Hand dermatitis is not a cosmetic problem. It is painful, it interferes with work, it can end careers in some trades, and it is among the most common work related diseases recorded in the UK. It is also substantially preventable, which makes its prevalence the more striking.
1. Irritant and allergic: the distinction that decides management
Irritant contact dermatitis is direct damage to the skin barrier from repeated exposure. It is dose related and cumulative: enough exposure will cause it in anyone. Water is itself an irritant when contact is frequent and prolonged, which is why wet work is the leading identified cause.
Allergic contact dermatitis is a delayed type immune response to a specific substance in someone who has become sensitised. It is not dose related in the same way: once sensitised, very small exposures provoke it, and the reaction typically appears twelve to forty eight hours later. It is identified by patch testing, which is the only reliable way to name the allergen.
The two frequently coexist, because a barrier damaged by irritants allows better penetration of potential allergens. That is one reason irritant dermatitis is worth treating early rather than tolerating.
2. Where it concentrates
| Sector | Main exposures | Common allergens where relevant |
|---|---|---|
| Construction | Wet cement, dust, abrasion, prolonged glove occlusion | Hexavalent chromate in cement, epoxy resins, rubber accelerators |
| Catering and food | Constant wet work, detergents, foods | Foods handled raw, rubber accelerators in gloves |
| Hairdressing | Shampooing, bleaches, dyes, prolonged wet work | Dye components, persulphates |
| Healthcare and cleaning | Frequent handwashing, alcohol gels, detergents, gloves | Rubber accelerators, preservatives |
| Engineering and metalwork | Cutting fluids, solvents, oils, swarf abrasion | Biocides and preservatives in metalworking fluids |
| Printing and coatings | Solvents, inks, resins | Acrylates, epoxy systems |
| Agriculture | Wet work, disinfectants, animal contact, weather | Rubber accelerators, plant material |
3. Recognising it
The picture is dryness and scaling, often starting on the finger webs and the backs of the hands, progressing to redness, fissuring, weeping and cracking. Fissures at the fingertips are painful and slow to heal. Involvement of the palms and the sides of the fingers may indicate a different pattern.
The temporal pattern is the most useful piece of information a patient can bring: improvement during a week or two away from work, deterioration within days of returning. Reporting that clearly to a GP changes the direction of the consultation, and it is the single most useful thing to observe before the appointment.
4. Prevention, which works better than treatment
UK occupational health guidance follows a hierarchy of control, and it is the same hierarchy that applies to any workplace hazard. The order matters: personal protective equipment is the last resort, not the first answer.
- Eliminate or substitute. Remove the substance, or replace it with a less hazardous one.
- Engineering controls. Automate or enclose the process, use tools rather than hands, provide splash guards.
- Organisational controls. Rotate tasks so no one is in wet work all day, provide time and facilities for proper drying, schedule breaks from glove use.
- Personal protection. The correct glove material for the specific substance, with cotton liners where occlusion is prolonged, changed when contaminated inside.
- Skin care and surveillance. Emollient available and used, and a health surveillance programme where the risk warrants it.
Gloves deserve a specific note, because they are frequently a source of harm as well as protection. Occlusion inside a glove keeps skin wet and warm, which damages the barrier. Latex, and more commonly the accelerator chemicals used in rubber manufacture, are recognised sensitisers. The right glove for the specific chemical, worn for the shortest necessary time, with a liner where practical, is a different instruction from "wear gloves".
5. Treatment
Frequent and generous emollient use is the foundation, including at work and not only at home. Topical corticosteroids of appropriate potency are used for active inflammation, on clinical advice, since hand skin is thick and often needs a stronger preparation than facial skin. Secondary bacterial infection needs treating. Patch testing is indicated where allergic contact dermatitis is suspected and is arranged through dermatology. Severe or resistant hand eczema has specialist treatment options.
None of that succeeds while the exposure continues unchanged. Treatment without exposure control is managing a wound while the injury repeats.
6. Reporting and rights
Occupational skin disease has a formal place in the UK system. Employers have duties under health and safety law to assess and control exposures, and certain cases of occupational dermatitis are reportable by employers under the reporting regulations. Occupational asthma and dermatitis are among the conditions covered by Industrial Injuries Disablement Benefit in defined circumstances.
The practical implication for an individual is that this is worth documenting: when it started, what changed, which tasks provoke it, and what protective measures are actually available on site. A workplace that has not assessed the exposure will often only do so once a case is on record.
7. It is not only hands
Face and neck involvement occurs, often from airborne exposure to dusts, resins and volatile substances, and is frequently missed because the exposure is not obvious. Forearm involvement follows splashing. Sun exposure in outdoor trades is itself an occupational exposure, and it is dealt with in photoageing in men and skin cancer in men.
8. Returning to work without relapsing
Recovery during a period away from the exposure is common and can be misleading, because skin that looks normal is not the same as skin that has fully recovered. Barrier function lags behind appearance by weeks, which is why relapse on return to work is so frequent and why it is often blamed on the treatment having failed.
A more durable approach treats the return as a staged process. Continue emollient use for at least a month after the skin looks clear. Establish which specific tasks provoke it, and negotiate their frequency or the controls around them rather than accepting the whole job unchanged. Where gloves are needed, agree the correct material for the substance and the availability of liners, and treat contamination inside a glove as a reason to change it rather than to continue.
Where an allergen has been identified by patch testing, the position is different and simpler: the exposure has to stop, and that is a matter for the employer's risk assessment rather than for the individual's technique.