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.