What is contact dermatitis?
Contact dermatitis is inflammation of the skin that occurs when you come into contact with a particular substance.
Contact dermatitis is a type of eczema that can cause red, itchy and scaly skin, and sometimes burning and stinging. It leads to your skin becoming blistered, dry and cracked.
It can affect any part of the body but most commonly affects the hands.
Read more about the symptoms of contact dermatitis.
Contact dermatitis can be caused by:
- an irritant (a substance that damages the skin physically), or
- an allergen (a substance that causes the immune system to respond in a way that affects the skin)
Contact dermatitis caused by irritants is more common, causing up to 8 out of 10 cases.
Read more about the causes of contact dermatitis.
Treating contact dermatitis
If you can successfully avoid the irritants or allergens that cause your contact dermatitis then your condition will clear up.
However, this isn't always possible so treatment involves using emollients to soothe the skin. An emollient is a moisturiser that reduces the loss of water from the skin. Corticosteroid medicines can be used to treat severe symptoms.
With treatment, most people with contact dermatitis can expect their symptoms to improve and in up to two out of five people contact dermatitis will clear up completely. However, some people may experience complications of contact dermatitis such as an infection or severe symptoms which affect their quality of life.
Who is affected?
Contact dermatitis is more common in women, with approximately 1 in 5 women experiencing it on their hands at some point during their lives. This may be because women are exposed to more of the irritants that can cause contact dermatitis.
Contact dermatitis can develop at any age and can affect anybody.
Contact dermatitis symptoms
Contact dermatitis most commonly affects areas of skin on your hands and face. Depending on what has caused your contact dermatitis, you may also experience other symptoms.
Both allergic and irritant contact dermatitis can cause your skin to become:
Irritant contact dermatitis
Your symptoms will usually appear within 48 hours of coming into contact with the irritant.
Strong irritants may cause your skin to react immediately. More common irritants, such as soap and detergents, may need frequent and repeated contact before they cause problems.
Only the area of skin that has been in direct contact with the irritant will be affected.
Allergic contact dermatitis
It may take several days for your symptoms to appear after you come into contact with the allergen.
In most cases, the affected skin will be the area of skin that had contact with the allergen. For example, if you are allergic to an eye shadow or blusher, your eyelids or cheeks may be affected. However, in some cases other areas of skin may also be affected.
Contact dermatitis causes
Contact dermatitis occurs when your skin reacts to a particular substance.
This can be either:
- an irritant - a substance that damages the skin
- an allergen - a substance that can cause the body to react abnormally
Irritant contact dermatitis
Irritant contact dermatitis occurs when your skin comes into direct contact with an irritant. The irritant damages the outer layer of your skin, causing redness, itching, burning or stinging.
Irritant contact dermatitis may be caused by frequent exposure to a weak irritant, such as soap or detergent. It may also develop if you've been in contact with a stronger irritant for a short while.
You will be at increased risk of irritant contact dermatitis if you have atopic eczema, which is the most common form of eczema.
Common irritants include:
- detergents and soaps
- antiseptics and antibacterials
- perfumes and preservatives in toiletries or cosmetics
- oils used in machines
- chemicals, such as disinfectants
- acids and alkalis
- water, especially hard, chalky water or heavily chlorinated water
- some plants, such as clematis, hellebore and mustards
Irritant dermatitis at work
You may be more at risk of contact dermatitis if you work with irritants as part of your job or if your job involves a lot of wet work. If you do develop the condition because of a substance you work with, it may be referred to as occupational irritant dermatitis.
This type of dermatitis is more common in certain occupations, including:
- cleaners and housekeepers
- food preparers, cooks and and caterers
- hairdressers and beauticians
- farm and fisheries workers
- engineers and construction workers
- healthcare professionals (including dentists and vets)
- printers and painters
Other contributing factors
If you already have contact dermatitis symptoms, they can be made worse by:
- friction (rubbing against the irritant)
- low humidity (dry air)
These are more of a risk if you have irritant contact dermatitis.
Allergic contact dermatitis
Allergic contact dermatitis occurs when you come into contact with an allergen which causes your immune system to react abnormally. Your immune system is the body’s natural defence system that usually protects your body against infection and illness. During an allergic reaction, the immune system can attack healthy cells and tissue as well. This is what causes your skin to be sore and inflamed.
