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Health condition · Clinically reviewed

Contact dermatitis, know the trigger, protect the barrier, calm the skin.

A hub guide to irritant, allergic, photoallergic and urticarial contact reactions, with UK patch testing, workplace advice and modern treatment options.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD, BSCA and HSE occupational-health standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including patch testing, dupilumab, tralokinumab and oral JAK inhibitors.

Key facts

Contact dermatitis at a glance.

The essentials in plain English, what it is, who gets it and how UK dermatology approaches diagnosis and care.

  • What it is

    An eczematous reaction of the skin caused by direct contact with an irritant, allergen or physical trigger.

  • The main types

    Irritant (about 80 percent of cases), allergic, photoallergic or phototoxic, contact urticaria and systemic contact dermatitis.

  • Who it affects

    Common in wet-work occupations such as nursing, cleaning, hairdressing, catering and food handling.

  • The key test

    Patch testing at a specialist clinic identifies delayed-type allergy to specific chemicals, fragrances or metals.

  • First-line care

    Identify and avoid the trigger, protect the skin barrier with gloves and emollients, and settle inflammation with a topical corticosteroid.

  • Newer options

    Severe or refractory disease may respond to phototherapy, dupilumab, tralokinumab or an oral JAK inhibitor under dermatology.

Why this guide matters

One condition, several very different mechanisms.

Contact dermatitis is not one disease. Sorting irritant from allergic, and immediate from delayed, is what turns a stubborn rash into a treatable problem.

  • Irritant is the commonest

    Around 80 percent of cases are irritant contact dermatitis, a direct injury to the skin barrier that anyone with enough exposure can develop.

  • Allergic needs a specific culprit

    Allergic contact dermatitis is a delayed immune reaction to a substance you have become sensitised to, patch testing identifies the trigger, see /conditions/contact-allergies/.

  • Special patterns matter

    Photoallergic and phototoxic reactions, contact urticaria, systemic contact dermatitis and stasis dermatitis each need a different approach.

How the diagnosis is made

From an itchy rash to a named trigger.

The steps a UK GP, dermatologist and occupational-health team will normally follow, in order.

  1. 01

    Assessing

    Detailed history

    Onset, timing, work tasks, hobbies, cosmetics, jewellery, gloves and products used at home and on the job.

  2. 02

    Assessing

    Skin examination

    Pattern and distribution often point to the trigger, hands, face, eyelids, feet or exposed sites each tell a story.

  3. 03

    Assessing

    Occupational review

    A structured look at wet work, exposures, glove use and PPE, with input from an occupational-health team where relevant.

  4. 04

    Confirming

    Patch testing

    The definitive test for allergic contact dermatitis, using the British standard series and targeted extras at a specialist patch-testing clinic.

  5. 05

    Confirming

    Selective skin biopsy

    Used only when the diagnosis is uncertain or a mimic such as psoriasis or cutaneous lymphoma needs to be ruled out.

  6. 06

    Planning

    Specialist input

    Contact dermatitis clinics, dermatology and clinical toxicology combine to explain results and build an avoidance plan.

  7. 07

    Planning

    Written management plan

    A personalised plan covering triggers to avoid, emollient and steroid ladder, workplace adjustments and follow-up.

Typical timeline: first review to patch-test results in a matter of weeks.

Symptoms

What contact dermatitis actually looks like.

The classic eczematous picture, plus the distribution clues that often point straight at the trigger.

  • Redness and swelling

    Erythema and oedema in the area of contact, sharply demarcated in acute irritant reactions.

  • Vesicles and oozing

    Small blisters, weeping and crusting in acute or subacute disease, often intensely itchy.

  • Dryness and fissuring

    Cracked, tender skin on the hands and fingertips is a common chronic pattern in wet workers.

  • Lichenification

    Thickened, leathery skin with exaggerated markings after weeks or months of scratching and rubbing.

  • Pigment change

    Post-inflammatory hyperpigmentation or pale patches can persist long after the rash has settled.

  • Distribution clues

    Eyelids point to cosmetics or airborne allergens, feet to shoes and rubber, hands to gloves, soaps and metals.

  • Immediate wheals

    Contact urticaria produces itchy hives within minutes of exposure, latex and protein foods are typical triggers.

  • Red flag, spreading infection

    Increasing pain, honey-crusting or fever suggests bacterial superinfection or, rarely, eczema herpeticum.

Treatment

How contact dermatitis is treated in the UK.

Trigger avoidance and barrier care first, topical treatment for flares, and biologics or JAK inhibitors for severe, resistant disease under dermatology.

  • Trigger avoidance

    The single most important step, tailored to patch-test results, occupation and daily routine.

  • Barrier protection

    Cotton liners under vinyl or nitrile gloves for wet work, latex-free options if sensitised, and regular emollient use.

  • Emollients

    Generous, frequent use of a suitable emollient such as Doublebase, Zerobase, QV, Aveeno, Diprobase or Epaderm, often 500 g per week.

  • Topical corticosteroids

    Mild, potent or very potent, matched to site and severity for a defined course to settle inflammation.

  • Topical calcineurin inhibitors

    Tacrolimus or pimecrolimus for the face, eyelids and flexures as a steroid-sparing option.

  • Antihistamines

    A non-sedating antihistamine by day and, if needed, a sedating one at night to help with itch and sleep.

