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Reviewed by Dr Victoria Lewis, specialist registrar in dermatology
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Irritant contact eczema (or dermatitis) is far more common than
allergic contact eczema. It is the
second most common cause of occupational-related health problems, after muscle
and joint pains and injuries.
Almost all occupations in which skin (usually the hands) is made
wet repeatedly are associated with irritant contact dermatitis. Hairdressers,
cleaners, catering workers, food processors and fish handlers are occupations
where water is the wetting agent.
Prolonged contact with water swells the surface cells of the
skin and disrupts the normally tight joins between them, exposing the more
vulnerable deeper layers. In metal engineering light machine oils are commonly
in contact with the skin, and as many as half of workers in this industry have
irritant contact eczema. Many just accept it as part of the job.
Having one type of
eczema can increase the risk of
another, so people with a background history of
atopic eczema are particularly prone
to developing the irritant contact type.
It’s not just the industrial environment in which
skin-unfriendly agents can be found. Many household items such as cleaning
materials, detergents and bleach are just as potentially harmful. Hobby
interests or a passion for DIY can lead to frequent skin contact with
adhesives, paint, oils and cement.
Diagnosis
Irritant contact eczema looks the same as other types of
eczema. The connection with the work environment may be obvious if there is
routine contact with a known irritant or the job is a ‘wet work’ type;
otherwise it may take time to establish that the skin is reacting against an
irritant. Therefore irritant contact eczema is dependent for diagnosis on a
good history of work exposure and knowledge of likely problem agents. Also, a
negative patch test result can be useful to exclude an allergic contact
dermatitis.
Treatment
Removal from contact with the offending substance should be the
ideal, but this is often impractical. In these circumstances, however, the aims
of treatment can only be to reduce symptoms. Unfortunately, some irritants
cause skin reaction even with very little exposure.
Where contact is inevitable, protective gloves are essential.
Since the latex or rubber in gloves can cause or worsen eczema some people find
it helpful to use cotton-lined gloves or separate cotton inner gloves to reduce
the degree of direct skin contact.
Frequent
moisturising is essential, especially
in wet-work jobs. Barrier creams can be of some benefit, but may be
counter-productive if they encourage workers to take less care, thinking the
barrier cream alone protects them. Anti-inflammatory (steroid) creams are the
mainstay of irritant eczema treatment.
Employment issues
Employers have a duty to protect their workers against
occupational hazard. Similarly, workers have a duty to make use of the
protection measures offered by their employer.
As with any eczema, the cause and effect relationship between
the agent and the skin reaction is easier to explain than to
detect.
Many cases of irritant contact eczema could be completely
avoided by the use of simple avoidance and control measures.
Larger companies in known high-risk areas of employment will
probably make use of an occupational health doctor or nurse who can evaluate
the problem and advise on corrective measures. Most workers are not so
lucky.
Compensation issues can arise where the employer fails to
provide sufficient protective measures or warnings about the possibility of
eczema arising. However, proving such cases is a lengthy and expensive process
that is not usually successful.
It’s much better to be aware of the possibility of a link
between skin reactions and your occupation and to take as many practical steps
as possible to avoid running into trouble.
Other types of eczema
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Based on a text by Dr Dan Rutherford, GP
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Last updated 15.09.2005
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