Contact Dermatitis/Eczema

All About Contact Dermatitis Contents Page

Introduction 1

Irritant contact dermatitis 3

Allergic contact dermatitis 6

Contact dermatitis at work 11

Prevention 13

Management and treatment of contact dermatitis 15

Key points 18

Further information 18

Where to find more help 19

About the National Eczema Society 20

National Eczema Society Membership 20 All About Contact Dermatitis Introduction

This booklet is for people who may What does contact dermatitis have contact dermatitis or those who look like? are waiting for a referral to a contact Contact dermatitis can vary from mild dermatitis clinic or who have been to severe. The skin can be dry, red or diagnosed with contact dermatitis and scaly. need more information on prevention, management and work issues. What is contact dermatitis? Contact dermatitis, or contact eczema (‘dermatitis’ and ‘eczema’ can be used interchangeably - both refer to the inflammation of the skin) is the name given to types of eczema that occur as a result of contact with irritants or Irritant contact dermatitis allergens in the environment. Contact dermatitis can be broadly If you have severe contact dermatitis, divided into two types: irritant tiny blisters may appear that can burst contact dermatitis (ICD), where the and weep. When this happens it is eczema develops as a result of contact often referred to as ‘wet’ dermatitis. with substances that directly damage The most distressing symptom of or irritate the skin; and allergic contact dermatitis is the itch, which contact dermatitis (ACD), which can make it very hard not to scratch! develops when an individual becomes sensitised or allergic to something If the contact dermatitis is severe, in the environment. However, there the skin can develop painful cracking is overlap between the two and it is and splitting. Often this involves the possible to have both simultaneously. fingertips. Page ­1 What will my healthcare Does the skin improve when not at professional need to know work? (See pages 11–15). about my contact dermatitis? l Hobbies and leisure time What Your healthcare professional cannot types of hobbies do you have? Do make a diagnosis just by looking at they involve contact with particular materials and substances, pets your skin and they will also need to and animals, plants or exposure to ask you a number of questions. Your sunlight? answers will help them diagnose whether you have contact dermatitis l Clothing What types of clothing and, if so, whether it is irritant or fabrics are usually worn and which allergic. The questions may include: fabrics flare or irritate the eczema? l Jewellery What types of watches l Onset When did your skin first and jewellery are worn? become red, itchy and sore? l Impact on quality of life How l Duration How long has the are school, work, family and condition been present? relationships affected by the l Site What areas of the body are eczema? affected? If it is on the hands, which l Skincare What everyday products hand and what part of the hand? (e.g. shampoo, soaps, wipes) are l Pruritus (itch) How great is the used? What skincare products have degree of pain, itching and soreness been and are being used? What associated with the dermatitis? types of make-up, perfumes and What measures are used to cope after-shave are worn? with this, and how does it impact l Medication What medicines on your life? Have you noticed what are taken regularly? What topical makes the rash better or worse? treatments are used? l Family history Is there or has there l Allergies Do you have any known been anyone else in the family with allergies to medicines or substances skin disease, atopic eczema, asthma that come into contact with or are or hay fever? applied to the skin? l Occupation What types of l Food Does contact with any products are used? What kind of particular food make the dermatitis protection is used at work (e.g. worse? What sort of reaction clothing, gloves and barrier creams)? occurs? Page ­­2 If the contact dermatitis is made worse Other factors that may by being at work, a detailed description predispose you to ICD of the work environment will be needed If you have a history of atopy (eczema, (see page 12). asthma or hay fever), you are more likely to have a sensitive skin and therefore Irritant contact your skin is more vulnerable to ICD. If your hobbies or occupation involve dermatitis (ICD) you putting your hands in and out of water all day, your skin is more likely An irritant is a chemical that in most to develop ICD. This is particularly people is capable of producing skin likely if the hands are not well dried or damage if applied for a sufficient length if rough paper towels are used to dry of time and in a sufficient concentration. your hands. The effects increase over time. At the However, most people are not often in beginning the damage to the skin may contact with water alone. If you are be invisible and it is only later that the using water plus detergent or other damage can be seen. chemicals, these may cause your skin ICD occurs when there is frequent contact to become gradually drier and contact with everyday things such as soap, dermatitis may develop. detergents, oils, hair cosmetics, bleach, In addition to using water and household cleaning products, cold wind chemicals, if you are also working and raw food. ICD is far more common outside, possibly in very cold than ACD. Whether or not ICD develops temperatures, then additional chapping will depend on: may occur. Extremes of temperature, l What irritants the skin is exposed humidity – particularly a lack of it – will to and their strength – for example, also be important elements and may wet cement is a strong irritant and indeed be the sole factor causing ICD. detergent is a weak irritant. l The amount of exposure. l How often the skin is exposed to the irritant. Page ­3 or lead to worsening of the rash Age-specific ICD include repetitive skin cleansing, ICD and ACD can affect all ages. Here inadequate skincare, infections, we cover issues relating to ICD in antibiotics, diarrhoea and problems different age groups. with the gut or urinary tract. If nappy rash is persistent or severe, Infants and children especially if your baby is rubbing or scratching the area, this may be an Infants and children are susceptible eczema flare rather than contact to ICD due to everyday exposure to dermatitis. Speak to your GP about common irritants coming into contact assessment and additional eczema with their skin. These include: treatment. l Nappy rash (also called diaper rash, nappy dermatitis, diaper dermatitis or irritant diaper dermatitis) is one of the most common skin conditions found in infants. The wearing of nappies causes an increase in skin wetness and alkalinity. If the wetness is prolonged, this can lead to the softening and breaking down of skin (maceration), which makes it more susceptible to friction from the surface of the nappy. l Teething commonly causes ICD It also increases the risk of around the mouth and chin due further skin damage and other to the constant wetness from problems caused by exposure dribbling saliva. In addition, runny to irritants – especially faeces, noses, messy foods when weaning which contain proteases and and exposure to harsh weather can lipases, and ammonia in urine. exacerbate this irritant effect on Other factors that may aggravate the face in babies.

