Authors: Vanessa Ngan, Staff Writer, 2003; Updated: Dr Kajal Patel, Research Fellow, Occupational Dermatology Research and Education Centre, Carlton, Australia; A/Prof Rosemary Nixon AM, Dermatologist and Occupational Physician, Occupational Dermatology Research and Education Centre, Carlton, Australia. Copy edited by Gus Mitchell. July 2021
Irritantcontact dermatitis is a form of skin inflammation caused by contact with substances and/or environmental factors that injure the skin, damaging the skin barrier.
Irritant contact dermatitis of the hand
Hand dermatitis due to wet work
Who gets irritant contact dermatitis?
Irritant contact dermatitis will affect anyone with sufficient exposure to irritants, but those with atopic dermatitis are particularly susceptible. 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 can affect all age groups, both sexes, and any race.
What causes irritant contact dermatitis?
Irritant contact dermatitis develops when chemical or physical agents damage the skin surface faster than the skin can repair. 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.
Factors influencing the development and severity of the dermatitis include:
Concentration, amount, and properties of the irritant
Duration and frequency of exposure, for example short concentrated or repeated prolonged low exposure
Skin susceptibility such as pre-existing skin damage or atopic tendency
Mechanical trauma including hand scrubbing
Environmental factors such as temperature extremes or humidity.
Everyday examples of common skin irritants are water, soaps, and, in the era of COVID-19, hand sanitisers. Occupational irritants can include wet work, detergents, solvents, acids, alkalis, adhesives, and metalworking fluids. Topical medications such as retinoids and benzoyl peroxide, may cause irritant contact dermatitis with long-term use. Friction, sweating, and heat are examples of environmental factors. Irritant dermatitis is often the result of the cumulative impact of multiple irritants.
Irritant dermatitis due to benzoyl peroxide
Atopic irritant hand dermatitis
Acute irritant contact dermatitis
What are the clinical features of irritant contact dermatitis?
Irritant contact dermatitis:
Resembles dermatitis of any cause
Usually is confined to the site of contact with the irritant
Is the commonest cause of hand dermatitis in occupational and non-occupational settings
Interdigital dermatitis, also called the ‘sentinel sign’, is regarded as an early stage of irritant contact dermatitis affecting the hands. It is commonly seen in occupations involving wet work.
Sentinel sign
DERMATITIS
How do clinical features vary in differing types of skin?
Erythema of dermatitis may be more difficult to observe in darker skin types, and postinflammatory hyperpigmentation is more common after resolution of the dermatitis.
Sentinel sign
Irritant hand dermatitis
Postinflammatoryhyperpigmentation following irritant hand dermatitis
What are the complications of irritant contact dermatitis?
Irritant contact dermatitis may be diagnosed on detailed medical history, including occupational exposures, and clinical examination. There is no test for irritant contact dermatitis. Patch testing may be necessary to distinguish it from allergic contact dermatitis. Irritant and allergic contact dermatitis can co-exist.
What is the differential diagnosis for irritant contact dermatitis?
Brans R, Skudlik C, Weisshaar E, et al. Multicentre cohort study 'Rehabilitation of Occupational Skin Diseases - Optimization and Quality Assurance of Inpatient Management (ROQ)': results from a 3-year follow-up. Contact Dermatitis. 2016;75(4):205–12. doi:10.1111/cod.12614. PubMed
Johnston GA, Exton LS, Mohd Mustapa MF, et al. British Association of Dermatologists' guidelines for the management of contact dermatitis 2017. Br J Dermatol. 2017;176(2):317–29. doi:10.1111/bjd.15239. Journal
Li Y, Li L. Contact dermatitis: classifications and management. Clin Rev Allergy Immunol. 2021;10.1007/s12016-021-08875-0. doi:10.1007/s12016-021-08875-0. PubMed
Modi GM, Doherty CB, Katta R, Orengo IF. Irritant contact dermatitis from plants. Dermatitis. 2009;20(2):63–78. PubMed
Patel V, Atwater AR, Reeder M. Contact dermatitis of the hands: is it irritant or allergic?. Cutis. 2021;107(3):129–32. doi:10.12788/cutis.0204. Journal
Slodownik D, Lee A, Nixon R. Irritant contact dermatitis: a review. Australas J Dermatol. 2008;49(1):1–11. doi:10.1111/j.1440-0960.2007.00409.x. PubMed