The first time you come into contact with a type of allergen, your body becomes sensitised to it. It's only when you touch that substance again, that your skin reacts with an itchy red rash.
Common allergens that can cause allergic contact dermatitis include:
- metals, such as nickel or cobalt in jewellery
- cosmetics, such as fragrances, hair dye and nail varnish
- preservatives added to certain medicines (including medicated creams)
- rubber, including latex, a type of naturally occurring rubber
- textiles, particularly the dyes and resins that are contained in them
- strong adhesives (glue), such as epoxy resin adhesives
- some plants, such as chrysanthemums, daffodils, tulips and primula
- some topical medicines (medicines that are applied directly to the skin), such as topical corticosteroids and topical antibiotics
Diagnosing contact dermatitis
Your doctor will normally be able to diagnose contact dermatitis from the appearance of your skin and by asking about your symptoms.
They will want to know when your symptoms first appeared and what substances you have been in contact with.
Identifying allergens and irritants
If your doctor has diagnosed contact dermatitis, they will try to identify what has triggered your symptoms. If the allergens or irritants can be identified, you can take steps to avoid those substances and reduce the risk of your symptoms flaring up.
Your doctor will look at your medical history and ask questions about your lifestyle and occupation to see what factors may be causing your symptoms. They may also ask whether there is a history of dermatitis or eczema in your family.
If you and your doctor cannot identify the allergens or irritants that cause your contact dermatitis, you may be referred for further testing by a dermatologist (a doctor who specialises in treating skin conditions).
You may also be referred to a dermatologist if the trigger has been identified, but your symptoms are not responding to treatment.
The best way to test for a reaction to allergens is by patch testing. During a patch test, tiny amounts of known allergens are applied to your skin. The substances are attached to your back using a special kind of non-allergic tape. Sometimes, they may be attached to the upper arms.
After two days, the patches are removed and your skin assessed to check if there has been any reaction. Your skin will usually also be examined after four to six days as most allergic contact dermatitis reactions will take this long to develop.
Open application testing
Open application testing is used to assess potential irritants. In an open patch test, the substance is applied to the skin on your forearm or inner elbow and left uncovered. Your skin will initially be checked for a reaction and again after a few days.
In some cases, a repeated open application (ROAT) is useful, particularly to assess cosmetics. A ROAT involves reapplying the substance onto the same area of skin twice a day for 5-10 days to see how your skin reacts.
This is a particularly useful way for you to check your own existing or new cosmetics at home for reactions.
Treatment for contact dermatitis
The symptoms of contact dermatitis can be effectively managed with treatment. Some people's symptoms improve, whereas others find their symptoms clear up entirely.
Up to 8 out of 10 people will experience at least a partial improvement in their symptoms after treatment.
There are several ways to treat contact dermatitis, including:
- avoiding the cause
- topical corticosteroids (for severe symptoms)
- oral corticosteroids (for widespread severe symptoms)
These treatments are explained below.
Avoiding the cause
One of the most important steps in treating contact dermatitis is identifying and avoiding the allergens or irritants that affect you. If you can successfully avoid the cause, you should not experience any symptoms.
It is not always easy to avoid irritants or allergens that affect you. Your doctor or dermatologist (a specialist in treating skin conditions) can work with you to find ways to minimise your contact with them.
Read more information about preventing contact dermatitis.
If you are exposed to irritants as part of your job, wear adequate protective clothing to minimise any contact. Tell your employer about your condition so they can help you avoid the causes as effectively as possible.
The allergen nickel may rarely cause some cases of contact dermatitis. This is a trace element found in foods such as lentils, nuts and oats. There is limited evidence that people who are sensitive to nickel might benefit from following a diet low in nickel.
You should speak to your dermatologist before making any changes to your diet.
Emollients are substances that help soften and smooth your skin 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 to prevent it from becoming further irritated. Emollients prevent water being lost from the outer layer of the skin and add water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.
Choice of emollient
Several different emollients are available. You may need to try a few to find one that works for you. You may also be prescribed a mix of emollients, such as:
- an ointment for very dry skin
- a cream or lotion for less dry skin
- an emollient to use on your face and hands
- a different emollient to use on your body
- an emollient to use instead of soap
- an emollient to add to bath water or use in the shower
The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least oil so are not greasy but can be less effective. Creams are between the two.
