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British Association of Dermatologists' guidelines for the management of contact dermatitis 2017.В Br J Dermatol.

Johnston GA, Exton LS, Mohd Mustapa MF, et al.

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Multicentre cohort study 'Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)': results from a 3-year follow-up.В Contact Dermatitis.

Brans R, Skudlik C, Weisshaar E, et al.

Irritant contact dermatitis.В Clin Rev Allergy Immunol. What is the outcome for irritant contact dermatitis?Д¬hronic irritant contact dermatitis can be slow to improve or resolve, especially of the hands, without obsessive care.

Topical medications - topical steroids, calcineurin inhibitors, crisaborole.

Specific treatments for some chemical irritants eg, calcium gluconate gel for hydrogen fluoride burn.

What is the treatment for irritant contact dermatitis? General measures Other causes of hand dermatitis such as atopic hand dermatitis.Allergic contact dermatitis - which may co-exist.What is the differential diagnosis for irritant contact dermatitis? Irritant and allergic contact dermatitis can co-exist.

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Patch testing may be necessary to distinguish it from allergic contact dermatitis. There is no test for irritant contact dermatitis. Irritant contact dermatitis may be diagnosed on detailed medical history, including occupational exposures, and clinical examination. How is irritant contact dermatitis diagnosed? It is commonly seen in occupations involving wet work. Interdigital dermatitis, also called the вЂsentinel signвЂ™, is regarded as an early stage of irritant contact dermatitis affecting the hands.

Examples include dribble rash, napkin dermatitis, housewifeвЂ™s eczema, ring dermatitis.

May develop tolerance or hardening with time.

Evolves to include inflammatory changes with redness and itch.

Initial dryness and cracking of the skin.

Chronic due to mild irritants or repetitive cumulative exposure.

Example: kneeling in wet cement, which is very alkaline, causing severe dermatitis of the knees.

Localised well-defined, redness, papules, swelling, blistering ( vesicles/ bullae).

Burning and pain more common symptoms than itch.

Is the commonest cause of hand dermatitis in occupational and non-occupational settings.

Usually is confined to the site of contact with the irritant.

What are the clinical features of irritant contact dermatitis? Irritant dermatitis is often the result of the cumulative impact of multiple irritants. Friction, sweating, and heat are examples of environmental factors. Topical medications such as retinoidsВ and benzoyl peroxide, may cause irritant contact dermatitis with long-term use. Occupational irritants can include wet work, detergents, solvents, acids, alkalis, adhesives, and metalworking fluids.

Environmental factors such as temperature extremes or humidity.Д®veryday examples of common skin irritants are water, soaps, and, in the era of COVID-19, hand sanitisers.

Mechanical trauma including hand scrubbing.

Skin susceptibility such as pre-existing skin damage or atopic tendency.

Duration and frequency of exposure, for example short concentrated or repeated prolonged low exposure.Concentration, amount, and properties of the irritant.Irritants remove oils and natural moisturising factor from the outer layer of the skin, allowing chemical irritants to penetrate the skin barrier and trigger inflammation.ДЇactors influencing the development and severity of the dermatitis include: Irritant contact dermatitis develops when chemical or physical agents damage the skin surface faster than the skin can repair. Irritant contact dermatitis can affect all age groups, both sexes, and any race. Occupational hand dermatitis is due to irritants in 80% of cases, most often affecting those who involved in wet work such as cleaners, hairdressers, food handlers, and healthcare personnel. Irritant contact dermatitis will affect anyone with sufficient exposure to irritants, but those with atopic dermatitis are particularly susceptible.

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