• Introduction
• Symptoms
• Causes
• Diagnosis
• Treatment
• Complications
• Prevention
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Introduction

Symptoms

Both allergic and irritant contact dermatitis can cause your skin to become:

• red,
• inflamed,
• blistered
• dry,
• thickened, and
• cracked.

The most commonly affected areas of skin are your hands and face. Depending on the type of contact dermatitis you have, you may also experience other symptoms.

Allergic contact dermatitis

As well as the symptoms listed above, allergic contact dermatitis will also cause the skin to be itchy. It may take many hours, or several days for your symptoms to appear after coming into contact with the allergen.

In most cases, the area of skin which came into contact with the allergen will be the area which is affected. For example, if you are allergic to an eye shadow or blusher, your eyelids or cheeks may be affected. However, sometimes other areas of skin may also be affected, even if they did not come into contact with the allergen.

Irritant contact dermatitis

As well as the symptoms listed above, irritant contact dermatitis causes burning, stinging and soreness. Your symptoms will normally appear within 48 hours of contact with the irritant. Strong irritants may cause your skin to react immediately.

Irritant contact dermatitis will only affect the areas of skin which you have exposed to the irritant.

Causes

Contact dermatitis occurs when your skin reacts to a particular substance, which can either be an irritant or an allergen.

Allergic contact dermatitis

Allergic contact dermatitis occurs when you come into contact with an allergen which your body becomes sensitised to. When you touch that substance again, your skin reacts with an itchy red rash (dermatitis).

You develop a rash because your immune system reacts abnormally to the allergen. Your immune system usually protects your body against infection and illness, but during an allergic reaction, it can attack healthy cells and tissue as well. This is what causes your skin to be sore and inflamed.

Common allergens which can trigger allergic contact dermatitis are listed below.

• Metals - such as nickel, or cobalt, in jewellery.
• Cosmetics - such as fragrances, hair dye, and nail varnish.
• Rubber - including latex.
• Textiles - particularly the dyes and resins that are contained in them.
• Strong adhesives - such as epoxy resin adhesives.
• Some plants - such as chrysanthemums, daffodils, tulips, and primula.
• Some medicinal creams that are applied directly to the skin - topical medications, such as steroid cream.

Irritant contact dermatitis

Irritant contact dermatitis occurs when your body comes into contact with an irritant. Your skin is damaged by the irritant, which causes a burning and stinging sensation, as well as the other symptoms of reddening and soreness.

Your irritant contact dermatitis may be caused by frequent exposure to a weak irritant, or it may occur after a single exposure to a stronger irritant.

Irritant contact dermatitis can occur in anybody who is exposed to irritants for a sufficient duration of time.

Common irritants include:

• detergents and soaps,
• perfumes and preservatives in toiletries or cosmetics,
• solvents and abrasives,
• oils,
• acids and alkalis,
• cement
• powders,
• water (especially hard, chalky or heavily chlorinated water),
• dust,
• soil, and
• some plants (such as anemone, clematic, ranunculus, hellebrous and mustards).

If you work with irritants as part of your job, you may be more at risk of developing irritant contact dermatitis. There are some jobs where this type of dermatitis is more common. They include:

• cleaning and housekeeping,
• food preparation and catering,
• hairdressing,
• agriculture and fishing,
• engineering and construction,
• medical, dentistry and veterinary, and
• printing and painting.

Other factors

If you already have contact dermatitis symptoms, there are a number of other factors which can worsen your existing symptoms. These include:

• heat,
• cold,
• friction, and
• low humidity (dry air).

If you have irritant contact dermatitis, you are more at risk from these factors than if you have allergic contact dermatitis.

Diagnosis

Treatment

With treatment, the symptoms of contact dermatitis can be effectively managed. Some people find their symptoms clear up entirely, whereas others find their symptoms improve. Up to 80% of people will experience at least a partial improvement in their symptoms following treatment.

There are a number of different ways to treat contact dermatitis. These treatments are outlined below.

Avoiding trigger factors

Identifying and avoiding exposure to potential allergens or irritants is one of the most important parts of your treatment for contact dermatitis.

If you can successfully avoid trigger factors, then you should not experience any symptoms. However, it is not always easy to avoid trigger factors, but your GP will help you to find ways of minimising your contact with them (see 'prevention' section).

If you are exposed to irritants as part of your job, make sure you wear adequate protective clothing to help minimise any contact with potential irritants. Make sure you tell your employer about your condition so that they can help you avoid any trigger factors as effectively as possible.

Emollients

Emollients are substances that help to soften and soothe your skin in order to keep it supple and moist. As contact dermatitis can cause your skin to be dry and cracked it is important to keep it moisturised in order to prevent it from becoming further irritated.

The type of emollient you are prescribed will depend on:

• how dry your skin is,
• which area of skin the emollient is going to be used on,
• your individual preference (such as how convenient it is to use and whether you find it effective).

