Contact dermatitis
Contact dermatitis is inflammation of the skin exactly where it has met a particular substance.
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Medicines commonly prescribed for Contact dermatitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CREAM, 0.5 mgActive substance: betamethasoneManufacturer: Galenicum Derma S.L.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 5 mg cetirizine hydrochloride/5 mlActive substance: cetirizineManufacturer: Ucb Pharma S.A.Prescription requiredDosage form: TOPICAL SOLUTION, 64 g betamethasone dipropionate / 100 gActive substance: betamethasoneManufacturer: Organon Salud S.L.Prescription required
Contact dermatitis is inflammation of the skin exactly where it has met a particular substance. It belongs to the eczemas, the group of conditions in which skin dries out, itches and loses its protective barrier. What makes it distinctive is that there is a specific outside culprit: while that culprit is still around the skin will not settle, and once the contact stops it usually clears on its own. So the main work is not only creams but working out what is doing the irritating.
What it looks and feels like
The skin becomes dry, flaky and cracked, and it itches. On pale skin the patches look red; on brown and black skin they show up dark brown, purplish or greyish, which is why inflammation on darker skin is often spotted later than it should be. When the reaction is strong, blisters appear, sometimes filled with clear fluid, along with weeping areas.
Any part of the body can be affected, but the hands and face take the brunt of it, since they meet the outside world most. The shape of the rash is often a clue in itself: a band under a watch strap, a ring on a finger, the mark left by the elastic of a glove, or a patch exactly where a cream was applied all point almost directly at the cause.
The reaction is rarely instant. Anything from a few hours to two days usually passes between the contact and the rash, sometimes longer. That delay throws people off: you hunt for the culprit among yesterday's events when it was actually the day before.
Irritant or allergen
Two different mechanisms sit behind contact dermatitis, and telling them apart is useful.
Irritation. The substance directly damages the top layer of skin. The immune system plays no part, and anyone can react; it is purely a matter of how strong and how frequent the contact is. Ordinary soap, if you wash your hands twenty times a day, does as much harm as one encounter with something caustic. This is the commoner form.
Allergy. The immune system memorises the substance and starts responding to it. Nothing happens at the first encounter; the body is merely becoming sensitised. The reaction turns up on later contacts, sometimes after years of using the same cream or the same piece of jewellery without trouble. Not everyone develops an allergy, and as a rule it stays for life.
The two forms can overlap: skin damaged by an irritant holds its barrier less well, and an allergen finds it easier to get through.
The usual culprits
The commonest irritants are:
- soaps, shampoos, detergents and cleaning products;
- water, particularly hard or heavily chlorinated water, and simply washing your hands often;
- antiseptics and disinfectant solutions;
- solvents, industrial oils, acids and alkalis;
- cement, building dust, soil;
- the sap of certain plants, such as buttercup, spurge and giant hogweed.
Common allergens include:
- nickel and cobalt in costume jewellery, buckles, fasteners and spectacle frames;
- fragrances and preservatives in cosmetics and household products;
- hair dyes, nail extension products and nail hardeners;
- rubber and latex: gloves, elastic in clothing, footwear;
- dyes and resins in textiles;
- adhesives, including epoxy resins;
- plants such as chrysanthemum, primula, tulip, daffodil and sunflower;
- medicines applied to the skin, including, oddly enough, steroid ointments themselves and some topical antibiotics.
Heat and sweating, cold, dry air and friction all make the symptoms worse.
When the cause is your job
If your hands are clear by the end of a holiday and inflamed again by the end of the first week back, the cause is almost certainly at work. Occupational contact dermatitis is common wherever there is a lot of wet work or contact with chemicals: hairdressing and nail work, catering, cleaning, healthcare, construction, vehicle repair, farming, laboratories and manufacturing.
This is not a trivial matter: neglected occupational dermatitis forces people out of their trade. It is worth telling your employer early, going through the composition of the products you handle and sorting out proper protection, rather than putting up with it for years and applying cream at weekends.
