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 try to avoid this or put measures in place to protect yourself, for example, wearing gloves to handle certain chemicals.
Unfortunately, suppose the reactive substance is part of your job, such as a hairdresser with sensitivity to hair dyeing agents. In that case, 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 moisturizers.
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 or diphenhydramine is particularly effective for skin reactions. However, they have a short duration of action, around four to six hours, and hence require being taken several times daily. You should be aware that these medications can commonly cause drowsiness. The good news is that you should see improvement with just a couple of doses.
Newer longer-acting antihistamines such as cetirizine (Zyrtec), levocetirizine (Xyzal), Clarityn (contains loratadine 10mg), and fexofenadine (Allegra) 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. An example of this is Cortizone 10 cream (which contains hydrocortisone 1%), which is a mild steroid. Care must be taken not to apply on broken or infected skin.
Moisturizers will reduce dryness, which can cause an itch. Many types of these provide a moisturizing 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 moisturizer. A good example for itchy or irritated skin could be Dermacool 2% cream containing menthol for a soothing effect, aqueous cream to moisturize, 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.
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