Current Dermatology Reports (2022) 11:41–51

https://doi.org/10.1007/s13671-021-00351-4

CONTACT DERMATITIS (BRANDON ADLER AND VINCENT DELEO, SECTION EDITORS)

Irritant Contact Dermatitis — a Review

Kajal Patel1 · Rosemary Nixon1

Accepted: 3 December 2021 / Published online: 7 April 2022

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
Purpose of Review Irritant contact dermatitis is the most common form of contact dermatitis and the most common occu-
pational skin disease. This review provides a comprehensive summary of the endogenous and exogenous factors that play
a role in the pathogenesis of irritant contact dermatitis.
Recent Findings In conjunction with avoidance of irritants, barrier protection, and regular application of moisturizers,
management now emphasizes the importance of primary prevention through educational initiatives in high-risk
workplaces. Summary The diagnosis of irritant contact dermatitis is often difficult, as there is no confirmatory test, and it
is often a default diagnosis after allergic contact dermatitis has been excluded. Early recognition, prevention, and treatment
are vital in management, especially in the occupational setting.

Keywords Irritant contact dermatitis · Skin irritation · Occupational · Hand · Allergy · Patch testing

Introduction
The purpose of this review is to provide a
Irritant contact dermatitis (ICD) is an inflammatory cutane- comprehensive update with regard to the pathogenesis, risk
ous condition caused by skin barrier disruption, in combi- factors, clinical features, and management of ICD.
nation with the activation of innate immune responses.
ICD results from skin barrier damage from external agents
or environmental factors. ICD commonly affects the hands Contributing Factors in the Development
and can affect people of all ages and sex. ICD is more of ICD
prevalent than allergic contact dermatitis (ACD) [1] and is
the most common presentation of occupational skin disease Both exogenous and endogenous factors play a vital role in
(OSD). At a tertiary referral occupational dermatology the pathogenesis of ICD [5].
clinic in Australia, ICD was diagnosed in 71% of patients
with OSD [2••]. However, in the general patch testing
population, the most common diagnosis is ACD with a Exogenous
default diagnosis of an endogenous dermatitis, so ICD is
less commonly diag- nosed [3]. High-risk occupations for Skin Irritants
ICD include healthcare workers, food service workers,
metal workers, hairdressers, and construction workers [4]. The most common skin irritant is wet work [6] followed by
soaps, detergents, solvents, and oils [7]. Wet work has been
This article is part of the Topical Collection on Contact Dermatitis defined as:

1. Exposure of skin to liquid for > 2 h per day

2. Use of occlusive gloves for > 2 h per day or change of
 Kajal Patel Carlton 3053, Australia
[email protected]
Rosemary Nixon
[email protected]
1
Occupational Dermatology Research and Education
Centre, Skin Health Institute, Level 1/80 Drummond Street,

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2 Current Dermatology Reports (2022) 11:41–51
gloves > 20 times per day
3. Frequent hand washing > 20 times per day or use of
hand disinfectants > 20 times per day [8]

Exposure to wet work can occur both at work as

well as at home. High-risk occupations involving wet
work include cleaners, butchers, cooks, beauticians,
and health care

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Current Dermatology Reports (2022) 11:41–51

workers [9•]. The only regulations regarding exposure to Susceptibility of the skin to irritants decreases with age. It
wet work are found in Germany, the Technical Standards is postulated that differences in microcirculatory efficiency,
for Hazardous Substances (TRGS) 401[10], a guideline for
employers, providing information on occupational
hazardous skin exposure and prevention of OSD.
Since the start of the COVID-19 pandemic, the use of
soaps and alcohol-based hand sanitizers (ABHS) and the
frequency of handwashing have increased significantly
[11] resulting in a higher incidence of ICD [12, 13].
The potency of a chemical irritant and its ability to
pene- trate the skin are denoted by its properties including
molecu- lar size, ionization state, and fat solubility.
Different irritants target different structures in the
epidermis. For example, sodium lauryl sulfate targets
lipid synthesis [14] whereas acetone targets the
proliferation of basal keratinocytes [15]. Factors such as
concentration, volume, and duration of irri- tant exposure
will all contribute to an irritant’s ability to pen- etrate the
skin. Increasing the volume and duration of exposure will
enhance the ability of an irritant to penetrate the skin [16].
Increasing intervals between exposures will usually reduce
the chance of irritation. Recurrent irritant exposure may
result in an additive effect, with repeated exposures initially
inducing an increase, then a reduction in trans-epidermal
water loss (TEWL)
[17] , indicating functional adaptation or skin hardening.

