sodium-hypochlorite and Dermatitis--Irritant

Acute irritant contact dermatitis induced by cutaneous exposure to chemicals is a common dermatologic problem in the workplace. In severe cases, irritant contact responses can result in a caustic burn. Chemical burn induced by concentrated sodium hypochlorite (the active ingredient in bleach) has been reported infrequently in the literature, with no previously reported cases of chemical burn due to an alkyl sulfate (a common surfactant in cleaning fluids). Here we describe a chemical burn in a 16-year-old girl resulting from exposure to a solution of concentrated sodium hypochlorite and alkyl sulfate applied as a sanitizer to the interior of roller skates worn at work.. The diagnosis was made on the basis of the patient's exposure history, clinical appearance, and laboratory results. On physical examination, the erythematous plaque, located at the site of chemical exposure, had intact skin lines, surrounding edema, and decreased sensitivity to touch. The peripheral white blood cell count was within normal limits and bacterial and fungal cultures from the lesion were negative.. The irritant effect of exposure to chemicals, including those that usually are not major irritants, and the possible additive effect of simultaneous exposure to different chemicals, should be considered in the differential diagnosis of acute dermatitis of unknown etiology. Moreover, increased reporting of cases of chemical-induced acute irritant contact dermatitis will help lead to crucial early and appropriate treatment.

Topics: Acute Disease; Adolescent; Anti-Infective Agents, Local; Burns, Chemical; Dermatitis, Irritant; Detergents; Diagnosis, Differential; Female; Humans; Silver Sulfadiazine; Skin; Skin Transplantation; Sodium Hypochlorite; Sulfuric Acid Esters; Therapeutic Irrigation; Wound Healing

The onset of linear IgA bullous dermatosis (LABD) is generally spontaneous, but a number of cases of LABD have been reported either following drug exposure or in association with malignancies. We describe a patient who developed a vesicular eruption shortly after an irritant dermatitis caused by the contact with a detergent containing sodium hypochlorite. Direct immunofluorescence revealed linear deposits of IgA and C3 in the epidermal basement membrane. The patient's serum contained IgA that immunoblotted a 180-kD polypeptide in extracts of human keratinocytes. The patient responded promptly to therapy with dapsone. We suggest a possible pathogenetic relationship between the chemical dermatitis and LABD in this patient.

Topics: Adult; Basement Membrane; Complement C3; Dapsone; Dermatitis, Irritant; Detergents; Disinfectants; Epidermis; Female; Fluorescent Antibody Technique, Direct; Folic Acid Antagonists; Humans; Immunoblotting; Immunoglobulin A; Keratinocytes; Skin Diseases, Vesiculobullous; Sodium Hypochlorite