Guidelines
Investigation and Diagnosis
Gold standard: skin patch testing
Note that skin patch testing is for contact dermatitis and skin prick test is for IgE-mediated allergies.
Management
1st line:
- Avoid the stimulus if causative agent has been identified (most important)
- 8-12 weeks of avoidance may be needed before clinical improvement
- If complete avoidance not possible: advise on measures to prevent or minimise contact with affected skinFor example: - Rinsing with water or washing with soap or, preferably, a soap substitute as soon as possible after contact - Substituting products that contain identified allergens or irritants with other products that do not contain them. - Use of gloves (cotton-lined rubber or plastic) for handling potential irritants. Gloves should be removed frequently, as sweating may aggravate existing dermatitis. - Avoidance of accumulation of chemicals and water underneath jewellery.
- Use liberal emollients and soap substitutes to maintain skin hydration and improve barrier repair
2nd line: consider topical corticosteroids
If contact dermatitis is confirmed to be associated with occupation:
- The employer is legally obliged to assess health risks at work and prevent (or if this is not reasonably practicable) adequately control exposure to hazards (for example by change of duties or suitable personal protective measures).
- The employer has a legal duty to report a case of the disease to the Health and Safety Executive (HSE)