Physical, Mechanical, and Environmental Factors

The role of physical, mechanical, and environmental factors

in the development of ICD is often ignored. Mechanical
factors include occlusion, friction, pressure, and vibration.
The use of gloves or clothing can create an occlusive,
humid environ- ment, which increases irritation caused by
heat and sweating. Environmental factors include heat,
cold, humidity, and UV irradiation. Exposure of skin to
heat often results in sweating. The retention of sweat can
contribute to skin irri- tation, as sweat is more irritating
than water [18]. Heat, espe-
cially in combination with occlusion, can precipitate ICD.
Exposure to low ambient humidity and cold
temperatures are contributing factors to reduced water
content in the stra- tum corneum (SC) and as a result
increase the permeability of irritants in the skin. Cold
temperatures have also been associated with reducing the
plasticity of the horny layer with subsequent cracking of
the SC; however, a study has shown that exposure to cold
averted the development of ICD [19].

Endogenous

Age

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4 Current Dermatology Reports (2022) 11:41–51
percutaneous penetration, SC turnover time, and loss of
cor- neocyte cohesion [20] associated with increasing age
cause a slower and less intense response to irritants. This
is reflected in the decrease of TEWL in aged skin [21].

Sex

ICD is more common in women [22], likely as a result of

greater exposure to irritants rather than biological
factors. A study from Denmark showed women had 78%
higher odds of engaging in occupations involving wet
work [9•]. It is not clear whether women have a greater
susceptibility to irritants, given that experimental studies
show no dif- ference of irritant reactivity between sexes
[21]. However, one study produced differing results [23]
demonstrating an increased skin reactivity in males
compared to females. Further studies are required to
determine the difference in risk of developing ICD
between sexes.

Race

There is a paucity of evidence to demonstrate a significant

difference between black or Asian and Caucasian skin.
Studies using bioengineering techniques showed no
differ- ence in irritant susceptibility between black and
Caucasian skin [24] despite conflicting results from
previous studies that relied on visual scoring [25]. A study
showed Asian skin was significantly more susceptible to
ICD when com- pared to Caucasian skin both in
subjective and objective skin measurements [26].

Atopy

Atopy is a recognized risk factor for ICD involving the

hands [27]. Mucosal atopy is less predictive of irritant
reactivity, compared to prior atopic dermatitis (AD) [28].
Individuals with a history of AD are thought to
have a higher risk for the development of ICD, relating to
impairment of the epidermal barrier, higher TEWL, and
increased skin permeability to allergens and irritants,
com- pared to those with clinically normal skin [29].

Genetic Factors

Filaggrin is a protein which plays a role in skin barrier

function and SC hydration. Filaggrin loss-of-function
mutations are associated with increased expression of
interleukin (IL)-1, a cytokine which is key to the
initia- tion of the inflammatory response in ICD [30].
A study has shown an increased risk of the
development of ICD in individuals with filaggrin loss-
of-function mutations;

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Current Dermatology Reports (2022) 11:41–51 43

