Management of Irritant Contact Dermatitis

Introduction to Management Principles

The British Association of Dermatologists recommends avoiding irritants and protecting the skin as the primary management of irritant contact dermatatitis, combined with the use of emollients and topical corticosteroids to address active inflammation 1, 2

The American Academy of Dermatology suggests that common irritants such as soap, detergent, and water itself should be avoided – excessive contact with these substances should be prevented 3, 1
In occupational settings, other irritants like oils, coolants, alkalis, acids, and solvents should be identified 3
A workplace visit may be necessary to identify all potential skin hazards not apparent from the history alone 1, 2
Replace all soaps and detergents with emollients as cleaning substitutes 1

The National Institute for Health and Care Excellence recommends applying emollients immediately after washing hands to improve skin barrier function 4, 5
Use emollients in tube packaging instead of jars to prevent contamination 4, 5
The "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to still-damp skin, do this every night for up to 2 weeks 4
Apply two fingertip units of moisturizer to hands after every hand wash 4

The British Association of Dermatologists states that avoidance is the foundation of managing occupational irritant contact dermatitis 1, 2
Assess safety procedures to eliminate exposure sources 1, 2
Personal protective equipment like gloves may be an adequate solution 1, 2
It may be necessary to move the patient to a different area; changing jobs is usually a last resort 1, 2

The British Journal of Dermatology notes that the prognosis for occupational irritant contact dermatitis is often poor: only 25% of 555 patients with occupational contact dermatitis completely recovered within a 10-year period 1, 2, 7
50% still had periodic symptoms and 25% had permanent symptoms 1, 2, 7
In 40% of those who changed jobs, the overall prognosis did not improve 1, 2, 7
The prognosis for milder cases of contact dermatitis depends on the ease of avoidance 1