disease. [16]

Etiologi
Hampir semua bahan dapat menyebabkan iritasi kulit, jika paparannya cukup lama dan / atau
konsentrasi zat tersebut cukup tinggi. Kemungkinan mengembangkan dermatitis kontak iritan
(ICD) meningkat dengan durasi dan intensitas paparan iritan. [2] Faktor lingkungan dapat
meningkatkan efek iritan lainnya. [10, 11, 12]

Variasi udara dan suhu kering

Udara kering membuat kulit lebih rentan terhadap iritasi kulit. Udara yang cukup kering saja
dapat memicu dermatitis kontak iritan. Sebagian besar kasus gatal musim dingin adalah
akibat dari kulit kering dari udara kering yang ditemukan selama periode cuaca dingin yang
berkelanjutan.
Peningkatan suhu (hingga 43 ° C dari 20 ° C) meningkatkan efek kulit iritan. [13]

Air
Paparan air yang terus-menerus dapat menghasilkan maserasi atau penguapan air yang
berulang dari kulit dapat menghasilkan iritasi kulit dengan pengeringan kulit. Bahkan air
suling secara eksperimental memprovokasi peningkatan sel CD11c + dan neutrofil di
epidermis.

Pelarut
Banyak orang yang terpapar pelarut, khususnya di tempat kerja. Pelarut seperti alkohol atau
xylene menghilangkan lemak dari kulit, menghasilkan dermatitis kontak iritan langsung dan
membuat kulit lebih rentan terhadap iritasi kulit lainnya, seperti sabun dan air.
Dermatitis kontak iritan dari alkohol paling sering bersifat kumulatif. Pekerja manual dapat
mencuci tangan mereka secara tidak tepat dengan pelarut untuk menghilangkan minyak,
minyak, cat, atau bahan lainnya; dengan demikian, mereka mengembangkan dermatitis
kontak iritan.
Pembersihan kulit yang tidak pantas adalah penyebab utama dermatitis kontak iritan di
tempat kerja. Fasilitas dan metode mencuci harus diperiksa ketika menyelidiki tempat kerja
untuk 1 atau lebih kasus dermatitis kontak iritan di tempat kerja. Zat pengiritasi meliputi
pelarut aromatik, alifatik, dan diklorinasi, serta pelarut seperti terpentin, alkohol, ester, dan
keton. Beberapa pelarut organik menghasilkan reaksi eritematosa segera pada kulit dan
menghilangkan lipid dari stratum corneum.

Cairan pengerjaan logam

Minyak rapi paling sering menghasilkan folikulitis dan jerawat. Mereka dapat menyebabkan
dermatitis kontak iritan (dan juga dermatitis alergi). Cairan pengerjaan logam berbasis air
sering menyebabkan dermatitis kontak iritan pada pekerja yang terpajan; surfaktan dalam
cairan ini adalah penyebab utama.

Dermatitis kontak iritan kumulatif

Ini umum di banyak pekerjaan yang sering disebut "pekerjaan basah". Petugas kesehatan
mencuci tangan mereka 20-40 kali sehari, menghasilkan dermatitis kontak iritan kumulatif.
Paparan serupa terjadi di antara individu yang mencuci rambut berulang kali atau di tukang
pembersih atau pekerja dapur.
Iritasi kulit multipel mungkin bersifat aditif atau sinergis dalam efeknya. Gel pembersih
tangan berbasis alkohol menyebabkan iritasi kulit lebih sedikit daripada mencuci tangan dan
karenanya lebih disukai untuk kebersihan tangan dari sudut pandang dermatologis. Gel
pembersih tangan berbasis alkohol bahkan dapat mengurangi, daripada meningkatkan, iritasi
kulit setelah mencuci tangan, karena eliminasi parsial deterjen secara mekanik. [14]

Microtrauma
Fiberglass menghasilkan kerusakan langsung pada kulit, biasanya dimanifestasikan oleh
pruritus yang dapat menyebabkan eksoriasi dan kerusakan kulit sekunder. Iritasi kulit
terutama disebabkan oleh fiberglass dengan diameter melebihi 4,5 μm.
Sebagian besar pekerja dengan dermatitis kontak iritan yang dihasilkan dari fiberglass
mengalami pengerasan, di mana mereka mentolerir paparan kulit lebih lanjut terhadap
fiberglass.
Banyak daun dan batang tanaman mengandung spikula kecil dan duri yang menghasilkan
trauma kulit langsung.