Page ­­4 l Baby wipes can also irritate the Adults skin and in some cases cause Adults are exposed to common ACD – this is more often the case irritants throughout their lives but in infants who are atopic. Many are more susceptible to ICD on a daily wipes are now available and basis due to occupational and lifestyle vary in quality. If wipes are used, triggers. For example, new mums choose ones that are alcohol- and often experience problems due to the fragrance-free or water-only. increased hand washing associated Better still, clean your baby’s skin with caring for a baby: nappy with cotton pads and emollient or water. changes, making feeds etc. Constant wet work such as housework, DIY and l Messy and wet play As they activities at home can also cause ICD. play and learn, young children inevitably become involved with Older people messy activities that may irritate Older people experience problems their skin. Again, infants and with ICD for several reasons. As children with eczema are more we age, the skin barrier function prone to skin problems at nursery and school. is affected and our skin becomes more prone to irritation from soaps,

Teenagers over-washing, temperature changes Teenagers are exposed to a variety and exposure to irritants and wet of potential irritants and sensitisers: work associated with hobbies. In soaps, detergents, perfumes, shaving older people ICD can also affect products, make-up, hair dyes, and the buttocks and genital area if heat and sweat from physical activities. Hobbies and part-time or there are problems with urinary or weekend work may also expose them faecal incontinence (incontinence- to potential irritants or sensitisers. associated dermatitis). This can be (Further advice is available in the NES made worse by over-washing, the use booklet Information for Teenagers of wipes and the type of pad used to with Eczema). cope with the incontinence.

