Contact Dermatitis Peer Feedback- Jacqueline Fagan

Contact Dermatitis is a skin condition that happens when your skin comes in contact with a substance that irritates the skin. There is irritant contact dermatitis and allergic contact dermatitis. Irritant contact dermatitis can turn into allergic contact dermatitis once the body is sensitized after the first exposure. Irritant contact dermatitis can be prevented, and symptoms can go away with the simple removal of the irritants. Using hypoallergenic products can reduce the risk of irritant contact dermatitis. Irritant contact dermatitis is not immune mediated, no memory and no sensitization period is required. It is simply from damage to the skin barrier; stratum corneum which is the outer most layer of the epidermis, which allows penetration of substance and water loss. It can also cause damage to the keratinocytes, which can release proinflammatory cytokines which creates inflammation. Allergic contact dermatitis is a little more complicated in that it is an immune hypersensitivity IV reaction. Treatment can include antihistamines, corticosteroids, methotrexate, sargassum, and immunosuppressants. Risk factors can be acquired or inherent. Inherent means genetic. Acquired can be more from the irritant products themselves. Irritants include fragrances, adhesives, pigments, nickel, preservatives, and more. Other factors include fair skin, red hair, and being a female. As well as wearing gloves, washing hands and wet work. Hapten binds to skin proteins and then forms a complex recognized by APCs. The APC presents the hapten to T cells activating helper cells and memory cells. So, the next response is worse and leads to inflammatory cytokine release. This inflammatory cascade can create symptoms such as erythema, vesiculation, swelling, papules dry skin, burning edema, and blisters. Allergic contact dermatitis is diagnosed with a patch test performed by the dermatologist. The best thing to do to prevent irritant or allergic contact dermatitis is to make informed decisions on the products you’re using, use hypoallergenic products, and remove the irritants. Symptoms are generally worse in allergic contact dermatitis compared to irritant contact dermatitis. Irritant contact dermatitis symptoms will go away with the removal of the irritant whereas allergic contact dermatitis may not. As well, a positive result for Irritant Contact Dermatitis includes clear boundaries or erythema that don’t spread along lymphatic vessels.

I think this video was very well done and included all the relevant information needed to understand this topic well. There were no gaps in the information that I found. Although, I loved the use of a character such as Theo and think more characters would be beneficial to our learning if the time limit allowed it. The character of Theo was very helpful to understand the risk factors such as profession, genetic risk factors and irritant substances such as makeup, remover, hand washing and gloves. He was a well-developed and thought-out character. This way of learning made a lot of sense to me. I would have been interested to hear about a character that has a career as a nurse and what products they could be exposed to, to create irritant contact dermatitis or allergic contact dermatitis. I feel like there could be endless videos created with many different characters which could be informative for people in those careers. Information regarding what is put in place to reduce irritant contact dermatitis could be interesting as well. For example, the type of soap and hand sanitizer used in hospitals is likely hypoallergenic to prevent healthcare workers from developing irritant contact dermatitis. I would also be interested in product recommendations and such for personal use to prevent the breakdown of my skin barrier therefore preventing dermatitis. Another thought would be to include non-pharmaceutical treatments and preventions such as moisturizing creams, ice, etc. With a longer time limit this topic could go on and on and be even more informational.

One teaching and learning strategy that supported my learning was the visuals of the video. I know there was an option to create a video or podcast for this project but as I was watching it, I learned to appreciate the visuals as it aided in my understanding. They were very simple; therefore, it didn’t take away from or distract me from the content, but instead added to the content. The way the video was created and presented reminded me of the osmosis videos on YouTube that I have often watched on pathophysiology topics. They were similar because they both used; simple wording to aid in the understanding of the long pathophysiology terms and concepts, simple visuals to add to the understanding and capture the attention of the audience, and slow and clear voiceover of the video. I appreciated all the teaching learning strategies you guys used, such as visual, auditory, examples, characters, definitions etc. Some specific visuals that I can remember from your video are the pictures of the symptoms of ICD and ACD. This helped to visualize what signs and symptoms I can look for in future patients. Another visual that helped was the pictures while the pathophysiology was being explained. The simple visuals of APCs and cytokine release was helpful to trigger my previous knowledge and recall the pathophysiology processes. Thank you, guys, for including different teaching and learning strategies as it helped the understanding of the video and catered to different people learning styles. I appreciated the visual component even when visuals were not required for this project.

There are very few recommendations I have for this very well-done video. With the rubric and time limit given you guys did a great job. The only suggestion I would have for you guys is to have some moments of interaction with the audience. Interacting with the audience could further improve this capturing and informative video! For example, some questions throughout the video to prompt the viewers own critical thinking such as “Why would Theo get contact dermatitis with a career such as his? Well…”. This interaction could further capture the audience’s attention and keep them engaged while prompting critical thinking. I know this strategy is used in children’s TV shows, by our professors in class, and other teaching and learning environments. As the audience of this video may have previous knowledge of this topic, this strategy could be beneficial in allowing the audience to realize what they already know. In addition to creating space to critically think, this strategy can engage the audience further. I think this is why they use this strategy in children’s TV shows? I think it could create the feeling of interaction and conversation, and it can keep the audience more engaged and interested in the content being presented. Overall, the content was very engaging and informative, and I wouldn’t change anything about it. Nonetheless, I would be interested to see if these prompting questions and interaction with the audience would create even more engagement and understanding of the videos content. I will remember this for my future presentations and videos as well.

I will definitely take away many things from this video as I found it very easy to understand because it was well explained. Some take-aways are the teaching and learning strategies you used, the visuals of the symptoms, and the differences between irritant contact dermatitis and allergic dermatitis. The main take away though is the treatment and testing of irritant contact dermatitis and allergic contact dermatitis. I will integrate the treatment and testing part of the video into my practice. I will remember that irritant contact dermatitis treatment can be as simple as removing the irritant and using hypoallergenic products. But Allergic contact dermatitis is a little more complex than that, and this is how we can differentiate between the two types of contact dermatitis. Allergic contact dermatitis is an allergy response which means it creates an immune response involving Hapten binding to skin proteins. This then forms a complex recognized by APCs which presents it to T cells which then activate all T cells (helper, cytotoxic, memory).  I will also remember that the second exposure can be more severe than the first because the T memory cells are now created. The allergic contact dermatitis also requires more treatment such as corticosteroids and antihistamines. This can also require allergy patch testing to confirm the allergy to the irritant, whereas irritant contact dermatitis wont necessary require a patch test. Being able to identify these symptoms in patients, as well as know the next steps to treat this condition will be helpful in my practice.

Not only will I use this knowledge to help treat and manage patients’ symptoms. I will also use this knowledge to prevent contact dermatitis for myself as a nurse. As stated in the video, contact dermatitis accounts for about 10% of all occupational diseases. As healthcare workers we frequently wash our hand and wear gloves which are risk factors for developing contact dermatitis. We are also exposed to many adhesives, chemicals and drugs which can irritate skin too. There are many factors that could increase skin irritation at work therefore, I will be aware of this and try to reduce this risk. I will be conscious of using and buying hypoallergenic products to reduce the irritants on my skin.