Some people find that some emollients can irritate their skin. If this happens, speak to your pharmacist or doctor so that an alternative emollient can be prescribed instead.
How to use emollients
Use your emollient frequently and in large amounts. Many people find it helpful to keep separate supplies of emollients at work or at school.
To apply the emollient:
- use a large amount
- smooth the emollient into the skin in the same direction that the hair grows
- do not rub the emollient in
- for very dry skin, apply the emollient every three to four hours
- after a bath or shower, gently dry the skin and then immediately apply the emollient while the skin is still moist
- do not share emollients with other people
Creams and lotions tend to be more suitable for red, weepy and wet areas of skin. Ointments are more effective for areas of dry skin. However, as they are greasier, you may dislike the way they affect your appearance.
If you are exposed to irritants at work that cause your contact dermatitis, make sure you apply emollients regularly during and after work.
Occasionally, some emollients can irritate the skin. If you have contact dermatitis, your skin will be sensitive and can sometimes react to certain ingredients such as perfume in over-the-counter emollients. If your skin reacts to the emollient, stop using it and speak to your doctor, who will be able to recommend an alternative product.
If your skin is very red, sore and inflamed, your doctor may prescribe a topical corticosteroid (one that is applied directly to your skin). Corticosteroids work by quickly reducing inflammation.
Corticosteroids are any type of medication that contains steroids, a type of hormone. Hormones are groups of powerful chemicals that have a wide range of effects on the body.
You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used (illegally) by bodybuilders and athletes. When used as instructed by your pharmacist or doctor, corticosteroids are one of the safest and most effective treatments for contact dermatitis.
Choice of topical corticosteroid
Different strengths of topical corticosteroids can be prescribed depending on the severity of your contact dermatitis and where the affected skin is. You may be prescribed:
- a stronger topical corticosteroid for short-term use in severe contact dermatitis
- a weaker topical corticosteroid if the eczema is mild
- a weaker topical corticosteroid for use on your face, genitals or in the creases of your joints (such as your elbows), as your skin is thinner in these areas
- a stronger topical corticosteroid to use on your palms and the soles of your feet, as the skin is thicker here
How to use topical corticosteroids
When using corticosteroids, apply the treatment in a thin layer to all the affected areas. Unless instructed otherwise by your dermatologist, follow the directions on the patient information leaflet that comes with the corticosteroid. This will give details of how much to apply.
During an episode of severe contact dermatitis, do not apply the corticosteroid more than twice a day. Most people will only have to apply it once a day.
Topical corticosteroids may cause a mild burning or stinging feeling as you apply them. Rarely, and if used for long periods of time, they may cause:
- thinning of the skin, particularly in the crease of the elbow or knee joint
- telangiectasia (visible blood vessels), particularly on the cheeks
- acne (spots)
If you have a severe episode of contact dermatitis and it covers a large area of your skin, your dermatologist may prescribe corticosteroid tablets.
You may be prescribed prednisolone to take for five to seven days. Depending on how effective this is, your dose of prednisolone may gradually be reduced over three or four weeks.
If corticosteroid tablets are taken often or for a long time, they can cause a number of side effects, such as:
- affecting the growth rate of children
- high blood pressure (hypertension)
- osteoporosis (brittle bones)
- inflammation of the stomach lining
For this reason, your doctor is unlikely to prescribe repeat courses of corticosteroid tablets without referring you to a specialist (see referral, below).
In some cases, your doctor may refer you for assessment and treatment by a dermatologist. For example, your doctor may refer you if:
- it is not clear what is causing your contact dermatitis
- the prescribed treatments are not successfully controlling your contact dermatitis
- you have long-term or recurring symptoms despite avoiding the causes and using the treatments prescribed
Treatments from a dermatologist could include:
- phototherapy, where your contact dermatitis is exposed to ultraviolet (UV) light - this may be ultraviolet A or ultraviolet B, and may also involve a medicine containing psoralen, which makes your skin more sensitive to light
- steroid-sparing immunosuppressant therapy - immunosuppressant medicines suppress your immune system (the body’s natural defence system)
- alitretinoin (see below)
Alitretinoin (sold under the brand name Toctino) is a medication for severe, long-term hand eczema that has failed to respond to other treatments, such as topical corticosteroids. Treatment with alitretinoin must be supervised by a dermatologist and can only be used by people 18 years of age or over.