however, it was observed that the association was depend- the secretion of further chemokines including CXCL 8, CCL
ent on the presence of atopy [31]. Atopy, in combination 20,
with filaggrin loss-of-function mutation carrier status, has
shown to contribute to the severity of ICD affecting the
hands [32].
Single nucleotide polymorphisms (SNPs) within the
major histocompatibility complex (MHC) class I, II, and
III are significantly associated with skin response to
irritants [33, 34]. MHC SNPs have been demonstrated to
contribute to chemical irritancy thresholds, with different
MHC vari- ants being associated with different chemical
irritants. At present, the exact mechanism is unknown.
A link has been recognized between a tumor necro-
sis factor (TNF)-α gene polymorphism and susceptibility
to ICD. At the position P308 within the promoter region
of the TNF-α gene, a G to A transition polymorphism has
been detected. A study of genotypes showed an association
between the A allele and a low irritant threshold [35],
which has also been significantly linked to contact
sensitization to allergens such as p-phenylenediamine
(PPD) [36] and chro- mium [37]. Another G to A transition
polymorphism at the position of P238 has been identified.
A study found a poten- tial protective effect of the A allele
with carriers being less susceptible to developing ICD [38].
This has been specu- lated to result from increased
transcriptional repression of TNF α [39, 40].
These advancements represent a novel potential
approach in the detection of ICD susceptibility.

Pathogenesis

Previously, the pathogenesis of ICD was thought to be a

non- immunological reaction; however, it is now
recognized that the immune system plays a vital role in
causing ICD [41].
Irritation occurs by either damaging epidermal cells
[42], disruption of the epidermal barrier, or a combination
of both [43]. Disruption of the epithelial barrier allows for
increased permeability of irritants [44]. Keratinocytes act
as “signal transducers” responsible for instigating cutaneous
inflamma- tion via the conversion of exogenous stimuli into
the secretion of cytokines, adhesion molecules, and
chemotactic factors [45]. Upon damage to the keratinocyte,
upregulation of pri- mary cytokines IL-1α, IL-1β, and
TNF-α occurs [46] which triggers the proliferation of
keratinocytes and formation of lipids [47] playing a role in
restoring the epidermal barrier. Additional cytokines IL-6,
IL-8, and GM-SCF are subse- quently secreted, activating
Langerhans cells, dermal den- dritic cells, and endothelial
cells [44] which further recruits inflammatory cells to the
site of chemical trauma [48].
ICAM1, an adhesion molecule, is upregulated on
endothelial cells and fibroblasts in the skin and results in

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and IFN gamma [49]. CCL21, a chemokine which enables
naïve T lymphocyte migration, is upregulated in ICD [46,
50]. T lymphocytes recruited to irritated skin often
express the CLA antigen [51], which plays an important
role in transendothelial T lymphocyte migration.
Irritants can also trigger pattern recognition receptors
such as toll-like receptors (TLRs) and NOD-like
receptors, which result in activation of the innate immune
response via inflammasome and NFĸB pathways [44, 52].
There is growing evidence that oxidative stress with
the formation of reactive oxygen species plays a role in
the pathogenesis of ICD [53]. It has been postulated that
tar- geting oxidative stress could be beneficial in the
treatment of ICD, with clinical studies demonstrating the
therapeutic benefits of antioxidants [54].

Clinical Types

Acute Irritant Contact Dermatitis

Acute ICD occurs when the skin is exposed to a potent

irri- tant often in a single exposure, such as concentrated
acids, strong alkalis, and solvents such acrylonitrile. In
severe cases, this may present as burns, such as from
kneeling in wet concrete.
The irritant reaction quickly reaches a peak and then
begins to heal, usually described as a “decrescendo
phenom- enon” [55]. Symptoms reported include burning,
stinging, and soreness of affected skin. The clinical signs
of ICD are variable and include erythema, edema, bullae,
and necrosis [56]. While ACD may present with similar
clinical signs, it is characterized by a “crescendo
phenomenon” where signs worsen, despite removal of the
offending allergen [55].
Complete healing can take weeks in acute ICD,
generally with a good prognosis [57].

Delayed Acute Irritant Contact Dermatitis

Delayed acute ICD represents the most common form of

ICD. Chemicals such as benzalkonium chloride, anthralin,
calcipotriol, and tretinoin may cause a delayed inflamma-
tory response, not visible until 8–24 h after primary expo-
sure [58]. This may lead to misdiagnosis as ACD. Clinical
symptoms are similar to acute ICD with the skin
becoming sensitive to touch and water [59].

