An attempt is made to formulate some kind of working hypothesis concerning the pathophysiology, clinical appearance and treatment of irritant contact dermatitis. Acute irritant dermatitis may be caused by one single overwhelming external exposure of comparatively short duration. It is usually accidental and therefore recognized early as cause and effect. Chronic irritant dermatitis may be the result of a too early repetition of one impairing factor (chronic irritant dermatitis "traumiteration' type), but is more commonly the result of the influence of a variety of stimuli, each starting to be active before recovery from the foregoing stimuli has been completed (chronic irritant dermatitis 'summation' type.) By repetition of the same stimulus, or by a combination of varying stimuli, the degree of impairment surpasses a critical level, in consequence of which a clinical disease (irritant contact dermatitis) ensues. This clinical disease, however, is only 'the tip of the iceberg'. Such stimuli may be chemical, mechanical and/or climatic. To find out which are the harmful factors requires a detailed case history about the patient's work, habits and hobbies, thus enabling him to avoid as many damaging exposures as is practical, and hence reducing the sum of causative factors. A number of causative factors are enumerated. The article is intended to be a catalyst to promote discussion on this subject.

182 patients on the basis of 6 criteria were suspected of suffering from contact sensitization to cosmetics. 77 (42%) gave a positive reaction to one or more of a series of 22 fragrance and flavor raw materials. The hands were most often involved. Cinnamic alcohol, hydroxycitronellal, eugenol, coumarin, and abitol gave the most common positive reactions; less frequent were cinnamic aldehyde, dihydrocoumarin and dimethylcitraconate. Their relevance could not be traced. However, the first 4 substances were the most frequently identified in 79 suspected cosmetics sent in for analysis by the patients or their physicians. The stability of room-stored petrolatum-fragrance mixtures should be checked.

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Ephemeral topical contact with hexanediol diacrylate and butanediol diacrylate may cause delayed irritant dermatitis. During 4 years' observation of 20 workers utilizing these substances in the electron beam coating department of a door factory, contact sensitization did not occur. The characteristics of delayed contact irritancy are enumerated. The disease must be distinguished from allergic contact dermatitis, acute irritant dermatitis and cumulative irritant dermatitis.

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