🔍 Search
InflammatoryNon-immunologicICD-10 L24.x

Irritant contact dermatitis

ICD · occupational hand dermatitis · cumulative irritant dermatitis

Irritant contact dermatitis is the commonest occupational skin disease, accounting for ~80% of all contact dermatitis. It is a non-immunological direct cytotoxic reaction to chemical, physical or biological irritants — soaps, detergents, solvents, alkalis, acids, alcohol-based hand-sanitiser overuse, water, sweat, friction, low humidity. It does not require sensitisation. Healthcare workers (60-90% lifetime prevalence), hairdressers, food workers and cleaners are disproportionately affected. In skin-oncology practice it is common post-Mohs, with PPE / alcohol gel use, and with topical 5-FU / imiquimod.

CurrentLast reviewed 16 May 2026

Pathogenesis

  • Direct cytotoxic / barrier-disrupting effect on the stratum corneum and viable epidermis.
  • No prior sensitisation required (cf ACD).
  • Two main forms:
    • Acute: single high-dose exposure (caustic, acid, alkali) → burn-like reaction within minutes-hours.
    • Cumulative: repeated low-grade exposures over weeks-months → chronic eczematous dermatitis.
  • Common irritants:
    • Water (occlusion, repeated wetting).
    • Soaps, detergents, surfactants.
    • Alcohol-based hand-sanitiser (especially with frequent wash cycles).
    • Solvents (white spirit, kerosene).
    • Acids and alkalis.
    • Food handling (acids, raw meat, citrus).
    • Friction, occlusion (gloves, PPE, dressings).
    • Topical drugs (5-FU, imiquimod, tretinoin, salicylic acid).
  • Atopic background substantially increases susceptibility.

Clinical features

  • Acute: well-demarcated erythema, vesicles, erosions matching contact pattern; burning rather than itching.
  • Cumulative / chronic: ill-defined eczematous dermatitis with dryness, scaling, fissuring, lichenification.
  • Most common site: hands (occupational); also face / neck (cosmetic), nappy area (infants), peri-stoma / peri-wound (skin care).
  • Distribution related to exposure — finger webs and dorsal hands typical for water / soap; volar fingertips with food.
  • No sharp demarcation along Blaschko lines.
  • Symptoms: stinging, burning > itching; chronicity → cracking, bleeding, pain, functional impairment.

Differentials

  • Allergic contact dermatitis — pruritus dominates; geometric pattern, weakly responsive to barrier restoration alone; patch testing reveals.
  • Atopic hand eczema — atopic background; flexural eczema elsewhere.
  • Pompholyx — vesicular pruritic eruption on lateral fingers / palms / soles.
  • Tinea manuum — typically one hand + two feet; KOH+.
  • Psoriasis (palmar) — silvery scale, sharp demarcation, distal involvement.
  • EGFRi / hand-foot syndrome — drug history.

Investigations

  • Detailed occupational, leisure and cosmetic / hygiene history.
  • Patch testing: not for irritants themselves, but to exclude concurrent ACD (~20% of ICD patients have ACD on patch testing).
  • KOH if tinea suspected.
  • Bacterial swab if secondary infection.
  • Atopy screen (IgE, specific allergens) if atopic eczema suspected concurrent.
  • If occupational: capture exposure log, working pattern, PPE use, hand-wash frequency.

Management

  • Barrier restoration / avoidance:
    • Frequent emollient application (ointment-based for hands; ≥6 times daily).
    • Soap-substitute washing; warm not hot water.
    • Cotton-lined nitrile gloves for wet work; minimise wear to ≤20 minutes at a time.
    • Alcohol gel reduces irritation compared to soap in most settings.
  • Topical corticosteroids: potent corticosteroid 2-3 weeks for flare; taper.
  • Topical calcineurin inhibitors: maintenance / steroid-sparing.
  • Topical PDE4: crisaborole, off-label use.
  • Phototherapy: NBUVB hand & foot PUVA for chronic disease.
  • Systemic: alitretinoin 30 mg OD for severe chronic hand eczema (NICE TA177 — UK).
  • Occupational: HSE notification; reasonable adjustments; redeployment in refractory cases.
  • Counsel: chronic hand eczema may persist months-years after improving exposures; education on barrier maintenance.

References

  1. Diepgen TL et al. Guidelines on the management of hand eczema (German consensus). J Dtsch Dermatol Ges. 2009;7(Suppl 3):S1-S16.
  2. Diepgen TL, Coenraads PJ. The epidemiology of occupational contact dermatitis. Int Arch Occup Environ Health. 1999;72:496-506.
  3. NICE TA177. Alitretinoin for the treatment of severe chronic hand eczema. London: NICE; 2009.
  4. Health and Safety Executive (HSE). Managing skin exposure risks at work. London: HSE; 2022.
  5. Slodownik D, Williams J, Nixon R. Irritant contact dermatitis: a review. Australas J Dermatol. 2008;49:1-9.

Spot a correction?

If any clinical statement, citation or link on this page needs updating, please email admin@skinoncology.net with the page name, the proposed correction and the supporting source.