Private contact dermatitis & hand eczema clinic in London, same-day dermatology.

Two mechanisms

• Irritant contact dermatitis — around 80% of cases. Direct damage to the skin barrier from repeated wet work, soaps, detergents, solvents, friction or cold. No immune memory: everyone gets it with enough exposure. Typically starts in the finger webs and on the backs of the hands.
• Allergic contact dermatitis — a delayed immune reaction to a specific substance, appearing 24 to 72 hours after contact. Once sensitised, tiny amounts trigger it, and it is lifelong. Common culprits are nickel, fragrance, preservatives in cosmetics, rubber accelerators in gloves, hair dye and epoxy resins.
• The two frequently coexist — damaged skin absorbs allergens more readily.

Who gets it at work

Hairdressers, healthcare and care workers, cleaners, caterers and chefs, mechanics, construction and beauty workers are all high risk. If your hands improve on holiday and deteriorate within days of returning to work, that pattern is close to diagnostic and is worth recording.

Restoring the barrier

• Emollient, constantly — a thick greasy ointment, applied after every hand wash and at least six to eight times a day. Keep tubes at every sink, in the car, by the bed.
• An emollient as a soap substitute. Stop using soap and hand wash entirely on affected hands.
• Lukewarm water, and dry thoroughly including between the fingers.
• Overnight treatment — a thick layer of ointment under cotton gloves is the most effective single measure for cracked hands.
• Topical steroid ointment at adequate strength for flares, used properly for a defined course rather than sparingly and indefinitely.
• Remove rings before wet work — detergent trapped under a ring is a classic and easily missed cause.

Gloves, used properly

At work

Occupational dermatitis is reportable under RIDDOR and your employer has duties under COSHH to assess and control skin exposure. You are entitled to ask for a risk assessment, suitable gloves, emollients at the workplace and, where necessary, redeployment. A dermatology report supports that conversation considerably.