Page ­5 Common sites for ICD Allergic contact It may be impossible for your doctor, nurse or dermatologist to tell whether dermatitis (ACD) you have ICD or ACD simply by looking Although many people may have at your skin. There are, however, contact with chemicals, only a very few various sites that are particularly prone develop an allergy to them. In these to developing ICD. people the body’s defence mechanisms Hands Irritants such as dust and learn to recognise the chemical. They chemicals can collect: therefore develop a reaction when the chemical contacts the skin again. The l Under rings. allergy is ‘remembered’ by the body for l In the web spaces between the many years. In medical terms the body fingers. has become ‘sensitised’ to a chemical. l On the backs of the hands. Common sensitisers

Face ICD can be caused by: The most common contact dermatitis allergens in Europe are: fragrance, l Changes in temperature. thiomersal (antiseptic), cobalt (cement), l Cosmetics, especially some anti- nickel, paraphenylenediamine (hair aging cosmetics containing retinol- dye, henna, temporary tattoos) and type chemicals. formaldehyde (chemical preservative). l Toiletries, particularly ‘washes’, Prevalence of contact allergens can ‘toners’ and make-up removers. change over time, for example, there is a new epidemic of (meth)acrylate l Highly perfumed preparations. allergy in the UK, brought about by Body If the skin is very dry then simply the trend for acrylic nails (Rolls, Rajan, friction from clothes may produce ICD. Shah, 2018).

Page ­­6 ICD under ring ACD to nickel in watch strap Nickel Nickel allergy can affect all ages other clothing and accessories such as and is one of the most common causes of jewellery, belts and dummy clips. ACD. It develops in places where nickel- Perfume Many products such as containing metal touches the skin: for cosmetics, toiletries and hand washes example, the earlobes (from earrings), the contain perfume. A perfume has many wrists (from a watch strap), the lower chemicals within it, some of which may abdomen (from a jeans stud) and from sensitise. Allergy to perfume is the Methylisothiazolinone (MI) Methylisothiazolinone (MI) is a Other products that may contain MI preservative in the family of isothiazolines include the following: and is used in cosmetic, household and l Bubble bath and shower gel industrial products. MI is known to cause l Car polish and windscreen products allergy and although cosmetic products l Cutting oils and coolants have been reformulated to contain lower l Detergents and washing-up liquid concentrations, allergy still remains a l Fabric softener problem at reduced concentrations and l Glues and adhesives we therefore recommend that you avoid l Hair products MI. (Future legislation may enforce a ban l Ironing water on MI for leave-on cosmetic products but l not rinse-off). The use of MI is, however, Mouthwashes unrestricted in household products (e.g. l Polishes detergents, fabric conditioner, polish) and l Shampoos and conditioners industrial products (e.g. glues, adhesives, l Skin cream and body lotions paints). l Soap Unfortunately there is no readily available l Sunscreens information for the consumer about the l Watercolours and household paints presence of MI in products other than l Wet wipes cosmetics and household detergents. An individual who has a contact allergy Please be aware that Kathon, Euxyl K to MI is likely to develop problems with 100 and Grotan K are tradenames of other isothiazolinone preservatives preservative mixes that may contain MI, so they should check the ingredients so these products should be avoided if to avoid these preservatives as well – you have ACD caused by MI. In particular, methylchloroisothiazolinone (MCI) in household paints may contain MI in particular should be avoided, but also very high concentrations (even the paint octyl isothiazolinone. fumes can cause a reaction). Page ­7 commonest cause of ACD following manufacture) and chromates (e.g. contact with cosmetics and toiletries. potassium dichromate, used in leather Preservatives/biocides Preservatives are tanning) can be a problem, as can used to prevent the growth of bacteria formaldehyde (used in the tanning of and fungi and are used in household white leather shoes). Another potent goods, industrial chemicals, textiles, allergen that permeates the leather is cosmetics, skincare products (including dimethyl fumarate (placed in sachets in creams, topical corticosteroids, lotions), shoe boxes to prevent mould growth). medications and eye and ear drops. Adhesives Elastoplast has rosin or Common sensitising preservatives colophony as its ‘sticking’ agent and can include parabens, formaldehyde and the cause ACD. There are now adhesive tapes isothiazolines MCI and MI (see box on available which are less likely to sensitise. page 7). Acrylic nails There has been an Paraphenylenediamine increase in nail/fingertip contact Paraphenylenediamine (PPD) is found in dermatitis as a result of the trend for photographic developer and lithography acrylic nails. These allergies may be due plates, photocopying and printing inks, to acrylic chemicals, dip powder and gel black rubber, oils and greases. It is also colour/decoration. a common ingredient in permanent Rubber Goods made from natural hair dyes, textile dyes, dark-coloured rubber (e.g. rubber gloves and rubber cosmetics and temporary tattoos. Black tyres), have many chemicals added to henna or ‘natural henna’ tattoos contain the liquid latex. These chemicals are PPD at very high levels in order to known as accelerators, retardants or produce a dark colour quickly. The high antioxidants and can sensitise. concentration of henna on the skin can Plants Many plants can sensitise. cause chemical burns and lead to allergic Primula obconica, chrysanthemums reactions. In its natural form henna is and members of the daisy family are a red/orange colour; black henna is not particular culprits. ‘true’ henna and should be avoided. Treatments In addition to Footwear ACD in reaction to footwear preservatives, other ingredients of can occur as many materials, chemicals, topical treatments applied to skin (e.g. glues (e.g. colophony, and para- steroids and emollients) can sensitise. tertiary-butylphenol formaldehyde resin), dyes (e.g. PPD) and metals Patch testing (e.g. nickel and cobalt – found on If ACD is thought to be a possibility, buckles and decorations) are used in then you need to be referred to a the manufacturing process. Rubber dermatologist who may recommend Page ­­8 accelerators (used to speed up patch testing. Patch testing is very safe. It is used to detect allergies to substances that come into direct contact with skin. NICE guidance also advises referral for patch testing if ACD is suspected in cases of persistent atopic eczema or facial, eyelid or hand atopic eczema.