Trauma mekanis
Tekanan menghasilkan pembentukan kalus. Pound menghasilkan petechia atau ecchymosis.
Trauma atau gesekan yang tiba-tiba menghasilkan lepuh di epidermis. Menggosok atau
menggaruk berulang kali menghasilkan likenifikasi. Berkeringat dan gesekan tampaknya
menjadi penyebab utama dermatitis yang muncul di bawah penjaga tulang kering pada anak-
anak. [15]

Sarung tangan karet

Beberapa sarung tangan karet dapat memicu iritasi kulit langsung. Banyak pekerja mengeluh
iritasi dari bubuk di sarung tangan karet.
Ingatlah bahwa sarung tangan yang dikompromikan oleh lubang dapat menyebabkan iritasi
masuk; oklusi secara dramatis meningkatkan kerusakan kulit akibat iritasi. Penyumbatan
menonjolkan efek, baik atau buruk, agen topikal. Minyak tanah dapat menghasilkan
perubahan kulit yang mirip dengan nekrolisis epidermis toksik setelah paparan kulit
tersumbat. Jumlah etilen oksida dalam lembaran bedah yang berlebihan juga dapat
menghasilkan perubahan yang serupa.
Sodium lauryl sulfate
Zat kimia ini ditemukan dalam beberapa obat topikal, terutama obat jerawat, serta berbagai
sabun dan sampo. Ini juga merupakan iritasi kulit eksperimental klasik.

Asam hidrofluorat
Luka bakar asam hidrofluorik adalah keadaan darurat medis. Ingat bahwa timbulnya
manifestasi klinis mungkin tertunda setelah paparan akut (ini sangat penting untuk diagnosis).
Sayangnya, luka bakar asam hidrofluorik paling sering terjadi pada jari, di mana rasa sakitnya
paling parah dan penatalaksanaannya paling sulit (lihat Hydrofluoric Acid Burns).

Alkali
Permukaan kulit biasanya memiliki pH asam, dan alkali (misalnya, banyak sabun)
menghasilkan lebih banyak iritasi daripada banyak asam. "Mantel asam" dari stratum
corneum tampaknya penting untuk pembentukan penghalang permeabilitas dan pertahanan
antimikroba kulit. Penggunaan agen pembersih kulit, khususnya deterjen sintetis dengan pH
sekitar 5,5 daripada pH basa, dapat membantu mencegah penyakit kulit. [16]

1. [Guideline] Fonacier L, Bernstein DI, Pacheco K, et al. Contact dermatitis: a practice

parameter-update 2015. J Allergy Clin Immunol Pract. 2015 May-Jun. 3 (3 Suppl):S1-
39. [Medline].
2. [Guideline] Brasch J, Becker D, Aberer W, Bircher A, Kränke B, Jung K, et al.
Guideline contact dermatitis: S1-Guidelines of the German Contact Allergy Group
(DKG) of the German Dermatology Society (DDG), the Information Network of
Dermatological Clinics (IVDK), the German Society for Allergology and Clinical
Immunology (DGAKI), the Working Group for Occupational and Environmental
Dermatology (ABD) of the DDG, the Medical Association of German Allergologists
(AeDA), the Professional Association of German Dermatologists (BVDD) and the
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3. Lee HY, Stieger M, Yawalkar N, Kakeda M. Cytokines and chemokines in irritant
contact dermatitis. Mediators Inflamm. 2013. 2013:916497. [Medline].
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an interpretative update. Contact Dermatitis. 2009 Mar. 60(3):123-30. [Medline].
5. Fluhr JW, Akengin A, Bornkessel A, Fuchs S, Praessler J, Norgauer J, et al. Additive
impairment of the barrier function by mechanical irritation, occlusion and sodium
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6. Jacobs JJ, Lehé CL, Hasegawa H, Elliott GR, Das PK. Skin irritants and contact
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7. Heinemann C, Paschold C, Fluhr J, Wigger-Alberti W, Schliemann-Willers S,
Farwanah H, et al. Induction of a hardening phenomenon by repeated application of
SLS: analysis of lipid changes in the stratum corneum. Acta Derm Venereol. 2005.
85(4):290-5. [Medline].
8. de Jongh CM, Khrenova L, Verberk MM, Calkoen F, van Dijk FJ, Voss H, et al.
Loss-of-function polymorphisms in the filaggrin gene are associated with an increased
 susceptibility to chronic irritant contact dermatitis: a case-control study. Br J
Dermatol. 2008 Sep. 159(3):621-7. [Medline].
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development of occupational irritant contact dermatitis. Br J Dermatol. 2013 Feb. 168
(2):326-32. [Medline].
10. Pelletier JL, Perez C, Jacob SE. Contact Dermatitis in Pediatrics. Pediatr Ann. 2016
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induced by benzalkonium chloride exposure from laundry rinse aids. Australas J
Dermatol. 2016 Sep 19. [Medline].
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13. Kartono F, Maibach HI. Irritants in combination with a synergistic or additive effect
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irritant reaction?. Pediatr Dermatol. 2006 Jan-Feb. 23(1):19-20. [Medline].
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Association of Race/Ethnicity and Patch Test Results: North American Contact
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46(5):290-4. [Medline].