Irritant Reaction

Irritant reaction is a subclinical type of ICD that typically

affects individuals exposed to wet work. Clinical features
are monomorphic, characterized by erythema, scaling,
vesicles,
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pustules, and erosions [59]. It often begins on fingers under

occlusive jewelry such as rings and spreads to involve the Traumatic ICD
hands and forearms.
This condition may spontaneously resolve with Traumatic ICD occurs after acute trauma to the skin such
cessation of exposure, or can also progress to cumulative as burns, lacerations, or exposure to a potent irritant. The
ICD [60]. hands are the most commonly involved; however, there are
reported cases of nail involvement [67]. Usually, there is
delayed healing of the original trauma followed by the
Subjective/Sensorial Irritation
devel- opment of eczematous lesions [64]. It is usually a
chronic condition and may be resistant to treatment.
Subjective or sensorial irritation is characterized as sensory
discomfort in the form of stinging, burning, or a sensation
Pustular and Acneiform Dermatitis
of itch, in the absence of clinical or histological evidence
of skin irritation. Neural pathways are believed to be
Exposure to oils, naphthalene, chlorinated aromatic hydro-
respon- sible [61]. Irritants identified include propylene
carbons, and fluorinated compounds may result in pustular
glycol, hydroxy acids, ethanol, lactic acid, azelaic acids,
and acneiform dermatitis. Patients most affected are those
benzoic acid, benzoyl peroxide, mequinol, and tretinoin.
with seborrheic dermatitis, prior acne vulgaris, and atopy.
The prognosis is variable.
Non-Erythematous Irritation
Asteatotic Irritant Dermatitis
Non-erythematous ICD refers to early skin irritation with-
out clinical signs of inflammation. Associated SC barrier Asteatotic irritant dermatitis, also referred to as “exsicca-
changes can be demonstrated using assays that are usually tion eczematid,” “winter eczema,” and “eczema craquelé,”
available only in research settings [62]. Symptoms are is seen primarily during winter in cool climates. This
com- parable to subjective irritation. Prognosis is variable. variant is common amongst the elderly with dry skin on the
lower legs, especially in low-humidity environments.
Cumulative (Chronic) ICD Individuals report intense pruritus, dry skin, and scaling.
Reduction in natural moisturizing factors and lipids in the
Cumulative ICD is a result of multiple subthreshold insults SC is thought to contribute. Intense pruritus is usually
to the skin, if the interval between skin exposures is too relieved by the use of moisturizing creams, and topical
short to allow complete recovery of the skin barrier corticosteroid ointments are helpful [68].
function [63]. It develops slowly and is linked to exposures
to weak irritants [64]. Airborne Dermatitis
Clinical features include erythema, vesicles, and dry-
ness with progression to lichenification, hyperkeratosis, Airborne ICD results from exposure to irritants such as fib-
and chapping. Clinical features develop when the dam- ers, floating dusts, solvents, and sprays [69] dispersed and
age goes beyond the elicitation threshold. The threshold is carried in the air before coming into contact with exposed
dependent on the individual and may decrease as the skin [64]. Most cases are reported in occupational settings
disease progresses. [70].
Given that exposure to weak irritants often occurs both
at home and in the workplace, cumulative ICD may result
from exposure to multiple irritants, rather than a single Diagnosis
agent. The impact of combined multiple irritants produces
an increased skin inflammatory response; however, the ICD is a diagnosis of exclusion, as there is no routine diag-
extent of interac- tive effect is unpredictable [65]. nostic test. The diagnosis is established from the history,
clinical examination, and by excluding ACD with negative
Frictional Dermatitis patch testing. A thorough history regarding occupational
and domestic exposures is crucial, and relevant information
Frictional dermatitis results from repeated frictional includes the frequency, intensity, and duration of exposure
trauma, specifically shearing forces acting horizontally to to skin irritants, as well as the affected skin area(s) [44].
the skin sur- face [66]. It is characterized by hyperkeratosis, The pattern and distribution of dermatitis plays a key
acanthosis, and lichenification. Frictional ICD is role in the diagnosis. ICD always starts at the site of skin
recognized to contribute to ACD by enhancing percutaneous contact with the irritant and generally does not spread.
penetration of allergens [66]. Common