It is appropriate for infants and Patch tests in situ children, as well as adults, but requires time and preparation in order to be successful. There is a standard battery of patch tests – depending on your history, you may be patch tested for a range of different substances. (See www.cutaneousallergy.org for further information.) Patch testing is not used to detect ICD and neither is it used for diagnosing Positive results food allergy. The choice of sensitisers tested will depend on a number of will be an itchy, red, raised patch that is factors such as: sometimes blistered. l Where the eczema is. “I have had ‘patch testing’ l Your occupation or hobbies. but it didn’t help to identify l Personal use of cosmetics or creams, the cause of my allergy. What lotions and ointments. went wrong?” The sensitisers are placed in small Sometimes the results of patch testing amounts in chambers attached to are negative and no allergies are found. adhesive tape. The skin on your back Although you may feel frustrated is usually chosen for testing. The that the cause of your problem has chambers are placed on the back and not been identified, patch testing has left in place for 2 days. They are then been helpful in that it has excluded removed and the skin is examined. This the likelihood that your dermatitis is is known as the ‘first reading’. After caused by an allergy. a further 2 days a ‘second reading’ is taken. The dermatologist is looking for “I had atopic eczema as a an area of a positive reaction to one child, so am I more likely to of the sensitisers. A positive reaction develop contact dermatitis?” Page ­9 The answer is yes and no! If you have, who are ‘atopic’ than in the general or have had, atopic eczema, your population. skin is more vulnerable to developing ICD, particularly if the atopic eczema Adults with a history of atopic eczema affected your hands, as atopic eczema may find that in later life the condition is likely to have left you with a skin reappears on their hands as a result sensitive to irritants. However, ACD of contact with irritants such as is not more common in those people detergents. Hand eczema Eczema affecting the hands is common and can be very disabling. The hands can be affected by ICD or ACD and sometimes by both at the same time. Whatever the type of hand eczema, the clinical picture will Hand ICD with a glazed surface, redness and be of hands that are: scaling. l Itchy. long after an episode of eczema has l Scaly, dry and red. healed, the skin will continue to be l Often accompanied by blistering, vulnerable to irritants and will remain soreness and cracks or splits in the at risk. Hand ICD can be caused by skin. irritants in the home and working Not all these symptoms and signs environment. may be seen. Some people may have blistering, while others may have a Hand ACD may also occur both on thick, scaly skin. its own and with a background of atopic hand eczema. An example of Hand ICD is particularly common. a sensitiser would be to chemicals in Friction, dust and extremes of rubber gloves. A list of the common temperature are all irritants. Irritants will also collect under rings and sensitisers appears on pages 6–7. cause eczema between the fingers. For more information, please see the It is important to remember that, Society’s factsheet on hand eczema. Page ­­10 Pompholyx eczema Pompholyx is a particular type of eczema that occurs on both the hands and feet and its cause is unknown. The onset of pompholyx eczema can be very sudden. Blisters commonly Pompholyx eczema occur on the palms of the hands, may play a part, but usually no cause the sides of the fingers and the soles is found. Pompholyx can occur as of the feet. The skin is initially very an isolated solitary event, or may itchy and it may be hard to resist reoccur, coming and going in cycles. scratching. If you scratch, the blisters However, pompholyx is only rarely burst causing soreness and weeping. The skin will then dry out and often due to contact dermatitis. For more peel. information, please see the Society’s factsheet on pompholyx eczema. Factors such as stress, nickel sensitivity and hot, humid conditions