DKA
Etiology
Approximately 25 chemicals appear to be responsible for as many as one half of all cases of
allergic contact dermatitis. These include nickel, preservatives, dyes, and fragrances.

Poison ivy

Poison ivy (Toxicodendron radicans) is the classic example of acute allergic contact
dermatitis in North America. Allergic contact dermatitis from poison ivy is characterized by
linear streaks of acute dermatitis that develop where plant parts have been in direct contact
with the skin.

Nickel

Nickel is the leading cause of allergic contact dermatitis in the world. The incidence of nickel
allergic contact dermatitis in North America is increasing; in contrast, new regulations in
Europe have resulted in a decreasing prevalence of nickel allergy in young and middle-aged
women. [2, 3]

Allergic contact dermatitis to nickel typically is manifested by dermatitis at the sites where
earrings or necklaces (see the image below) containing nickel are worn or where metal
objects (including the keypads of some cell phones [4] ) containing nickel are in contact with
the skin.

Nickel may be considered a possible occupational allergen. Workers in whom nickel may be
an occupational allergen primarily include hairdressers, retail clerks, caterers, domestic
cleaners, and metalworkers. Individuals allergic to nickel occasionally may develop vesicles
on the sides of the fingers (dyshidrotic hand eczema or pompholyx) from nickel in the diet.
 Allergic contact dermatitis to nickel
in a necklace.

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[5]
Rubber gloves

Allergy to 1 or more chemicals in rubber gloves is suggested in any individual with chronic
hand dermatitis who wears them, unless patch testing demonstrates otherwise. Allergic
contact dermatitis to chemicals in rubber gloves typically occurs maximally on the dorsal
aspects of the hand. Usually, a cutoff of dermatitis occurs on the forearms where skin is no
longer in contact with the gloves. Individuals allergic to chemicals in rubber gloves may
develop dermatitis from other exposures to the chemicals (eg, under elastic waistbands).

Hair dye and temporary tattoos

p-Phenylenediamine (PPD) is a frequent component of and sensitizer in permanent hair dye

products and temporary henna tattoos [6] ; exposure in to it in hair dye products may cause
acute dermatitis with severe facial edema. Severe local reactions from PPD may occur in
black henna tattoos in adults and children. Epidemiologic data indicate that the median
prevalence of positive patch test reactions to PPD among dermatitis patients is 4.3%
(increasing) in Asia, 4% (plateau) in Europe, and 6.2% (decreasing) in North America. [7]

Textiles

Individuals allergic to dyes and permanent press and wash-and-wear chemicals added to
textiles typically develop dermatitis on the trunk, which occurs maximally on the lateral sides
of the trunk but spares the vault of the axillae. Primary lesions may be small follicular
papules or may be extensive plaques.

Individuals in whom this allergic contact dermatitis is suspected should be tested with a series
of textile chemicals, particularly if routine patch testing reveals no allergy to formaldehyde.
New clothing is most likely to provoke allergic contact dermatitis, since most allergens
decrease in concentration in clothing following repeated washings.

Preservatives
Preservative chemicals added to cosmetics, moisturizers, and topical medications are major
causes of allergic contact dermatitis (see the image below). The risk of allergic contact
dermatitis appears to be highest to quaternium-15, followed by allergic contact dermatitis to
isothiazolinones. Methylisothiazolinone is used as an individual preservative and may be a
significant allergen. [8] Kathon CG is methylchloroisothiazolinone in combination with
methylisothiazolinone.

Although parabens are among the most widely used preservatives, they are not a frequent
cause of allergic contact dermatitis.

