Irritant Contact Dermatitis — SCE Dermatology MCQ

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EasyInflammatory DermatosesIrritant Contact DermatitisSCE Dermatology

A 25-year-old woman has eczema predominantly on the dorsa of her hands and wrists. She is a healthcare worker who washes her hands frequently with alcohol gel and soap. Patch testing is negative. What is the most likely diagnosis?

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Correct answer: A — Irritant contact dermatitis from cumulative hand washing

Healthcare workers with hand eczema and negative patch testing most commonly have irritant contact dermatitis (ICD) from cumulative exposure to wet work, soap, hand sanitiser, and glove occlusion. ICD is the most common form of occupational dermatitis, accounting for approximately 80% of occupational hand dermatitis. It does not involve immune sensitisation (hence negative patch testing). Pre-existing atopic eczema increases susceptibility to ICD. Management includes skin protection (emollients as barrier creams, cotton-lined gloves), soap substitute use, and minimising unnecessary hand washing. Occupational health referral and workplace adaptation are important to maintain employment.

Reference: BAD 2017 Contact Dermatitis; HSE Skin at Work