  • Phototherapy

    Narrowband UVB at a dermatology unit for chronic or refractory disease, see /treatments/phototherapy-uvb-clinic/.

  • Biologics and JAK inhibitors

    Dupilumab, tralokinumab and JAK inhibitors such as upadacitinib, abrocitinib or baricitinib for severe, resistant disease, see /treatments/dupilumab-clinic/.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and occupational-health regulation, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, dermatologist or occupational-health team knows your skin, your work and your history and can tell you which parts of this apply to you.

  • NICE Clinical Knowledge Summary. Dermatitis, contact.

  • British Association of Dermatologists (BAD). Guidelines and patient information leaflets on contact dermatitis and patch testing.

  • British Society for Cutaneous Allergy (BSCA). British standard series and patch testing standards.

  • Health and Safety Executive (HSE). Skin at work and RIDDOR reporting guidance.

  • MHRA. Safety updates on dupilumab, tralokinumab and oral JAK inhibitors.

Red flags

When contact dermatitis needs urgent attention.

Most contact dermatitis is manageable in primary care with dermatology support. These are the situations that need faster action.

  • Spreading bacterial infection

    Increasing pain, warmth, honey-coloured crusts or fever needs a same-day GP review and often oral flucloxacillin.

  • Eczema herpeticum

    Painful, punched-out vesicles with fever in eczematous skin is an emergency needing urgent aciclovir and dermatology input.

  • Facial or airway involvement

    Severe facial swelling, lip or tongue involvement or breathing difficulty suggests contact urticaria or anaphylaxis, call 999.

  • Occupational disease

    Skin disease caused or made worse by work is reportable under RIDDOR, and Access to Work can fund adjustments.

  • Chronic hand dermatitis

    Persistent hand disease in a wet-work occupation is a strong reason for early patch testing and occupational-health referral.

  • Psychological impact

    Sleep loss, anxiety and low mood are common with chronic itch, mention them at every review.

  • Airborne contact dermatitis

    A pattern on exposed skin without clear direct contact suggests airborne triggers such as fragrance, epoxy resin or plant material.

  • Systemic contact dermatitis

    A generalised flare after ingesting or being given a drug you were previously topically sensitised to, needs specialist review.

  • Phototoxic reaction

    Sunburn-like reactions after contact with psoralen-containing plants such as giant hogweed or wild parsnip are true burns and need urgent care.

Living with it

Manageable, when the plan is clear.

Four things that make the biggest difference day to day, knowing your triggers, guarding the barrier, using steroids well, and asking for more when you need it.

A quiet reminder

Barrier care every day beats heroic treatment now and then.

Emollients, gloves and small daily habits, kept up for months, protect skin more than any single course of steroid.

  1. 01 Avoid

    Know your triggers

    Keep a copy of your patch-test results and a written list of substances to avoid, at home and at work.

  2. 02 Protect

    Guard the barrier

    Gloves for wet or dirty tasks, cotton liners underneath, and an emollient applied many times a day.

  3. 03 Treat

    Use steroids well

    A short, adequately potent course settles a flare faster than weeks of a too-weak cream. Follow your written plan.

  4. 04 Escalate

    Ask for more if you need it

    Phototherapy, dupilumab, tralokinumab and JAK inhibitors have changed outcomes in severe disease, ask about a referral.

Frequently asked

Everything we get asked about contact dermatitis.

Quick answers on irritant versus allergic, patch testing, workplace rights and modern treatment.

  • What is contact dermatitis?

    It is an eczematous skin reaction caused by contact with something in the environment. The two main groups are irritant contact dermatitis, from direct chemical or physical injury to the skin, and allergic contact dermatitis, which is a delayed immune reaction to a specific substance you have become sensitised to.

  • How is irritant contact dermatitis different from allergic contact dermatitis?

    Irritant contact dermatitis happens in anyone with enough exposure and does not need previous sensitisation, it accounts for around 80 percent of cases and is common in wet-work occupations. Allergic contact dermatitis is a type IV delayed hypersensitivity reaction and needs a specific allergen and prior sensitisation, patch testing is the definitive test.

  • What is patch testing?

    Patch testing places small amounts of standardised allergens on the back for 48 hours, with readings at 48 and 96 hours. It is the reference test for allergic contact dermatitis and is offered by specialist dermatology and contact-dermatitis clinics in the UK using the British standard series.

  • Can I get contact dermatitis from work?

    Yes, contact dermatitis is one of the most common occupational skin diseases. Nurses, cleaners, hairdressers, chefs, food handlers, mechanics and construction workers are all at higher risk. Where work causes or worsens skin disease it is reportable under RIDDOR, and Access to Work can help fund adjustments.

  • Are steroid creams safe to use?

    Used correctly, topical steroids are safe and effective. Use the right potency for the site, apply enough (a fingertip unit covers two adult palms of skin) and follow the written plan from your GP or dermatologist. On the face, eyelids and flexures, tacrolimus or pimecrolimus is a steroid-sparing alternative.

  • What are the newer options for severe contact dermatitis?

    Where standard care is not enough, dermatology teams can consider narrowband UVB phototherapy, dupilumab (an anti-IL-4Rα biologic), tralokinumab (anti-IL-13) or oral JAK inhibitors such as upadacitinib, abrocitinib and baricitinib. Their main licences are in atopic dermatitis, but there is a growing role in severe chronic contact dermatitis, see /treatments/dupilumab-clinic/.

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