It cannot be stressed too much that Contact early investigation is essential if you suspect that you have contact dermatitis at dermatitis. An early diagnosis will help to reduce time off work. Your work dermatologist or occupational For some people the development of health nurse or doctor may need to contact dermatitis may be due to their thoroughly investigate your working working environment. Skin problems environment. are a major cause of time off work, Contact dermatitis can develop on and from the statistics available it any part of the body. Occupational would appear that contact dermatitis is hand eczema is common. An airborne particularly important. irritant or sensitiser can lead to facial Page ­11 eczema. Even covered skin can be affected if working clothes come into contact with sensitisers and irritants. What will happen when I see the dermatologist? If your working environment is suspected, your dermatologist will need to ask you a number of questions and ACD on eyelids due to epoxy resin will ask you to describe your working practices and environment. l How many hours do you work per day? Below are examples of some of the basic questions you are likely to be l Are there other members of the asked. The dermatologist is looking for workforce who may be affected? clues that will indicate what may be Once the dermatologist has a general causing your contact dermatitis, the picture of your working conditions and protective clothes and barrier creams working practices, they will probably available to you and whether the skin ask you questions that are specific problem affects other members of staff to your job. Again, your answers will in the same job. provide clues to the possible cause of Basic questions you may be asked: your dermatitis. l Do you work inside or outside? Specific questions a dermatologist l Can you explain the processes may ask about your work: involved in your work and provide l Are you involved in wet or dry work? safety data sheets for the chemicals you work with? l Do you use detergents or solvents? l What washing or showering l Are you handling specific chemicals facilities are available to you? or any other materials? l Do you use barrier creams or after- l How often are you handling work creams? chemicals? l What kind of temperature and l How powerful are the chemicals you humidity do you work in? are handling? l How long have you been employed l How much of your work involves in your job? handling chemicals? Page ­­12 l Does your work involve oils or grease? great deal of care needs to be exercised. l Does your work involve friction to Both you and your employer will need the hands (e.g. by the regular use of to be patient. tools)? l Is there a lot of dirt in your job? Prevention l Do you wear protective clothing Most ICD and ACD is preventable (but and, if yes, what sort of clothing? this is not always easy) by taking the l Describe all the areas visited during following precautions: your day at work. Avoid irritants Your answers to these questions will The most common irritants are soaps help to build a complete picture of and detergents, although water itself is the irritants and sensitisers you come also an irritant. A good skin protection into contact with and particularly routine is needed to keep the skin the precautions that are being used strong and healthy. Most ICD involves to reduce contact with an irritant or the hands. Gloves are therefore the sensitiser. As with all other types of mainstay of protection. For general eczema, your occupational health purposes and household tasks, rubber nurse, doctor or dermatologist will or PVC household gloves, possibly with want to know if you have a history of a cotton liner or worn over cotton eczema or sensitive skin. gloves, should suffice. Investigation It is important to remove the gloves The dermatologist will need details frequently as sweating may aggravate of specific irritants you are exposed existing dermatitis. to and may want to carry out ‘patch testing’ (see pages 8-9) on these Below are some practical tips. individual occupational irritants. If In the home: your dermatologist suspects that your working environment is causing your l Avoid frequent contact with water contact dermatitis, you will be asked to and use protective gloves for bring with you a list of the substances household tasks. used in your work and the safety data l Ensure the gloves give complete sheets. Finding the cause of contact protection and that the insides of dermatitis can be a long process as a the gloves remain dry. Page ­13 l Wash hands with your leave-on l Protective gloves should be: emollient as a soap substitute or an - worn for as short a time as possible; emollient wash, and then rinse off. - kept dry and clean; and l Use plenty of moisturiser and reapply - possibly worn with cotton gloves frequently throughout the day. underneath as well. l Do not wear rings while carrying out l Moisturise the skin at frequent household tasks. intervals (during tea, coffee and l Disinfectants and cleansers should lunch breaks). be used as little as possible. l Avoid wearing rings where possible. In the workplace: l Do not use abrasive skin cleaners Avoid sensitisers and keep the use of disinfectants to Whenever sensitisers have been a minimum. identified, measures should be in place

