Dermatitis (sometimes also called eczema) simply means inflammation of the skin, and so contact dermatitis is the name used when this inflammation is caused by direct or indirect contact of the skin with something in your environment that it reacts to.
##What causes contact dermatitis?
There are two main types of contact dermatitis:
Irritant contact dermatitis. This type develops when the skin comes into contact with things that irritate the skin, such as detergents or very hot water that strip the skin of its natural oils and so dry it out. If you have regular contact with these you can then get an irritant dermatitis. This means it’s common in people who put their hands in water a lot, such as nurses, hairdressers, and cleaners. This type of contact dermatitis is more likely to happen in people who have suffered from childhood eczema.
Allergic contact dermatitis. This type occurs when you develop an allergy to a specific substance that’s been in contact with your skin. Common examples of these include hair dye, cosmetics, and perfumes. It’s unclear why some people who are exposed to these develop dermatitis while others don’t but unlike irritant dermatitis, contact dermatitis doesn’t seem to be more likely in people who had eczema when young.
##What are the symptoms of contact dermatitis?
The commonest symptoms is itching of the skin, and this can be very intense and to a level where you can’t stop scratching it. The skin can also become sore and red, with blisters developing that can weep. In contact dermatitis of the hands, there may be painful cracking of the skin that can make it difficult to use your hands normally. The hands are the commonest area where contact dermatitis occurs, followed by the arms, neck and face
The reaction will likely continue while the skin continues to be exposed to the allergen or irritant, and will recur each time it meets it, possibly increasing in severity. So if you can identify what is causing the reaction, you can then try to avoid this, or put measures in place to protect yourself, for example, wearing gloves to handle certain chemicals.
Unfortunately, if the reactive substance is part of your job, such as a hairdresser with sensitivity to hair dyeing agents, this may have future implications and you should seek medical advice on avoidance or protective measures at work.
Depending on how severe the reaction is, you can see your pharmacist about treatments such as a mild steroid cream and thick moisturisers.
The first line of treatment for allergic or contact dermatitis at the pharmacy would be antihistamines to calm down the allergic response.
Piriton (containing chlorphenamine 4mg) is particularly effective for skin reactions, however, it has a short duration of action around four to six hours, and hence requires being taken every several times a day. The good news is that you should see improvement with just a couple of doses. You should be aware that this medication can commonly cause drowsiness.
Newer longer-acting antihistamines such as Piriteze (contains cetirizine 10mg) or Clarityn (contains loratadine 10mg) are less likely to cause drowsiness and can be taken once a day.
Add-on therapy such as using a mild corticosteroid can help to further reduce redness and swelling. Examples of these are HC45 cream (contains hydrocortisone 1%), which is a mild steroid, or Eumovate cream (contains clobetasone 0.05%), which is a slightly stronger steroid. Care must be taken not to apply on broken or infected skin.
Moisturisers will reduce dryness, which can cause an itch. There are many types of these to provide a moisturising barrier over the skin and aid healing. They can be used instead of a steroid cream or can be used on top of the steroid cream if required - just remember to leave a 20-minute gap between applying the steroid and the moisturiser. A good example for itchy or irritated skin could be Dermacool 2% cream which contains menthol for a soothing effect plus aqueous cream to moisturise, or calamine in aqueous cream. Other natural alternatives include aloe vera, which has natural healing properties.
If the reaction is not improving after seven days of over-the-counter treatment, is spreading, is particularly sore, or you have skin cracks or crusting, you should see your doctor. If you are having difficulty negotiating special measures at work, and suspect that this may have caused your reaction, your doctor may be able to offer support.
You may be fit for work, depending on how bothersome the dermatitis is. If you suspect or know that allergens or irritants at work are responsible for the dermatitis, you may need to avoid these while awaiting medical advice.
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