Severe allergic contact dermatitis

resulting from preservatives in sunscreen. Patch testing was negative to the active ingredients in the
sunscreen.

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Schnuch et al estimated that preservatives found in leave-on topical products varied over 2
orders of magnitude in relative sensitization risk. [9]

Formaldehyde is a major cause of allergic contact dermatitis (see the image below). Certain
preservative chemicals widely used in shampoos, lotions, other moisturizers, and cosmetics
are termed formaldehyde releasers (ie, quaternium-15 [Dowicil 200], imidazolidinyl urea
[Germall 115], and isothiazolinones [9] ). They are, in themselves, allergenic or may produce
cross-sensitization to formaldehyde.
 Onycholysis developing from allergic contact
dermatitis to formaldehyde used to harden nails.

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[10, 11]
Fragrances

Individuals may develop allergy to fragrances. Fragrances are found not only in perfumes,
colognes, aftershaves, deodorants, and soaps, but also in numerous other products, often as a
mask to camouflage an unpleasant odor. Unscented products may contain fragrance
chemicals used as a component of the product and not labeled as fragrance.

Individuals allergic to fragrances should use fragrance-free products. Unfortunately, the exact
chemicals responsible for a fragrance in a product are not labeled. Four thousand different
fragrance molecules are available to formulate perfumes. The fragrance industry is not
required to release the names of ingredients used to compose a fragrance in the United States,
even when individuals develop allergic contact dermatitis to fragrances found in topical
medications.

Deodorants may be the most common cause of allergic contact dermatitis to fragrances
because they are applied to occlude skin that is often abraded by shaving in women.

Massage and physical therapists and geriatric nurses are at higher risk of occupational
allergic contact dermatitis to fragrances.

Corticosteroids

In the last decade, it has become clear that some individuals with chronic dermatitis develop
allergy to topical corticosteroids. Most affected individuals can be treated with some topical
corticosteroids, but an individual can be allergic to all topical and systemic corticosteroids.
Budesonide and tixocortol pivalate are useful patch test corticosteroids for identifying
individuals allergic to topical corticosteroids.

Neomycin

The risk of allergy to neomycin is related directly to the extent of its use in a population. The
risk of allergy to neomycin is much higher when it is used to treat chronic stasis dermatitis
and venous ulcers than when it is used as a topical antibiotic on cuts and abrasions in
children. Assume that individuals allergic to neomycin are allergic to chemically related
aminoglycoside antibiotics (eg, gentamicin, tobramycin). [12] Avoid these drugs both topically
and systemically in individuals allergic to neomycin.

Benzocaine

Avoid topical use of benzocaine. Benzocaine is included in most standard patch test trays.
Individuals allergic to benzocaine may safely use or be injected with lidocaine (Xylocaine),
which does not cross-react with benzocaine.

Sunscreens

Many individuals complain of adverse reactions to sunscreens, but many of these individuals
are not allergic to the sunscreen materials. They may be allergic to preservatives in these
products or may have nonspecific cutaneous irritation from these products.

Photoallergy

Occasionally, individuals develop photoallergic contact dermatitis. Allergic contact

dermatitis may be accentuated by ultraviolet (UV) light, or patients may develop an allergic
reaction only when a chemical is present on the skin and when the skin is exposed
sufficiently to ultraviolet light A (UV-A; 320-400 nm).
[13, 14]
Acrylates and methacrylates

These agents are used in manufacturing, nail acrylics, and wound dressings, among other
uses.

DKA

Etiologi
Sekitar 25 bahan kimia tampaknya bertanggung jawab atas sebanyak setengah dari semua
kasus dermatitis kontak alergi. Ini termasuk nikel, pengawet, pewarna, dan wewangian.

Poison ivy

Poison ivy (Toxicodendron radicans) adalah contoh klasik dari dermatitis kontak alergi akut
di Amerika Utara. Dermatitis kontak alergi dari poison ivy ditandai oleh garis-garis linier
dermatitis akut yang berkembang di mana bagian tanaman telah bersentuhan langsung
dengan kulit.