For general purposes and household A word about tasks, rubber or polyvinyl chloride household gloves, possibly with a protective cotton liner or worn over cotton clothing gloves, should suffice. It is important to take the gloves off For sensitisers and irritants, suitable on a regular basis as sweating may preventive clothing should be made aggravate existing dermatitis. In the available to you at work, including the workplace, the type and length of correct gloves for the materials you glove worn will depend upon the are handling. Gauntlets should also nature of the chemicals involved. be provided by your employer if they Health and safety information for are necessary for adequate protection. handling the chemicals should Whether at home or at work, care stipulate which gloves should be used. needs to be taken when selecting Further information regarding the use gloves if you are allergic to any of gloves in the workplace can be found materials used in gloves. at www.hse.gov.uk/skin/employ/ gloves.htm Page ­­14 to reduce contact with them. Avoiding sensitisers you are allergic to is the best Management way to prevent ACD, but this is often and treatment easier said than done.

If you and your dermatologist have of contact identified things you are allergic to, dermatitis then you will need to pay attention to product labels on things such Once contact dermatitis has occurred, as cosmetics and perfumes and, management of the skin is very because there is no legal obligation important. Apart from the avoidance to include a complete ingredients list of irritants and known sensitisers, on the label, it may be necessary to treatment of contact dermatitis involves: contact manufacturers to find out if l Emollients (medical moisturisers) to the sensitiser is present or to identify rehydrate the skin. substitutes. l Avoiding soaps and detergents – use a soap substitute or leave- Employers are required by law to on emollient as a soap substitute prevent, or where that is not reasonably instead. practicable, to provide adequate l Topical steroids – to reduce controls against, exposure to materials inflammation. in the workplace that cause ill-health, l Development of a good skincare including dermatitis. More information routine. is available from the HSE (see page 18).

Many products are described as Emollients ‘hypoallergenic’ but what exactly The use of emollients is very important. does this word mean? Unfortunately Most can be used as soap substitutes. the word gives no idea of what has They soothe and relieve dry skin, been included or excluded from a producing an oily layer over the skin product and without this information, surface that traps water beneath it. ‘hypoallergenic’ means very little. The aim is to restore the skin’s barrier and rehydrate the skin. You may have to try several different emollients

