Occupational Contact Dermatitis

Types of occupational contact dermatitis

For a general overview, see contact dermatitis and allergic contact dermatitis. People can have both types, and irritant damage makes allergic sensitization more likely. People with a history of atopic dermatitis are at higher risk.

Common causes by occupation

Latex allergy is a different, immediate (hive-type) allergy that can cause contact urticaria and anaphylaxis.

Symptoms

• redness, dryness and scaling (skin rash), often on the backs of the hands and between the fingers
• itching or burning
• painful cracks (fissures), especially on fingertips and knuckles
• small blisters, which may weep (a pattern similar to dyshidrotic eczema)
• thickened, leathery skin with long-standing dermatitis
• rash on the forearms, face or neck from airborne exposures

Diagnosis

1. Detailed work history: tasks, materials, safety data sheets, glove use, hand hygiene, and whether symptoms improve away from work.
2. Examination of the pattern and location.
3. Patch testing: small amounts of common allergens and workplace substances are applied to the back for 48 hours, with readings over several days. It is the only way to confirm allergic contact dermatitis.
4. Tests to rule out other causes: skin scrapings for fungal infection, sometimes biopsy for psoriasis.

Treatment

• Identify and avoid the cause. Avoidance is the most effective treatment and the most important for long-term control.
• Topical corticosteroids: medium to strong steroid ointments for flares on the hands, used as directed.
• Non-steroid options: calcineurin inhibitors for thin skin, and topical PDE4 or JAK inhibitors for chronic hand eczema in some cases.
• Moisturizers: thick, fragrance-free emollients applied after each handwash and at night.
• Treat infection if present.
• Severe chronic hand eczema: phototherapy, oral alitretinoin (where available), or systemic immune-modifying medicines under specialist care.

Prevention at work

• Substitute less harmful products where possible.
• Engineering controls: automation and ventilation to reduce contact.
• Gloves: choose the right material for the substance (nitrile for many chemicals; check manufacturer charts). Wear cotton liners under occlusive gloves, change gloves when wet inside, and remove them promptly.
• Hand hygiene: use alcohol-based hand sanitizers rather than soap and water when hands are not visibly dirty; they are gentler on the skin.
• Moisturize during breaks and after work.
• Avoid wearing rings under gloves.
• Training and early reporting of skin problems.

Outlook and work

Many people recover fully once the cause is controlled. Chronic occupational hand eczema can persist, sometimes for years, especially with allergic dermatitis or continued exposure. Some people need job modifications or a change of occupation. In the US, work-related dermatitis may qualify for workers' compensation.

Frequently asked questions

What is occupational contact dermatitis?

It is a skin rash caused by substances at work, most often on the hands. It may be irritant dermatitis from repeated wet work, soaps and chemicals, or allergic dermatitis from substances like rubber chemicals, preservatives or epoxy. It is the most common occupational skin disease.

What jobs have the highest risk of contact dermatitis?

High-risk jobs include health care, hairdressing, cleaning, food service, construction, metalworking and manufacturing. These involve frequent wet work, gloves, detergents, solvents, cement, resins or dyes.

How do I know if my rash is caused by work?

Clues include a rash on the hands or areas in contact with work materials, symptoms that improve on weekends or vacations and return at work, and coworkers with similar problems. Patch testing by a dermatologist can identify specific allergens.

Can wearing gloves cause dermatitis?

Yes. Gloves trap sweat, causing irritant dermatitis, and rubber gloves can contain chemicals that cause allergic dermatitis. Choosing the right gloves, wearing cotton liners, and limiting time in gloves reduce the risk.

Will occupational contact dermatitis go away?

It often improves once the cause is identified and avoided, along with good skin care and treatment. Long-standing or allergic cases can persist, and some people need to change tasks or jobs to fully recover.