Nikel

Nikel adalah penyebab utama dermatitis kontak alergi di dunia. Insiden dermatitis kontak
alergi nikel di Amerika Utara meningkat; sebaliknya, peraturan baru di Eropa telah
mengakibatkan penurunan prevalensi alergi nikel pada wanita muda dan setengah baya. [2, 3]

Dermatitis kontak alergi terhadap nikel biasanya dimanifestasikan oleh dermatitis di lokasi di
mana anting-anting atau kalung (lihat gambar di bawah) yang mengandung nikel dipakai atau
di mana benda-benda logam (termasuk keypad dari beberapa ponsel [4]) yang mengandung
nikel berada dalam kontak dengan kulit.

Nikel dapat dianggap sebagai alergen kerja yang mungkin. Pekerja di mana nikel mungkin
merupakan alergen kerja terutama meliputi penata rambut, pegawai ritel, katering, pembersih
rumah tangga, dan pekerja logam. Orang-orang yang alergi terhadap nikel kadang-kadang
dapat mengembangkan vesikel pada sisi jari (eksim tangan dishidrotik atau pompholyx) dari
nikel dalam makanan.

Allergic contact dermatitis to nickel in a necklace.

Sarung tangan karet [5]

Alergi terhadap 1 atau lebih bahan kimia dalam sarung tangan karet disarankan pada setiap
individu dengan dermatitis tangan kronis yang memakainya, kecuali pengujian patch
menunjukkan sebaliknya. Dermatitis kontak alergi terhadap bahan kimia dalam sarung tangan
karet biasanya terjadi secara maksimal pada aspek punggung tangan. Biasanya, potongan
dermatitis terjadi pada lengan bawah di mana kulit tidak lagi bersentuhan dengan sarung
tangan. Individu yang alergi terhadap bahan kimia dalam sarung tangan karet dapat
mengembangkan dermatitis dari paparan lain terhadap bahan kimia (misalnya, di bawah ikat
pinggang elastis).

Pewarna rambut dan tato temporer

p-Phenylenediamine (PPD) adalah komponen yang sering dan peka pada produk pewarna
rambut permanen dan tato henna sementara [6]; paparan dalam produk pewarna rambut dapat
menyebabkan dermatitis akut dengan edema wajah yang parah. Reaksi lokal yang parah dari
PPD dapat terjadi pada tato pacar hitam pada orang dewasa dan anak-anak. Data
epidemiologis menunjukkan bahwa prevalensi median dari reaksi uji tempel positif terhadap
PPD di antara pasien dermatitis adalah 4,3% (meningkat) di Asia, 4% (dataran tinggi) di
Eropa, dan 6,2% (menurun) di Amerika Utara. [7]

Tekstil

Individu yang alergi terhadap pewarna dan bahan kimia pers dan pencuci permanen yang
ditambahkan ke tekstil biasanya mengalami dermatitis pada batang tubuh, yang terjadi secara
maksimal pada sisi lateral batang tubuh tetapi tidak menggunakan kubah aksila. Lesi primer
bisa berupa papula folikel kecil atau bisa berupa plak yang luas.

Orang-orang yang dicurigai menderita dermatitis kontak alergi ini harus diuji dengan
serangkaian bahan kimia tekstil, terutama jika uji tempel rutin menunjukkan tidak ada alergi
terhadap formaldehida. Pakaian baru kemungkinan besar akan memicu dermatitis kontak
alergi, karena sebagian besar alergen menurunkan konsentrasi pakaian setelah dicuci
berulang kali.

Pengawet

Bahan kimia pengawet yang ditambahkan ke kosmetik, pelembab, dan obat topikal adalah
penyebab utama dermatitis kontak alergi (lihat gambar di bawah). Risiko dermatitis kontak
alergi tampaknya paling tinggi dibanding quaternium-15, diikuti oleh dermatitis kontak alergi
terhadap isothiazolinones. Methylisothiazolinone digunakan sebagai pengawet individu dan
mungkin merupakan alergen yang signifikan. [8] Kathon CG adalah
methylchloroisothiazolinone dalam kombinasi dengan methylisothiazolinone.

Meskipun paraben adalah salah satu pengawet yang paling banyak digunakan, mereka tidak
sering menjadi penyebab dermatitis kontak alergi.

Severe allergic contact dermatitis

resulting from preservatives in sunscreen. Patch testing was negative to the active ingredients in the
sunscreen.
Schnuch et al memperkirakan bahwa bahan pengawet yang ditemukan dalam produk topikal yang
dibiarkan bervariasi lebih dari 2 kali lipat dalam risiko kepekaan relatif. [9]

Formaldehyde adalah penyebab utama dermatitis kontak alergi (lihat gambar di bawah). Bahan
kimia pengawet tertentu yang banyak digunakan dalam shampo, lotion, pelembab lainnya, dan
kosmetik disebut pelepas formaldehida (yaitu, quaternium-15 [Dowicil 200], imidazolidinyl urea
[Germall 115], dan isothiazolinones [9]). Mereka, dalam dirinya sendiri, alergi atau dapat
menghasilkan sensitisasi silang terhadap formaldehida.

