Contact dermatitis is one of the most common dermatological conditions pharmacists encounter. It accounts for a significant proportion of skin-related pharmacy consultations, with presentations ranging from mild irritation to widespread, intensely itchy eruptions. Community pharmacists play a key role in symptom management, trigger identification and appropriate referral.

Two Types of Contact Dermatitis

Contact dermatitis falls into two categories with different mechanisms:

Irritant contact dermatitis is more common overall, but allergic contact dermatitis is the form that most often puzzles patients because of the delayed onset — they may not connect the rash to an exposure that occurred two days earlier.

Common Allergens to Ask About

When a patient presents with a localised, itchy rash that follows a pattern suggesting external contact, pharmacists should ask about exposure to:

• Nickel — jewellery (earrings, watch straps, belt buckles, jeans studs), the most common cause in the UK
• Fragrances — perfumes, scented moisturisers, fabric softeners, candles
• Preservatives — methylisothiazolinone (MI) in cosmetics and household products, a rising cause of contact allergy
• Hair dye — paraphenylenediamine (PPD) in permanent hair dyes
• Rubber chemicals — latex gloves, elasticated clothing, shoe soles
• Topical medications — lanolin in creams, neomycin in antibiotic preparations
• Plants — primula, chrysanthemum, poison ivy (rare in the UK but seen in travellers)

The pattern of the rash often reveals the culprit: wrist rash suggests a watch strap (nickel); earlobe rash suggests earrings; scalp-margin rash suggests hair dye; hand dermatitis suggests occupational exposure.

Pharmacy Treatment

Emollients

The foundation of contact dermatitis management is barrier repair. The skin barrier is compromised in all forms of contact dermatitis, and regular emollient use reduces water loss, soothes irritation and helps prevent secondary infection.

Recommend:

• A greasy emollient (Cetraben, Diprobase, Epaderm) as a leave-on moisturiser, applied liberally at least twice daily
• An emollient wash product instead of soap (Dermol 500, Cetraben wash) — soap strips the skin barrier further
• Avoid aqueous cream as a leave-on emollient — it contains sodium lauryl sulfate, which can worsen contact dermatitis

Hydrocortisone 1% cream

For mild to moderate allergic contact dermatitis, OTC hydrocortisone 1% cream applied twice daily for up to seven days can reduce inflammation and itch effectively. It should not be used on the face (except under pharmacist or doctor advice), on broken skin, or in areas of suspected fungal infection.

Antihistamines

Oral antihistamines can help manage itch, particularly at night:

• Cetirizine 10mg or loratadine 10mg for daytime (non-sedating)
• Chlorphenamine 4mg at night (sedating — useful when itch disrupts sleep)

Antihistamines are less effective for contact dermatitis itch than for urticaria (hives), but they provide moderate relief and are a reasonable adjunct.

Cool compresses

A cloth soaked in cool water and applied to the affected area for 10–15 minutes can reduce acute inflammation and provide immediate comfort. This is particularly useful while waiting for topical steroid treatment to take effect.

The Importance of Trigger Avoidance

No amount of treatment will resolve allergic contact dermatitis if the patient continues to be exposed to the causative allergen. Pharmacists should:

• Help the patient identify the likely trigger based on rash distribution and history
• Advise reading product ingredient lists — particularly for preservatives (MI/MCI) and fragrances
• Suggest switching to fragrance-free, hypoallergenic alternatives for skincare, laundry and household products
• Recommend nickel-free jewellery or clear nail polish painted on the underside of metal items as a barrier
• Advise wearing cotton-lined gloves for wet work if hands are affected

When to Refer

Pharmacy management is appropriate for mild, localised contact dermatitis where the trigger is identified and avoided. Referral to a GP is appropriate if:

• The rash is widespread, affecting large body areas
• The face or genitals are involved (may need a stronger topical steroid on prescription)
• There is suspected secondary bacterial infection — increasing redness, warmth, weeping, crusting or pustules
• Symptoms have not improved after seven days of OTC hydrocortisone and trigger avoidance
• The trigger cannot be identified — the GP can refer for patch testing at a dermatology clinic
• The patient has occupational contact dermatitis — this may require workplace assessment and reporting under RIDDOR
• The condition is recurrent despite avoiding known triggers

Patch testing is the gold standard for identifying allergic contact dermatitis triggers. It involves applying a panel of common allergens to the back under adhesive patches, which are read at 48 and 96 hours. This is performed in secondary care dermatology departments.

Occupational Contact Dermatitis

Pharmacists should be aware that certain occupations carry high risk:

• Healthcare workers (frequent handwashing, latex or nitrile glove use)
• Hairdressers (PPD, perming solutions, frequent wet work)
• Cleaners (detergents, bleach, rubber gloves)
• Construction workers (cement, epoxy resins)
• Florists (plant allergens, wet handling)

If a patient's hand dermatitis correlates with their working pattern (worse during the working week, improving on holiday), occupational contact dermatitis should be considered and the patient referred.

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