Irritant Contact Eczema

What is irritant contact eczema and what causes it?

Irritant contact eczema (dermatitis) occurs when the epidermis (outer skin layer) is damaged by an external substance - the irritant. Irritant chemicals are harsh substances that can harm the skin. Damage to the outer epidermal cells triggers an inflammatory reaction in the dermis, and starts an eczema reaction. If the skin is only exposed to the irritant once or intermittently, it has a chance to heal. However, if exposure is repeated and more damage occurs before healing has taken place, a chronic persistent eczema can develop.

Many different substances are skin irritants, ranging from mild irritants such as soap and detergents through to stronger irritants such as industrial chemicals. Although most people appreciate that strong chemicals such as solvents, acids or alkalis are harmful, milder irritants actually cause more problems and are often overlooked. Exposure to a mild irritant such as bubble bath or a shaving gel may need to be repeated many times before the damaging effects are noticeable,leaving the sufferer unaware of the underlying cause. A single or occasional exposure to a mild irritant does not usually cause any visible skin damage or symptoms. For example, most people with normal skin have no problems from washing the dishes once or twice a day. However, if they work as a kitchen cleaner and repeatedly immerse their hands in water and detergents, this is likely to damage the skin and can cause irritant contact eczema.

Occasionally, other delicate body areas such as the face and axillae (underarms) can be affected by irritant contact eczema from cosmetics or toiletries. Infantile nappy rash in babies is an example of irritant contact eczema, and is caused by the repeated exposure of delicate skin to wet nappies. Irritant contact eczema is uncommon in children and the elderly because they get very little exposure to irritants.

Although irritants can damage everyone's skin, some people have more problems than others. People who have atopic eczema, or have suffered with this in the past, are more susceptible to getting irritant contact eczema.

What does irritant contact eczema look like?

Irritant contact eczema on the hands often starts as dryness and soreness or chapping, especially between the fingers, on the back of the hands and under rings. It is less common on the palms where the skin is tougher. The skin feels rough, and may become cracked and red. Irritant contact eczema is much drier than other kinds of eczema, and does not usually blister or weep unless it has been caused by a very strong chemical or is infected.

How is irritant contact eczema treated?

It is important to identify which irritants have caused the problem, and to minimize contact with these. Irritant contact eczema weakens the skin barrier, so sufferers have to be more careful than usual about how they treat their skin. Exposure to all irritants should be avoided and soothing emollients applied regularly to help repair the skin. A topical steroid may be needed if there is a lot of inflammation and irritation. The skin will not have recovered completely until several weeks after it looks better, so continued care and emollients are needed.

Tips on treating irritant hand eczema

• Take every opportunity to apply moisturizers. Carry a tube of cream in your pocket or handbag. Find a spare moment to reapply it whenever the skin feels rough or dry, for example, while sitting on the train or watching TV.
• Avoid all soaps, detergents and liquid hand cleansers. Many simple emollients can be used as soap substitutes, and some come in pump-action dispensers which are handy to keep near the wash basins at home and at work.
• Keep on being kind to your skin. Remember that the skin is vulnerable for weeks after it looks normal again.

Work-related (occupational) irritant contact eczema

Irritant contact eczema is the most common work-related skin condition. In certain jobs it is impossible to avoid all exposure to irritants, but changing tasks may reduce exposure, and protective gloves and barrier creams can help. Unfortunately these measures do not always clear the skin, and irritant contact eczema can become such a persistent problem that the person needs to change their career.

Loss of time at work because of eczema has major financial consequences for the affected person as well as their employer, and people with suspected work-related skin conditions should be referred to a specialist in work-related diseases (occupational physician) or a dermatologist for further advice.