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sites include the hands, face, and perineal areas, well as glove permeation time will determine the necessary
particularly in infants and adults experiencing type of glove material [80]. For example, neoprene gloves
incontinence.
Patch testing is recommended to exclude the differential
diagnosis of ACD, which may be clinically
indistinguishable from ICD. Even if the results are
negative, patch testing has been shown to have a positive
impact on quality of life [71]. Bioengineering techniques,
such as the measurement of TEWL, provide a non-
invasive method to measure skin irri- tation in ICD;
however, these are not always available in a
clinical setting.
The role of skin biopsy remains limited in the diagnosis
of ICD, given that histopathological changes vary between
irritants and relates to their mode of action and concentra-
tion [72]. Histological findings in chronic ICD are gener-
ally similar to those of ACD. Reflectance-mode confocal
microscopy (RCM) is a non-invasive novel technique
which can be used to differentiate between acute ICD and
ACD in experimental settings, with superficial epidermal
changes (SC disruption, parakeratosis, and separation of
individ- ual corneocytes) being more prominent in ICD
compared to ACD [73, 74]. RCM is postulated to be more
sensitive and specific than clinical examination during
patch testing and could potentially play a role in
distinguishing between doubtful-positive and negative
reactions [75]. RCM allows repeated observation of the
affected area in real time, which is non-invasive compared
to conventional histology [76].

Prevention

Approaches to preventing exposure to irritants in the work-

place involve standard occupational hygiene principles
including elimination and/or substitution of the irritant,
isolation, and engineering controls including changing the
way a job is performed, administrative controls, and finally
use of personal protective equipment (PPE) [77].
Recent studies have highlighted the importance of pre-
employment screening tools in the workplace in early iden-
tification of hand dermatitis [78].
The use of PPE is recommended in the prevention of
ICD. The choice of PPE is guided by the nature of the
irritants, the areas of skin exposed, the chemical and
physical properties of PPE, and its functionality in relation
to the occupation [79].
Gloves are a frequently used form of PPE, given that
ICD usually affects the hands. Selection of appropriate
gloves for the management of ICD may be challenging,
given that the protective capabilities of gloves are
dependent on many variables.
Gloves should be selected based on the specific task and
associated chemical exposures. The nature of the irritant as

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have been shown to be the most protective against application has been shown to exacerbate some skin
acrylate monomers compared with polythene polymer conditions [101]. Nevertheless, BC can raise awareness of
gloves [81]. Occasionally, components of protective the possibility of skin problems in the workplace.
gloves can cause sensitization and ACD; common culprits
include thiurams and carbamates found in both latex and
nitrile gloves, but are absent from those made of polyvinyl
chloride [82].
Glove thickness plays a major role in chemical permea-
tion. However, thin gloves provide greater user comfort
and dexterity than thicker gloves made from the same
material [83].
Even when a suitable glove has been chosen, if the
user does not don or remove the glove appropriately,
skin con- tamination can occur. Incorrect glove sizing can
increase the rate of glove perforation [84]. It is important
that gloves are changed regularly, as sweating may
exacerbate existing der- matitis [85]. Additionally, there
is evidence that occlusion from gloves may impair the
function of the skin barrier [86]. Training in glove choice
and use has been shown to reduce user error and
allergen exposure [87, 88]; however, studies have shown
that workplace glove education remains
limited [89, 90].
Given that half of the cases of occupational contact
der- matitis (OCD) have been observed to appear within
the first 2 years of employment [91], there is a role for
educational strategies to promote awareness of potential
irritants, appro- priate use of PPE, and recognition of the
early signs of OCD, specifically ICD. Interdigital
dermatitis, also referred to as the “sentinel” sign, is
regarded as an early stage of hand ICD in occupations
involving wet work [92]. The impact of work-related
educational programs has been shown to be effective in
Danish healthcare workers [93], student nurses [94], and
hairdressers [95].
A soap-free cleanser is preferable, as synthetic deter-
gents are less irritating to the skin because of the neutral
or slightly acidic pH [96]. The relatively high-free fatty
acid content of soap free cleansers also provides a
moisturizing effect, preventing hand irritation and
dryness. The use of ABHS including moisturizers
avoiding common allergens is recommended as an
alternative to detergents [97].
Barrier creams (BCs) are designed to prevent
penetration of irritants into the skin. They are thought to
play a role in the prevention of ICD but are only
recommended for low grade irritants [98]. A recent
Cochrane review found that use of barrier creams alone
may have a slight protective effect, but the evidence was
deemed low quality and not clinically significant [99••].
Application methods can impact the effi- cacy of barrier
creams, with studies highlighting that BCs are often
poorly applied during real-world use, especially on the
dorsa of the hands and at significantly lower doses than
required to prevent irritation [100]. Inappropriate
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Inflammasome-targeted therapies such as topical disul- There may be a role for topical corticosteroids in chronic
firam have been shown to be effective in inhibiting ICD in hyperkeratotic irritant dermatitis [56], but prolonged use can
a recent study on human subjects [102]. This is thought to result in epidermal atrophy and therefore increase irritant
be a result of the reduction in the inflammatory cytokine sensitivity. However,
IL-18. This advancement provides a novel approach in the
prevention of ICD.

