Contact Dermatitis: Types, Causes & Treatments

Hand cream for contact dermatitis

Our skin is our largest organ and our most exposed, and consequently, it’s vulnerable to many infections and irritations. Contact dermatitis is just one problem that can affect our skin, and occurs in 15% to 20% of people[i]. Although it can be very uncomfortable it is not contagious.

Below, we will explore what contact dermatitis is, its causes, and how it can be treated.

Article contents

  1. What is contact dermatitis?
  2. Types of contact dermatitis
  3. Causes and symptoms
    1. Irritant
    2. Allergic
    3. Photocontact
  4. Diagnosis
  5. Treatment
  6. Who is at risk?
  7. Complications
  8. When to see a doctor

What is contact dermatitis?

Contact dermatitis is inflammation of the skin and a type of eczema that can affect any area of the skin although the hands and face are usually the most affected. The condition is triggered by the skin coming into contact with a substance that it is sensitive to, and this trigger varies from person to person[ii]. Some symptoms may include red, itchy, blistered, dry and cracked skin.

Unlike some forms of eczema, contact dermatitis can generally be avoided by avoiding the substance that triggered the reaction.


Types of contact dermatitis

There are three primary forms of contact dermatitis – Irritant, Allergic and Photocontact. Although symptoms may be similar, they are caused by different factors.

  • Irritant Contact Dermatitis (ICD) – caused by physical and/or chemical irritants[iii].
  • Allergic Contact Dermatitis (ACD) – is a form of dermatitis but is caused by an allergic reaction when the skin comes into contact with an allergen which causes the immune system to react in a way that affects the skin.
  • Photocontact Dermatitis (PCD) – Sometimes referred to as photoaggravated dermatitis, this is a condition that occurs when a particular substance is applied to the skin, and then exposed to the sun and reacts[iv].

Causes and Symptoms of Contact Dermatitis

The causes (often referred to as triggers) of contact dermatitis are varied. Triggers depend upon the type of contact dermatitis someone has with the most common types listed below including their symptoms[v].

Symptoms of contact dermatitis vary depending on the type of contact dermatitis someone has and the severity.


Irritant Contact Dermatitis

Triggers

  • Hand sanitiser (alcohol based)
  • Household cleaners (bleach, drain cleaners, etc.)
  • Soap & Detergents
  • Perfume
  • Preservatives in cosmetics & toiletries
  • Oils
  • Many plants
  • If you are suffering with symptoms of ICD your symptoms may be exacerbate by heat, cold, dry air or friction

Symptoms – may occur immediately after exposure or within 48 hours

  • Blistering
  • Red rash
  • Itching (may be severe)
  • Skin inflammation (swelling)
  • Tight or stiff skin
  • Dry, cracked, scaly skin

 


Allergic Contact Dermatitis

Triggers

  • Topical medications
  • Medication such as antibiotics
  • Hair dye
  • Skin lotions and creams
  • Acidic citrus fruits
  • Cosmetics
  • Perfumes, aftershave and fragranced soaps
  • Nickel or other metals
  • Products containing latex

Symptoms – may take several days to present

  • Urticaria (hives)
  • Red skin which may appear in patches
  • Dry, scaly skin
  • Blisters that may weep
  • Sensation that the skin is burning
  • Itching which may be severe
  • Swelling (most common in sensitive areas like around the groin and face)
  • Sensitivity to the sun

Photocontact Dermatitis

Triggers

Photocontact dermatitis is different from ICD & ACD because there is not generally an instant reaction when a trigger substance touches the skin. The reaction begins when the area is exposed to UV light; usually sunlight.

  • Particular medications
  • Sunscreen
  • Some oils
  • Shaving cream
  • Skin ointments

Symptoms

The symptoms of Photocontact Dermatitis can be split into two subtypes:

  • Phototoxic reaction, which can present as bad sunburn.
  • Photoallergenic reaction, which presents with more typical ACD contact dermatitis or eczema symptoms.

Diagnosis

Your GP will usually be able to diagnose your contact dermatitis easily by examining the appearance of the skin and a history of when the symptoms started and what substances you have been in contact with.

In some instances, patch testing may be required. Patch testing requires a small number of allergens being applied to the skin underneath a patch of paper and removed after 48 hours. The skin reaction is examined and scored. However, you may need to go back after 72 to 96 hours as some allergens can take longer to develop. You may be tested for several common allergens at the same time to help narrow down what you are specifically allergic to, and your bodies reaction to the allergens[vi].


Treatments

Treatment for contact dermatitis is dependent on the severity of it, and how it is triggered. Once this has been diagnosed, your doctor or GP is likely to look at the following courses of treatment[vii]:

Avoiding the trigger

Often, contact dermatitis can be quickly cleared up by merely avoiding what caused the reaction in the first place. This is easily achieved by most but on some occasions it may be difficult if you are unable to avoid the trigger, especially if the trigger is in the workplace. If this is the case have a discussion with your employer about minimising your contact with the trigger and if the cause is not completely unavoidable then protective clothing may be an option to help minimise contact.

Emollients

An emollient is a cream that is applied to the skin. Once applied, it creates a barrier on the skin which locks in moisture, helping to prevent inflammation and flare-ups of contact dermatitis. There are different forms, such as ointments, creams and lotions. You may be prescribed a mixture of these.

Emollients are beneficial when you are unable to avoid the cause for your flare-ups. For example, if someone experiences urinary or faecal incontinence[viii], they or their carers may use an emollient as part of their cleansing routine to soothe irritation. MoliCare® Barrier Cream is a good option for everyday use. It forms a protective, transparent film on the skin to protect it from irritation without compromising the absorbency of any incontinence products being worn.