Alitretinoin is a type of medication called a retinoid. Retinoids reduce the levels of irritation and itchiness associated with eczema.
Alitretinoin comes as a capsule that most people take once a day for 12-24 weeks.
It should never be taken during pregnancy because it can cause severe birth defects. Also avoid taking alitretinoin when breastfeeding because the medication can enter your breast milk and harm your baby.
Due to the risk of birth defects, the use of alitretinoin is not recommended for women of child-bearing age. If you are a woman of child-bearing age, you will only be prescribed alitretinoin if you agree to the following strict rules:
- You fully understand why you should not get pregnant and what you need to do to prevent it.
- You agree to use one or preferably two methods of contraception, including a barrier form of contraception such as condoms.
- You start using these contraception methods from one month before starting treatment until one month after finishing treatment.
- You agree to have pregnancy tests before, during and after treatment.
- You confirm that you are aware of the risks and precautions you need to take, for example by signing a form stating this.
Some common side effects of alitretinoin include:
- dry mouth
- anaemia (a reduced number of red blood cells)
- flushed (warm and red) skin
- increased levels of cholesterol and triglyceride (fatty substances) in the blood
- joint or muscle pain
- dry eyes or eye irritation
Uncommon side effects of alitretinoin include nosebleeds and sight problems, such as blurred vision. If you have vision problems, stop treatment immediately and contact your dermatologist.
There have also been reports of people suddenly having thoughts of hurting or killing themselves while taking retinoids, which are related to alitretinoin. However, to date, this has never been reported with alitretinoin.
It may be helpful to tell a close friend or relative that you are taking alitretinoin and ask them to tell you if they notice changes in your behaviour or are worried about the way you are acting. If you have any concerns, let you dermatologist know.
Complications of contact dermatitis
Most people are able to manage their contact dermatitis symptoms effectively, but sometimes complications can develop, such as infections.
See your doctor if your dermatitis symptoms are unusual or suddenly get worse. If you have an infection, it can usually be easily treated with antibiotics (medication to treat infections caused by bacteria).
For some people, symptoms may be severe and long lasting and may affect their quality of life.
For example, contact dermatitis may affect your ability to do your job. This can cause you to feel unhappy or depressed. If your symptoms have a significant impact on your quality of life, speak to your doctor. They might be able to help you manage your symptoms more effectively.
Preventing contact dermatitis
The best way to prevent contact dermatitis is to avoid contact with the allergens or irritants that cause your symptoms. However, this is not always possible.
If you cannot avoid contact, you can take steps to reduce the risk of the allergens or irritants causing symptoms.
Washing or cleaning your skin
If you come into contact with an allergen or irritant, rinse the affected skin with water or wash it using a soap substitute (an emollient, see below). Do this as soon as possible after coming into contact with the allergen or irritant.
Using protective clothing
You can wear protective clothing to reduce contact you have with the allergens or irritants.
Irritant contact dermatitis usually affects the hands, so gloves are an easy and effective way of minimising your contact with an irritant. You could wear cotton gloves underneath gloves made of rubber, if the rubber also irritates you. Take your gloves off every now and again as sweating will make any symptoms you have worse.
If you work with chemicals, there may be health and safety guidance at work that tells you what sort of gloves you need to wear.
If you know a certain product causes your contact dermatitis, such as a type of make-up or soap, try changing to a different product. Check the ingredients to make sure it does not contain any irritants or allergens you know will affect you. In some cases, you may need to contact the manufacturer or check on-line to get this information.
Apply emollients frequently and in large amounts (read more about how contact dermatitis is treated). These will keep your skin hydrated and help the skin repair itself. Once repaired, your skin can provide better protection against contact with allergens and irritants.
Also use emollient soap substitutes as both bar and liquid soaps will dry out your skin. This is particularly important if you need to wash your hands frequently at work.
Barrier creams can be applied to create a barrier between you and the irritant. If used correctly, they may help prevent contact with the irritant. However, do not rely on them as your only form of protection.
After-work creams are designed to be used at the end of your working day. Applying after-work creams may reduce the number of times contact dermatitis occurs.