Synopsis
Separate cumulative irritant barrier injury from delayed allergic contact dermatitis, identify occupational exposures, use patch testing appropriately, and build feasible avoidance and treatment plans.
- Irritant dermatitis reflects exposure dose and barrier damage; allergic contact dermatitis is delayed type IV hypersensitivity requiring previous sensitisation.
- Wet work means repeated hand wetting or prolonged glove occlusion as well as obvious chemical exposure; atopic skin lowers the irritant threshold.
- Allergic dermatitis can spread beyond the exact contact border, while irritant disease often affects the most exposed surfaces, but morphology alone is not definitive.
- Patch testing assesses delayed contact allergy; skin-prick testing and serum specific IgE do not diagnose allergic contact dermatitis.
- Ask for product ingredient lists, safety-data sheets, glove composition, tasks, hobbies and improvement away from exposure before giving avoidance advice.
- A positive patch test identifies sensitisation; clinical relevance requires a real exposure and a compatible site and time course.
- For Irritant and allergic contact dermatitis, document body sites, severity, sleep and function, recent treatment, infection features and what the patient can realistically apply each day.
- In Irritant and allergic contact dermatitis, reassess the diagnosis when a well-used, correctly potent regimen fails rather than repeatedly intensifying treatment without examining adherence, exposure and mimics.
Key red flags
Eye involvement, deep chemical injury, widespread bullae, fever, rapidly progressive pain, occupational inability to avoid exposure or persistent facial and hand disease requires urgent or specialist assessment.
Wheals, respiratory symptoms or collapse within minutes suggests contact urticaria or anaphylaxis and requires an immediate-allergy pathway.
Investigation priorities
Identify irritant dose, plausible sensitiser and opportunities for substitution.
Management branches
Exposure is frequent and dose-related, patchy on contact surfaces and lacks a specific delayed allergen pattern.
- Substitute soap and harsh cleanser with a suitable emollient wash, reduce wet-work duration and use task-specific gloves with cotton liners when prolonged wear is unavoidable.
- Apply leave-on emollient repeatedly and a site-appropriate topical corticosteroid to active inflammation for a defined course.
- Review actual workplace implementation, fissure healing and time away; investigate allergy or tinea if response remains incomplete.
Key medicines
Hydrocortisone 1% creamAdults apply thinly once or twice daily for no more than seven days under this licence, with site-specific clinician review if further treatment is needed.Avoid eyes, broken chemical burns, infection and prolonged face or flexure use; excipients themselves can irritate or sensitise and persistent disease needs exposure reassessment.
Betamethasone valerate 0.1% creamApply a thin layer once or twice daily to affected trunk, limb or hand skin for up to four weeks, then reduce or stop with control.Avoid thin sites, untreated infection, large areas and occlusion unless prescribed; monitor atrophy and systemic absorption and do not let suppression conceal continued workplace exposure.