until you find the one that suits you Page ­15 best. You may wish to use a lighter, A good skincare routine less greasy emollient in the day and a Good general skincare measures can heavier, more greasy one at night. help to look after the skin and are Topical steroids essential, particularly for those with hand eczema (see pages 10 and 11). It Skin that is experiencing a flare-up of can take several months for the skin to contact dermatitis will need topical recover completely from an attack of steroids to bring the contact dermatitis contact dermatitis, so even when it looks rapidly under control. Topical steroids apparently normal it is still vulnerable. help to reduce inflammation, make the skin less red, hot, itchy or sore and Additional treatments speed up the healing of the skin. In very severe cases of hand eczema that is not responding to treatment Topical steroids for hand eczema need with topical steroids and emollients, to be prescribed at the correct potency other treatments may be needed. These to adequately treat eczema, so a potent may include light treatment (PUVA), or very potent strength may be used immunosuppressants (e.g. methotrexate, for a short treatment burst and then cyclosporine, azathioprine) or alitretinoin stepped down to a weaker steroid, or (Toctino). used every other day, until the eczema For further information, see the has settled. Generally, very potent Society’s booklet Eczema Management: or potent steroids are prescribed for Additional treatment options for the palms of the hands and soles of moderate to severe eczema. the feet, where the skin is thicker, whereas if contact dermatitis is on the Outcome – “Why has my face, where skin is thinner, a mild or contact dermatitis not cleared moderate steroid would be prescribed. up?” If topical steroids are prescribed at There can be a number of reasons why the correct potency and you follow contact dermatitis does not clear up: the instructions of your healthcare l It is not always easy to avoid professional, side effects are unlikely. sensitisers/contact allergens. If you have infected eczema, you l It will depend on how long the may also be prescribed a combined problem has been present. steroid/antibiotic cream or a course of l There may be other factors that need antibiotic tablets to bring the infection to be considered, e.g. the presence of under control. atopic eczema. Page ­­16 l If atopic eczema is present as well “Will patch testing tell me as contact dermatitis, the dermatitis whether I might become may not clear completely even when allergic in the future?” the irritant or sensitiser is avoided. Unfortunately there are no tests Patch testing should be carried out that can be undertaken to determine early and thoroughly to achieve the whether or not you will become allergic best outcome if an allergy has been to substances. identified. Checking ingredient lists of cosmetics, work chemicals, etc. is very Contact urticaria important. Urticaria , also known as ‘nettle-rash’ or ‘hives’ and often described as a ‘weal Career advice and flare’ reaction, is not eczema. It can People with a history of atopic or hand occur in anyone but is perhaps more eczema need to consider carefully their common in atopics. Urticaria is an choice of career and this is better done immediate reaction to a protein. The while still at school. Many individuals ‘weal and flare’ is not always seen and with a background of eczema run into sometimes the immediate reaction will problems if they want to undertake be blistering of the skin. certain occupations because of the Urticaria is most commonly seen in materials used – see below for a list of people working in the catering industry, potential problem jobs. who come into contact with raw meat, fish, fruit or vegetables. Animal Risk occupations include: proteins may cause urticaria in those l Hairdressing people working with or handling l Catering animals. l Healthcare professionals Natural rubber latex can also cause l Metal work contact urticaria. l Florists In all these cases there is a different l Mechanics type of hypersensitivity to that present in contact dermatitis and investigation l Domestic work will be by prick or scratch tests, rather l Some types of engineering than patch testing. l Printing

Page ­17 Key points Further

l Contact dermatitis is a common information problem. BRITISH SOCIETY FOR CUTANEOUS l External agents cause contact ALLERGY (BSCA) dermatitis and these can cause ICD http://cutaneousallergy.org or ACD. l Hand eczema may be caused by HEALTH AND SAFETY EXECUTIVE (HSE) contact dermatitis. Skin at work: l Avoiding future exposure to the http://www.hse.gov.uk/skin known irritant is a major part of HSE leaflet: Preventing contact preventing ICD. dermatitis and urticaria at work l Avoiding known sensitisers is http://www.hse.gov.uk/pubns/ essential in controlling ACD. indg233.pdf l Moisturisers and avoidance of NICE soaps and irritants is important for Clinical Knowledge Summary all types of eczema and contact http://cks.nice.org.uk/dermatitis- dermatitis. contact l The use of suitable gloves can prevent ACD. BRITISH ASSOCIATION OF l Patch testing is an important DERMATOLOGISTS investigation when ACD is a Patient information sheet on contact possibility. dermatitis l There is no reliable resource http://www.bad.org.uk/for-the- giving allergy avoidance advice as public/patient-information-leaflets/ manufacturers constantly change contact-dermatitis/ formulations. The British Society for NHS CHOICES Cutaneous Allergy (BSCA) is the best www.nhs.uk/conditions/contact- online resource (see opposite). dermatitis

