Contact dermatitis occurs when the skin meets a chemical or substance in the environment that causes a reaction. This inflammation usually manifests as red raised bumps that may be fluid-filled (vesicles) and could increase in size to larger blisters (bullae). These areas are likely to be sore and possibly itchy. A red rash may develop and the skin may become swollen, dry and cracked. Commonly this affects the area exposed, such as a nickel belt buckle affecting the abdomen, or it may affect a sensitive skin area that is not directly in contact, such as a nickel earring causing redness and swelling around the eyes. The face, hands and feet are commonly affected. Common allergens include nickel, certain plants like poison ivy, rubber or latex found in condoms and gloves, and parabens in cosmetics - reactions can occur up to three days after exposure. Common irritants (so-called due to a technical distinction about the type of immune response, compared to allergens) include chemical components of substances such as paint, solvents and also detergents and soaps or shampoo, and a reaction to these is likely to happen immediately.
The reaction will likely continue while the skin continues to be exposed to the allergen or irritant, and will recur each time it meets it, possibly increasing in severity. So if you can identify what is causing the reaction, you can then try to avoid this, or put measures in place to protect yourself, for example, wearing gloves to handle certain chemicals. Unfortunately, if the reactive substance is part of your job, such as a hairdresser with sensitivity to hair dyeing agents, this may have future implications and you should seek medical advice on avoidance or protective measures at work. Depending on how severe the reaction is, you can see your pharmacist about treatments such as a mild steroid cream and thick moisturisers.
The first line of treatment for allergic or contact dermatitis at the pharmacy would be antihistamines to calm down the allergic response. Piriton (containing chlorphenamine 4mg) is particularly effective for skin reactions, however, it has a short duration of action around four to six hours, and hence requires being taken every several times a day. The good news is that you should see improvement with just a couple of doses. You should be aware that this medication can commonly cause drowsiness. Newer longer-acting antihistamines such as Piriteze (contains cetirizine 10mg) or Clarityn (contains loratadine 10mg) are less likely to cause drowsiness and can be taken once a day. Add-on therapy such as using a mild corticosteroid can help to further reduce redness and swelling. Examples of these are HC45 cream (contains hydrocortisone 1%), which is a mild steroid, or Eumovate cream (contains clobetasone 0.05%), which is a slightly stronger steroid. Care must be taken not to apply on broken or infected skin. Moisturisers will reduce dryness, which can cause an itch. There are many types of these to provide a moisturising barrier over the skin and aid healing. They can be used instead of a steroid cream or can be used on top of the steroid cream if required - just remember to leave a 20-minute gap between applying the steroid and the moisturiser. A good example for itchy or irritated skin could be Dermacool 2% cream which contains menthol for a soothing effect plus aqueous cream to moisturise, or calamine in aqueous cream. Other natural alternatives include aloe vera, which has natural healing properties.
If the reaction is not improving after seven days of over-the-counter treatment, is spreading, is particularly sore, or you have skin cracks or crusting, you should see your doctor. If you are having difficulty negotiating special measures at work, and suspect that this may have caused your reaction, your doctor may be able to offer support.
You may be fit for work, depending on how bothersome the dermatitis is. If you suspect or know that allergens or irritants at work are responsible for the dermatitis, you may need to avoid these while awaiting medical advice.