How the cause is tracked down
The doctor reaches a diagnosis from the appearance of the skin and from what you describe: when it started, exactly where, what is new at home and at work, and whether eczema, asthma or hay fever run in the family. It helps to photograph the ingredient lists of your cosmetics, gloves and cleaning products and bring them to the appointment. A diary is worth as much as any test: for a few weeks, note where and when the rash flares and what came before it.
When the culprit is not obvious or treatment is not working, a dermatologist arranges patch testing. Patches carrying a panel of known allergens in tiny amounts are taped to the back, or less often to the upper arms. After two days they come off and the skin is assessed, then looked at again a couple of days later: an allergic reaction needs time to show itself, and an early reading often misses it.
Treatment and everyday skin care
First and foremost, remove the contact. Once the substance is identified and avoided, the skin eventually clears by itself, and that works better than any ointment. When complete avoidance is impossible, what helps is gloves (taken off from time to time, because sweat is an irritant in its own right; cotton ones underneath rubber work well), swapping the particular product for a fragrance-free and preservative-free alternative, and washing the area with warm water as soon as the substance lands on the skin.
Emollients, that is moisturisers, are the backbone of care. Use them often, generously and without rationing: they rebuild the barrier and stop the irritant getting in. Ointments are the greasiest and hold water best, lotions are lighter and suit inflamed areas, and creams sit in between. Smooth them on rather than rubbing them in, following the direction of hair growth, and always straight after a shower while the skin is still damp; a separate tub kept at work is a good idea. If a product starts to sting over time, switch it.
Topical corticosteroids, steroid creams and ointments, settle inflammation quickly when the skin is sore and swollen. The doctor matches the strength to the site: milder on the face and neck, stronger on palms and soles where the skin is thick. Apply a thin layer, usually once a day and in short courses, about half an hour after the emollient. Prolonged or excessive use thins the skin, changes its colour and brings on spots and extra hair growth, so they are not used "just in case".
In severe cases covering a large area, a short course of corticosteroid tablets may be prescribed. This is uncommon. If that does not help either, a dermatologist will consider drugs that damp down the immune response, light treatment, or alitretinoin for stubborn hand eczema; the last of these is entirely incompatible with pregnancy and requires reliable contraception.
There is no good evidence that herbal remedies or food supplements help contact dermatitis, and some plant preparations become allergens themselves.
When not to wait
Call emergency services immediately if, after contact with a substance and especially with latex, there is swelling of the lips, tongue or throat, difficulty breathing, wheezing, dizziness or hives across the body. That is a severe allergic reaction, and it develops within minutes.
See a doctor urgently if signs of added infection appear on the affected skin:
- the pain increases and the redness starts spreading;
- cloudy fluid comes from the cracks or blisters and yellow crusts form;
- you have a temperature, chills and general malaise;
- small identical blisters with a dip in the centre erupt and hurt badly: this is herpes infection on damaged skin, and it needs treatment without delay.
A routine appointment is warranted if symptoms persist, keep returning or are severe; if the cause cannot be found; if a steroid cream has not helped within a few days; or if the dermatitis is linked to your job.
Online consultation
Contact dermatitis lends itself well to being handled remotely, because half the answer lies in the conversation rather than the examination. The doctor needs photographs of the skin taken in daylight, the story of how the patches appeared, and a detailed list of what you wash with, what you put on your skin and what you handle at work. From that, the list of suspects can often be narrowed to a handful of substances.
In a video appointment the doctor will explain how to use an emollient and a steroid cream, how long to wait for an effect and what to avoid. They will also say when patch testing and a face-to-face dermatology review are needed, and that is the second purpose of the consultation: not to spend months self-treating. Faced with signs of a severe allergic reaction, do not wait for any appointment at all; that needs emergency care.
This material is for information only and does not replace medical advice.
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