Contact dermatitis

Also called Contact eczema, Occupational dermatitis

Eczema caused by something the skin is touching. Finding what, rather than treating the rash, is the treatment.

What it is

Inflammation of the skin caused by contact with a substance. Two kinds, and telling them apart changes what to do.

**Irritant** contact dermatitis is damage from repeated exposure: water, soap, detergents, solvents. It affects anybody exposed enough, and it is the commonest work-related skin disease in the UK. Care workers, cleaners, hairdressers, caterers and health staff are most affected, because of frequent hand washing and glove use.

**Allergic** contact dermatitis is an immune reaction, in people who have become sensitised. Common culprits are nickel in jewellery and fastenings, fragrance, preservatives in cosmetics, hair dye, rubber accelerators in gloves, and adhesives in plasters and dressings.

The distinction matters: an irritant reaction improves with protection; an allergic one requires complete avoidance, and identifying the allergen usually needs patch testing at a dermatology clinic.

It is not the same as atopic eczema, though people with eczema get it more easily, and the two often coexist.

Signs you might notice

Red, itchy, dry or blistered skin where something has been in contact.

On brown and black skin, the redness may be hard to see; look for darkening, greyness, or a change in texture and shine.

Hands are the commonest site. Cracks and splits in the finger webs and around the nails.

Irritant: pain, stinging and cracking, worse with exposure, better on holiday.

Allergic: intense itch, sometimes spreading beyond the contact area, appearing a day or two after exposure.

Clues in the pattern: a band at the wrist or under a belt buckle, a rash matching the shape of a plaster, the eyelids from something transferred by the hands.

See a GP for a hand rash that is not settling, any rash affecting work, or signs of infection: weeping, yellow crust, spreading redness and pain.

How it can affect day-to-day life

In care work this is a genuine occupational injury and it drives people out of the job. Hands that crack and bleed cannot do personal care, and the person often keeps working until the skin fails.

Employers have duties under health and safety law: assessing the risk, providing suitable gloves and emollients, and arranging health surveillance. Almost nobody knows this is a reportable occupational disease.

Glove choice matters. Latex causes its own allergy; the rubber accelerators in some nitrile gloves cause allergic dermatitis; and wearing any glove for long periods traps sweat and worsens irritation. Cotton liners help.

The commonest reason treatment fails is not using enough emollient and not using it often enough. The amounts recommended feel absurd until the skin improves.

Supporting someone well

Work out what is touching the skin, including things worn, applied and handled at work.

For hands: lukewarm water, a soap substitute, dry thoroughly including between the fingers, and emollient after every wash and at bedtime. Carry it.

Wear gloves for wet work, keep them on for as short a time as possible, and use cotton liners underneath.

Use the steroid ointment as prescribed and for long enough. Under-treating and stopping early is why it keeps returning.

Ask for patch testing if an allergy is suspected. It is the only way to identify the allergen properly, and it is under-requested.

Raise it at work. It is preventable, it is an employer duty, and it is reportable.

Remove nickel-containing items and check cosmetic ingredient lists once an allergen is known.

Where to get help

A pharmacist for emollients and mild steroid creams.

A GP practice for persistent rash, for stronger treatment, and for referral to dermatology for patch testing.

Occupational health, where there is one, for work-related cases.

British Association of Dermatologists publish patient leaflets on contact dermatitis and patch testing.