Management

The primary treatment in ICD is avoidance, skin protection

from the offending irritant(s) both in the workplace and at
home [103], and use of topical therapy, particularly
moisturizing creams.
Moisturizers are commonly used to improve dry skin
symptoms and maintain healthy skin [104]. There is
increas- ing evidence of their role in the treatment of ICD
by prevent- ing the absorption of exogenous substances
and improving skin barrier recovery [105]. It is thought
that using moistur- izers increases skin hydration and that
their lipid compo- nents modify endogenous epidermal
lipids, with high lipid content moisturizers significantly
preventing ICD when compared to formulations with lower
lipid content [104]. Patients should be advised to apply
moisturizers frequently, particularly before and after
shifts, and after handwash- ing [106]. Evidence has also
shown the protective role that moisturizers play in the long
and short term, in the primary prevention of occupational
ICD [99••, 107].
Strontium salts have been shown to be effective in
treating sensory irritation and are thought to act by
selectively block- ing the activation of cutaneous type C
nociceptors [108]. However, this treatment is not
commonly used worldwide.
Cool compresses are a primary treatment of acute ICD
by providing an environment which reduces the
inflammation and surface temperature changes associated
with acute ICD [109, 110].
Complications of ICD include bacterial superinfections.
These are usually treated aggressively with antibiotics to
prevent the development of cellulitis.
Although histamine is not involved in the mechanism of
ICD, in clinical practice, oral antihistamines are often pre-
scribed for symptomatic relief. Studies on mice have
shown the potential role of topical antihistamines in ICD
by reduc- ing inflammation and enhancing barrier function
[111]. How- ever, to date, there have been no randomized
clinical trials demonstrating the efficacy of antihistamines
in ICD [111].
Despite the frequent use of topical corticosteroids in
ICD, their use remains controversial. In humans, studies of
clini- cal efficacy are inconsistent [112] with some
suggesting that they may reduce barrier function associated
with inhibition of lipid synthesis in the epidermis [113].

