Contact Dermatitis
An itchy, red or darker, dry or blistered rash where something touched your skin. Usually an irritant like soap and water, sometimes a true allergy like nickel. Find the trigger and it usually settles.
The contact dermatitis ladder
Avoiding the trigger is the real treatment; everything else calms the skin while it heals. Hands are the slowest to recover because they never get a day off.
- Step 1 · Self-careFind and avoid the triggerThink about what touched that spot in the days before: soaps, wet work, jewellery, hair dye, new creams, plants, gloves.
- Works
- The main treatment for both types; the rash usually clears once the trigger is gone
- Cost
- Free
- How long
- Irritant rashes ease over days to weeks; hand dermatitis can take months
- Watch for
- Allergic rashes can appear 2 or more days after contact, so the obvious suspect isn’t always the guilty one.
Your skin is the crime scene. Work backwards a few days, not a few minutes.
- Step 2 · PharmacyMoisturiser and a soap substituteThick, fragrance-free moisturiser applied often and generously; wash with a soap-free wash instead of soap.
- Works
- Helps repair the skin barrier; in work trials, regular moisturiser may have cut new hand dermatitis from about 1 in 5 to 1 in 8 (low-certainty evidence)
- Cost
- About $10–25 a tub
- How long
- Every day, especially after each hand wash
- Watch for
- Some moisturisers contain fragrance or lanolin, which can be the allergen. Keep it plain.
Moisturiser is a habit, not an event. Put a tub by every sink.
- Step 3 · PharmacyMild steroid cream (hydrocortisone 1%)A short course on red, itchy patches, for mild rashes on the body.
- Works
- Calms itch and redness; works best alongside avoiding the trigger
- Cost
- About $8–15 a tube
- How long
- Usually up to 7 days, then review
- Watch for
- Not for broken, weeping or infected skin, or the face for long. If it isn’t better in a week, see your GP.
Hydrocortisone is a fire blanket, not a sprinkler system. Short bursts.
- Step 4 · PrescriptionStronger steroid cream or ointmentFor thick, stubborn or hand dermatitis, from your GP.
- Works
- In hand eczema trials, about half rated a strong steroid foam as good control, vs about 1 in 5 on a dummy foam
- Cost
- Under the $25 PBS co-payment for most generics
- How long
- Often 1–2 weeks daily, then tapering to a couple of days a week
- Watch for
- Thinning skin with long, unsupervised use. Ask how much and how often.
Strong doesn’t mean scary when used as directed. Under-using it is the commoner mistake.
- Step 5 · SpecialistPatch testing and specialist careA dermatologist or allergy specialist tapes small amounts of common allergens to your back and checks them over the next week.
- Works
- Identifies the allergen so you can avoid it; no trials of benefit in numbers
- Cost
- Specialist fees vary; Medicare rebates with a GP referral
- How long
- Patches stay on about 2 days, with checks over the following week
- Watch for
- Bring the products you use, and ask before stopping steroid creams. Severe or widespread rashes may need tablets or light therapy.
The only test that answers ‘what am I allergic to’ for this kind of rash.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Barrier creamsTrials at work found they made no meaningful difference to preventing hand dermatitis. Gloves and moisturiser do more.
- Allergy blood tests or skin-prick testsThey check the quick, hives-type allergy. Contact allergy is a slow reaction, and patch testing is the right test.
- ‘Natural’ or ‘organic’ skincarePlant extracts and perfumes are common causes of contact allergy. Natural is not the same as gentle.
- Swapping products at randomWithout patch testing, people often swap one allergen for another. If it keeps coming back, get tested.
What you can do
- Wear gloves for wet work and chemicals; cotton liners under rubber gloves stop sweat making things worse, and take them off regularly.
- Wash with lukewarm water and a soap-free wash, pat dry and moisturise straight after.
- Check labels for fragrance, and cover jeans studs or watch backs if nickel is the problem.
- Rinse skin with water as soon as possible after contact with a known trigger.
- Tell your employer if work seems to be the cause; workplace changes and protective gear can fix it.
See your GP if
- The rash isn’t improving after a week of pharmacy treatment, or keeps coming back
- It’s on your face, eyelids or genitals, or you can’t work out the cause
- It’s affecting your job; you may need patch testing and a work plan
See a doctor the same day if the rash is spreading fast, very painful, crusted with yellow pus, or you have a fever or feel unwell: it may be infected. Get urgent help for swelling of the lips, tongue or throat, or trouble breathing: call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
Common questions
What does contact dermatitis look like?
Itchy skin that becomes red on lighter skin or darker brown, purple or grey on darker skin, then dry, cracked or blistered. Irritant rashes stay where the irritant touched. Allergic rashes can spread beyond the contact area.
What causes it?
Irritants cause most cases: frequent hand washing, soaps, detergents, solvents and wet work. Allergies are less common; nickel, fragrances, hair dye, rubber, preservatives and some plants and creams are frequent culprits. About 8% of people are allergic to nickel.
How is it diagnosed?
Your GP looks at the rash and asks about everything that touches your skin, including work, hobbies, cosmetics and medicines. If an allergy is suspected or it keeps coming back, patch testing finds the cause.
Is it contagious?
No. It’s a reaction, not an infection, unless the broken skin becomes infected.
Helpful resources
- ASCIA: Allergic contact dermatitisCommon allergens, from nickel to plants, and how patch testing works. Free, from Australia’s clinical immunology and allergy society.
- Healthdirect: Contact dermatitisPlain-English guide, plus the free 24/7 nurse line (1800 022 222). Australia.
Evidence and more information
- NHS: Contact dermatitis
- Healthdirect: Contact dermatitis
- ASCIA: Contact dermatitis
- Cochrane (2019): Interventions for hand eczema
- Cochrane (2018): Preventing occupational irritant hand dermatitis
maladywise.com/contact-dermatitis/