Section 2.1 Irritant Contact Dermatitis

Irritant contact dermatitis (ICD) is the most common type of work-related dermatitis. ICD is often cumulative in nature, meaning it builds up over time and follows frequent, repeated exposure to skin irritants.

Skin dryness is usually the first sign of irritant contact dermatitis, and often starts in the web spaces between the fingers. This is referred to as the “Sentinel sign”, as shown below. If the dryness persists, inflammation then develops, causing erythema and itch.

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The sentinel sign Irritant contact dermatitis

Common irritants are:

  • Water and wet work e.g. frequent hand washing, prolonged glove use, dish washing, food preparation, patient bathing in aged care and hospitals, and repeated client shampooing in the hairdressing setting.
  • Soaps and detergents
  • Solvents such as turpentine, thinners and kerosene
  • Oils and coolants
  • Cement and other dusts
  • Heat and sweating, especially if wearing occlusive gloves for extended periods of time
  • Friction

Irritant contact dermatitis is an important diagnosis for which there is no test available, and it relies on the exclusion of allergic contact dermatitis (by patch testing).

The likelihood of developing ICD is related to how irritating a particular substance is, plus the frequency and duration of exposure to this irritant. Once ICD has developed it opens up the pathway for ACD to develop, increasing the risk of allergens entering the body via broken skin in the cracks and splits.

Healing of the skin after an episode of ICD may take weeks or months, depending on the severity. If the dermatitis has been present for some time or if it has been severe, the skin may appear to have healed but for several months may have a lower threshold than normal for developing dermatitis again when exposed to skin irritants. ICD can be severe enough that people need job modification, or extended time away from work.

Wet work

Wet work is one of the most common causes of irritant contact dermatitis. People often don’t realise how many times a day their hands are wet or how any times a day they wash their hands. This is particularly the case for those working in the healthcare industry, or those with young children at home performing regular bathing, nappy changing, clothes washing and food preparation.

Wet work is defined as:

  • Being in water for longer than 2 hours a shift
  • Handling wet things for more than 2 hours a shift
  • Wearing occlusive gloves for longer than 2 hours a shift
  • Washing hands more than 20 times a shift

It is recommended that wet work be limited to or rostered to a maximum of 4 hours a shift. However, it is optimal to restrict wet work to 2 hours a shift.

Guidelines regarding wet work can be found at www.safeworkaustralia.gov.au

Recommended reading

https://dermnetnz.org/topics/irritant-contact-dermatitis

2019 Bains SN, Nash P, Fonacier L. Irritant Contact Dermatitis. Clin Rev Allergy Immunol. 2019 Feb;56(1):99-109. doi: 10.1007/s12016-018-8713-0. PMID: 30293200.

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