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Current Dermatology Reports (2022) 11:41–51 49
systemic corticosteroids may be required during severe
acute phases of ICD [114].
The Osnabrueck tertiary intervention program (TIP) is
a multidisciplinary approach intended to treat severe
recalci- trant OSD, comprising a 3-week inpatient phase
followed by a 3 week no-exposure outpatient phase.
Therapy aims to be free of corticosteroids in order to
promote long-term stabi- lization of the epidermal barrier.
TIP intervention has been shown to significantly reduce
the use of corticosteroids [115, 116, 117••]. Management
also includes intensive patient education, health-
psychological intervention, and specialized employment
consultants [118]. Follow-up studies have shown a
significant reduction in hand eczema severity and days of
absence from work as well as improvement in quality of
life both in short-term [115] and long-term follow up [116,
117••]. Topical calcineurin inhibitors (TCIs) are topical
immu- nomodulators that provide a safe alternative to
corticoster- oids. An association of topical TCIs with
skin cancer has been suggested, but there is no strong
evidence [119], while there may be an association with
risk of lymphoma [120]. TCIs have been shown to be
favorable in the treatment of ICD [121, 122]. Other
systemic treatments include alitreti- noin, which has been
shown to be an effective treatment in study of patients
with chronic hand eczema, 43.2% of whom
were diagnosed with ICD [123].
Oral immunomodulators may be required in the
treatment of chronic ICD if other first- or second-line
treatments fail. Cyclosporine is reported to be beneficial
in the treatment of chronic hand eczema [114] but is used
with caution given its associated side effects.
Limited evidence has highlighted the use of dupilumab,
a monoclonal antibody treatment approved for the
treatment of atopic dermatitis, to be effective in the
treatment of chronic recalcitrant hyperkeratotic ICD [124]
and non-atopic hyper- keratotic hand eczema [125].
Further studies are required to determine the use of
dupilumab as a potential therapeutic agent in ICD.
Phototherapy has proven to be beneficial in the
treatment of cumulative ICD, where repeated low levels
of UV expo- sure upregulate skin barrier function by
reducing epidermal proliferation [126]. Grenz–ray therapy
is an alternative which may induce an extended response
by suppressing Langerhans cells [127, 128].

Prognosis

Severe ICD is associated with a poor prognosis despite

advancements in prevention and treatment strategies. A
worse prognosis is linked to history of atopy, female sex,
and delayed diagnosis [44]. Prognosis can be improved
with early detection, patch testing to clarify the diagnosis,
and exclude ACD and educational interventions to
increase knowledge of ICD in affected individuals [129].

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50 Current Dermatology Reports (2022) 11:41–51

Conclusion 4. Zhai H, Maibach H. Skin occlusion and irritant and allergic

con- tact dermatitis: an overview. Contact Dermatitis.
ICD is a complex disease influenced by endogenous and 2001:201–6.
exogenous factors. ICD remains a diagnosis of exclusion, 5. Marks J, Elsner P, Deleo V. Allergic and irritant contact der-
matitis. Contact and Occupational Dermatology. St Louis:
and currently, there is no diagnostic test available. For Mosby; 2002. p. 3–12.
many clinicians, the diagnosis may be difficult, especially 6. Dickel H, Kuss O, Schmidt A, Kretz J, Deipgen T. Importance
if patch testing is not available. Delays in diagnosing ICD of irritanct dermatitis in occupational skin disease. Am J Clin
are associ- ated with a poorer prognosis. Advancements Dermatol. 2002;3:283–9.
7. Slodwnik D, Lee A, Nixon R. Irritant Contact Dermatitis: a
into RCM as a diagnostic approach appear to be promising. review. Australas J Dermatol. 2008;49:1–11.
The mainstay of treatment in ICD remains avoidance of 8. Menne T, Johansen J, Sommerlund M, Veien N. Hand eczema
skin irritants and the use of PPE, with moisturizers to guidelines based on the Danish guidelines for the diagnosis and
maintain skin barrier function. In cases of occupationally treatment of hand eczema. Contact Dermatitis. 2011;65(1):3–12.
9.• Lund T, Flachs E, Sorenson J, Ebbenhoj N, Bonde J, Agner T.
acquired ICD, the role of health promotion and A job-exposure matrix addressing hand exposure to wet work.
preventative strategies has been shown to be beneficial, but Int Arch Occup Environ Health. 2019;92:959–66. Established
are often poorly implemented in workplaces. Further framework to assess the extent of wet work exposure in dif-
ferent occupations.
studies are required to more fully evalu- ate predisposing
10. Federal Institue for Occupational Safety and Health. Technical
factors, as well as informing clinicians of therapeutic rules for hazardous substances: risks resulting from skin contact
approaches to better manage ICD. - identification, assessment, measures (TRGS 401). 2008.
11. Reinholz M, Kendziora B, Frey S, Oppel EM, Rueff F,
Abbreviations ACD: Allergic contact dermatitis; ICD: Irritant contact Clanner- Engelshofen BM, et al. Increased prevalence of
dermatitis; CLA: Cutaneous lymphocyte association; OSD: Occupa- irritant hand eczema in health care workers in a
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