You may have to try a number of different emollients before you find one which is effective. If the first emollient that is prescribed is not suitable, your GP will prescribe a different one.

You may also need a number of different emollients for long-term use. For example, you may need a more intensive emollient for when your symptoms are severe and a milder one at other times. You may also need different emollients for different areas of skin. For example, you may need a different emollient for your hands and one for your face.

How should I use emollients?

Emollients should be applied by smoothing them into the skin in the same direction that the hair grows. However, you should avoid rubbing emollients in because doing so can irritate the skin.

After washing, make sure that you gently pat the skin dry. Apply the emollient as soon as the skin is dry. Do not share emollients with other people.

Creams and lotions tend to be more suitable for red, inflamed areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.

When should I use emollients?

Emollients should be used frequently, even when the skin appears to be clear. If the skin is very dry, emollients should be applied every 2-3 hours.

To ensure that you apply emollients frequently, you may wish to consider keeping separate supplies of emollients at work, or at nursery or school if your child has the condition.

Creams and lotions tend to be more convenient and easier to use during the day, whereas ointments are best used at night as they can be greasy.

If you are exposed to irritants at work which trigger your irritant contact dermatitis, make sure you apply emollients regularly during and after work to help prevent your symptoms being triggered.

Can emollients cause any side effects?

The most common side effect of using emollients is a rash. If you have contact dermatitis, your skin will be sensitive, and can sometimes react to certain ingredients within the emollient. If your skin reacts to the emollient, you should speak to your GP, who will be able to prescribe an alternative product.

If you are using an emollient for the first time, you may want to try applying a small amount of the emollient first, before applying it to a widespread area. This will allow you to check whether your skin will react to it or not.

It is important to be aware that some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, they should not be left near a naked flame. You should also avoid applying emollients while you are smoking.

Emollients which are added to your bath or shower can also be easy to slip on. As long as you are aware of these hazards, you can use emollients safely.

Topical corticosteroids

If your skin is very red, sore and inflamed, your GP may prescribe you a topical corticosteroid. This type of medicine works by quickly reducing inflammation. It is applied directly to your skin.

You may be concerned about using medication which contains steroids. However, corticosteroids are not the same as anabolic steroids (which are sometimes used by bodybuilders and athletes to build muscle and improve performance). When used correctly, corticosteroids are a safe and effective treatment for contact dermatitis.

The strength of the topical corticosteroid your GP prescribes you will depend on the severity and location of your symptoms. For example, if your dermatitis is affecting your eyelids or face, you will require a very mild corticosteroid, because the skin is thin and delicate.

Children will always be started with a very mild corticosteroid, to reduce the risk of side effects.

Applying topical corticosteroids

When using topical corticosteroids, you should follow the information that comes with your particular product.

However, as a general guide, you should always apply your emollient first and then wait several minutes before you apply your topical corticosteroid. This will give the emollient a chance to be fully absorbed into your skin.

You should apply a thin layer of corticosteroid to all of your affected skin, but you should not make more than two applications a day. For most people, applying the corticosteroid once a day will be sufficient.

The corticosteroid should then be applied for 48 hours after your symptoms have cleared. If you have not noticed an improvement after two weeks, you should see your GP.

Complications

Quality of life

Most people are able to manage their contact dermatitis symptoms effectively. However, for some, the symptoms may be severe and long lasting, and may affect your quality of life.

For example, contact dermatitis may impact on your ability to carry out your job. This may cause you to feel unhappy or depressed. If your symptoms are having a significant impact on your quality of life, make sure you tell your GP about it, as they may be able to help you manage your symptoms more effectively.

Bacterial infection

Sometimes, contact dermatitis can become infected with bacteria. This is more likely if you frequently scratch your dermatitis or your skin is cracked, as it provides an opening for bacteria to enter.

A bacterial infection will cause your symptoms to worsen. Your skin will become redder, hotter, and more painful and tender to touch, and it may start to ooze fluid and crust over. If you develop an infection, it can usually be easily treated by using a course of antibiotics.

See your GP if your dermatitis symptoms appear unusual.

Prevention

The best way to prevent contact dermatitis is to avoid contact with the allergens or irritants that you know trigger your symptoms. However, this is not always possible. If you cannot avoid contact, then there are some steps you can take, which include:

• Washing or cleaning your skin after contact with a trigger factor. If you come into contact with an allergen, or irritant, rinse the affected skin with water, or wash it using a very mild soap or, preferably, a soap substitute. You should do this as soon as possible after coming into contact with the allergen, or irritant.
  
  
• Using protective clothing. Irritant contact dermatitis usually affects the hands, so gloves are an easy and effective way of minimising your contact with an irritant.
  
  
• Substituting products containing allergens or irritants. If you know a certain product, such as a type of make-up, triggers your symptoms, swap it for something which does not contain the allergens or irritants which affect you. Check the ingredients.
  
  
• Frequently applying emollients (see 'treatment' section).