Onycholysis developing from allergic contact

dermatitis to formaldehyde used to harden nails.

Parfum [10, 11]

Individu dapat mengembangkan alergi terhadap wewangian. Wewangian tidak hanya ditemukan
dalam parfum, cologne, aftershave, deodoran, dan sabun, tetapi juga di banyak produk lainnya,
seringkali sebagai masker untuk menyamarkan aroma yang tidak sedap. Produk yang tidak berbau
mungkin mengandung bahan kimia pewangi yang digunakan sebagai komponen produk dan tidak
diberi label sebagai pewangi.

Orang yang alergi terhadap wewangian harus menggunakan produk bebas pewangi. Sayangnya,
bahan kimia yang tepat yang menyebabkan aroma dalam suatu produk tidak diberi label. Tersedia
empat ribu molekul aroma berbeda untuk merumuskan parfum. Industri wewangian tidak
diharuskan untuk merilis nama bahan yang digunakan untuk membuat wewangian di Amerika
Serikat, bahkan ketika individu mengembangkan dermatitis kontak alergi terhadap wewangian yang
ditemukan dalam obat topikal.

Deodoran dapat menjadi penyebab paling umum dari dermatitis kontak alergi terhadap wewangian
karena mereka digunakan untuk menyumbat kulit yang sering diabrasi dengan mencukur pada
wanita.
Pijat dan terapis fisik dan perawat geriatri berisiko lebih tinggi terkena dermatitis kontak alergi
terhadap wewangian.

Kortikosteroid

Dalam dekade terakhir, telah menjadi jelas bahwa beberapa individu dengan dermatitis kronis
mengembangkan alergi terhadap kortikosteroid topikal. Kebanyakan individu yang terkena dapat
diobati dengan beberapa kortikosteroid topikal, tetapi seorang individu dapat alergi terhadap semua
kortikosteroid topikal dan sistemik. Budesonide dan tixocortol pivalate adalah kortikosteroid uji
tempel yang berguna untuk mengidentifikasi individu yang alergi terhadap kortikosteroid topikal.

Neomisin

Risiko alergi terhadap neomisin terkait langsung dengan tingkat penggunaannya dalam suatu
populasi. Risiko alergi terhadap neomisin jauh lebih tinggi ketika digunakan untuk mengobati
dermatitis stasis kronis dan borok vena dibandingkan ketika digunakan sebagai antibiotik topikal
pada luka dan lecet pada anak-anak. Asumsikan bahwa individu yang alergi terhadap neomycin
alergi terhadap antibiotik aminoglikosida yang terkait secara kimiawi (misalnya, gentamisin,
tobramycin). [12] Hindari obat-obatan ini baik secara topikal maupun sistemik pada orang yang
alergi terhadap neomycin.

Benzocaine

Hindari penggunaan benzocaine secara topikal. Benzocaine termasuk dalam sebagian besar baki uji
tempel. Orang yang alergi terhadap benzocaine dapat dengan aman menggunakan atau disuntik
dengan lidocaine (Xylocaine), yang tidak bereaksi silang dengan benzocaine.

Tabir surya

Banyak orang mengeluh reaksi buruk terhadap tabir surya, tetapi banyak dari orang-orang ini tidak
alergi terhadap bahan tabir surya. Mereka mungkin alergi terhadap bahan pengawet dalam produk
ini atau mungkin memiliki iritasi kulit spesifik dari produk ini.

Fotoalergi

Kadang-kadang, individu mengembangkan dermatitis kontak fotoalergi. Dermatitis kontak alergi

dapat ditekankan oleh sinar ultraviolet (UV), atau pasien dapat mengembangkan reaksi alergi hanya
ketika bahan kimia ada pada kulit dan ketika kulit terpapar secukupnya pada sinar ultraviolet A (UV-
A; 320-400 nm) .

Acrylates dan methacrylates [13, 14]

Agen ini digunakan dalam pembuatan, akrilik kuku, dan pembalut luka, di antara kegunaan lain.

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