Topical corticosteroids

A topical corticosteroid may be prescribed if your skin is sore and inflamed. It’s applied directly to the skin and is a fast way to reduce inflammation.

Steroid tablets

On occasion when other treatments have not worked, you may be prescribed steroid tablets. This is likely only to be a short course.

If the course of treatment prescribed by your doctor does not improve your symptoms you may be referred to a dermatologist. A dermatologist is a doctor who can diagnose, treat and manage skin diseases.


Who is at most risk of contact dermatitis?

Although anyone can be affected by contact dermatitis, certain groups are more at risk.

People with incontinence

Incontinence, especially in older people, can weaken the skin around the genitals and make it more susceptible to infection and conditions such as contact dermatitis. A good cleansing routine and high quality incontinence products can help to prevent or reduce the effects of contact dermatitis.

People in certain occupations

Many people who work with irritants daily are affected by contact dermatitis. This is known as ‘occupational dermatitis’. Occupations that increase this risk include beauty therapy, healthcare, floristry, construction and cleaning[ix].

Women

More women suffer from contact dermatitis than men. For example, in 2019, HSE reported that of 875 occupational diagnoses 42% were among men compared to 58% in women[x]. More women work in occupations such as beauty that involve a lot of hands-on contact with chemicals that can cause a flare-up.

Infants

Generally, infants are at high risk of the condition because they have thinner skin which can absorb more applied substances[xi].


Complications of contact dermatitis

Despite contact dermatitis being relatively easy to handle in most cases, some people can develop complications if they have pre-existing conditions, or the condition is left untreated. Some complications include:

  1. Infection – broken skin caused by contact dermatitis is susceptible to bacterial and fungal infections which can lead to infectious conditions such as impetigo.
  2. Cellulitis – this is a bacterial infection that can be dangerous for those who have weakened immune systems, and causes pain in infected areas.
  3. Neurodermatitis – this is an effect of the condition, where sustained itching can cause the skin to become leathery, discoloured and thickened.
  4. Quality of life – those affected badly by contact dermatitis can be embarrassed about their skin condition. This may affect their self-confidence, lead to mental health problems which may impact on day-to-day lives

When to see a doctor

If you are ever concerned about your skin, you shouldn’t hesitate to contact your GP to ask for help and guidance. Skin problems can be indicative of a huge variety of health issues.

You should talk to your GP if your symptoms are severe and recurrent, but your pharmacist may also be able to help you.


References

Authority, H. a. S., n.d. Occupational Dermatitis – Frequently Asked Questions. [Online] Available at: https://www.hsa.ie/eng/Workplace_Health/Occupational_Asthma_and_Dermatitis/Occupational_Dermatitis_Frequently_Asked_Questions/
[Accessed February 2021].

Brown, H., 2019. Incontinence-associated dermatitis. [Online] Available at: https://dermnetnz.org/topics/incontinence-associated-dermatitis/
[Accessed February 2021].

Fletcher, J., 2017. Triggers of contact dermatitis and how to treat it. [Online] Available at: https://www.medicalnewstoday.com/articles/318099
[Accessed February 2021].

Health and Safety Executive, 2020. Work-related skin disease statistics in Great Britain, 2020. [Online] Available at: https://www.hse.gov.uk/statistics/causdis/dermatitis/skin.pdf
[Accessed February 2021].

Moore, A., 2020. CONTACT DERMATITIS OVERVIEW. [Online] Available at: https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis#:~:text=Contact%20Dermatitis%20Overview,)%20or%20irritant%20(ICD).
[Accessed February 2021].

Moore, A., 2020. CONTACT DERMATITIS OVERVIEW. [Online] Available at: https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis
[Accessed February 2021].

Ngan, V., 2006. Photocontact dermatitis. [Online] Available at: https://dermnetnz.org/topics/photocontact-dermatitis/
[Accessed February 2021].

NHS, 2021. Overview Contact Dermatitis. [Online] Available at: https://www.nhs.uk/conditions/contact-dermatitis/
[Accessed February 2021].

NHS, 2021. Treatment. [Online] Available at: https://www.nhs.uk/conditions/contact-dermatitis/treatment/
[Accessed February 2021].

Tang, G. T., 2020. Allergic contact dermatitis in children — codes and concepts. [Online] Available at: https://dermnetnz.org/topics/allergic-contact-dermatitis-in-children/
[Accessed February 2021].

Wikipedia, n.d. Allergic contact dermatitis. [Online] Available at: https://en.wikipedia.org/wiki/Allergic_contact_dermatitis
[Accessed February 2021].

Wikipedia, n.d. Irritant contact dermatitis. [Online] Available at: https://en.wikipedia.org/wiki/Irritant_contact_dermatitis
[Accessed February 2021].

 

Sources

[i] https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis#:~:text=Contact%20Dermatitis%20Overview,)%20or%20irritant%20(ICD).

[ii] https://www.nhs.uk/conditions/contact-dermatitis/

[iii] https://en.wikipedia.org/wiki/Irritant_contact_dermatitis

[iv] https://dermnetnz.org/topics/photocontact-dermatitis/

[v] https://www.medicalnewstoday.com/articles/318099

[vi] https://www.aaaai.org/conditions-and-treatments/library/allergy-library/contact-dermatitis

[vii] https://www.nhs.uk/conditions/contact-dermatitis/treatment/

[viii] https://dermnetnz.org/topics/incontinence-associated-dermatitis/

[ix]https://www.hsa.ie/eng/Workplace_Health/Occupational_Asthma_and_Dermatitis/Occupational_Dermatitis_Frequently_Asked_Questions/

[x] https://www.hse.gov.uk/statistics/causdis/dermatitis/skin.pdf

[xi] https://dermnetnz.org/topics/allergic-contact-dermatitis-in-children/

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