Page ­­18 ROYAL COLLEGE OF PHYSICIANS Guidelines on occupational contact Where to find dermatitis www.rcplondon.ac.uk/guidelines- more help policy/diagnosis-management-and- Even in a mild form, eczema can prevention-occupational-contact- be difficult to manage. If you can dermatitis take a positive approach, you will DERMNET NZ probably feel a bit more in control and https://www.dermnetnz.org/topics/ better able to cope. Here are a few contact-dermatitis/ suggestions on where to find help: l Talk to your doctor or nurse if you https://www.dermnetnz.org/topics/ encounter a new problem, or if you irritant-contact-dermatitis/ have run out of ways of dealing with existing ones. l Contact the National Eczema Society.

We can provide you with more information on the topics covered in this booklet including: l Hand eczema (factsheet) l Pompholyx eczema (factsheet) l Allergy (factsheet) l Emollients (factsheet) l Topical steroids (factsheet) l Additional treatment options for moderate to severe eczema (booklet) Contact our Eczema Helpline: 0800 089 1122, helpline@eczema. org or visit our website: www.eczema.org

Page ­19 Further information from the National Eczema Society

More information than can be given in struggling to cope with eczema. We a booklet of this size is available from are not medically qualified and do not the National Eczema Society. We have diagnose, prescribe, give medical advice other booklets including: or opinions on treatments prescribed l Living with Eczema by your healthcare professional. We do, however, offer a wealth of practical l Childhood Atopic Eczema information about the day-to-day l Itching and Scratching management of eczema and the l A Guide for Teenagers with different treatment options available. Eczema The Helpline is open to all UK residents Booklets and factsheets can be ordered who are affected by eczema. Please from our website or from our helpline. allow five working days for us to reply to you if you are emailing with Website: www.eczema.org a question. We are not able to answer queries from non-UK residents as Helpline: Telephone* 0800 089 1122 terminology, healthcare systems (Monday to Friday 10am to 4pm) and treatments may differ in your * Calls are free from UK landlines. Charges country of residence, which may cause vary from mobiles. confusion. Email: [email protected] In addition, the National Eczema We are proud of the wealth of Society publishes Exchange, a quarterly information available on our website magazine packed with: and recommend you visit it whenever l articles on eczema management you need information. It is updated l features by people with eczema frequently. You can also check out our sharing their experiences Facebook page for eczema news and views. l treatment and research news l experts’ replies to your questions. Our confidential telephone and email Helpline is at the heart of our work, You can subscribe to Exchange for providing information, support and £20 p.a. at www.eczema.org or by reassurance to thousands of people calling our administrative office on Page ­­20 020-7281 3553. The information in this booklet is only a general guide. Individual circumstances differ and the National Eczema Society does not prescribe, give medical advice or endorse products or treatments. We hope you will find the National Eczema Society information useful, but it does not replace and should not 11 Murray Street replace the essential guidance given by your doctor and other healthcare professionals. Camden London NW1 9RE This edition reviewed and updated February 2019 by Julie Van Onselen, Dermatology Nurse Adviser to the National Eczema Helpline: 0800 089 1122 Eczema Society. email: [email protected] The National Eczema Society is grateful to the St John’s www.eczema.org Institute of Dermatology for their permission to reproduce the images used in this booklet. The National Eczema Society is registered as a charity with the Charity Designed and produced by de Winter PR & Marketing Commission for England and Wales (number 1009671) and in Scotland © National Eczema Society 2019 (number SCO43669) and a company limited by guarantee (number 2685083). All rights reserved. You must have our written Registered Office 11 Murray Street, permission to electronically or mechanically reproduce Camden, London NW1 9RE or transmit this publication or any part of it.