TNF and granular corneal dystrophy type II: There is a rapid activation of the innate immune system causing the release of cytokines, including interleukin-1-beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and chemokines, resulting in a proinflammatory milieu in the skin.8,9,25,26 Irritant contact dermatitis can occur as a distinct phenomenon and separately definable from ACD.