Contact dermatitis (also called eczema) is an inflammatory reaction of the skin to physical, chemical, or biologic agents. It may be of the primary irritant type, or it may be allergic. The epidermis is damaged by repeated physical and chemical irritation. Common causes of irritant dermatitis are soaps, detergents, scouring compounds, and industrial chemicals. Predisposing factors include extremes of heat and cold, frequent use of soap and water, and a preexisting skin disease. Women tend to be affected more commonly than men.

• Eruptions occur when the causative agent contacts the skin.
• Pruritus, burning, and erythema are followed by edema, papules, vesicles, and oozing or weeping as first reactions.
• In the subacute phase, the vesicular changes are less marked and alternate with crusting, drying, fissuring, and peeling.
• If repeated reactions occur or the patient continually scratches the skin, lichenification and pigmentation occur; secondary bacterial invasion may follow.

• The goal of management is to soothe and heal the involved skin and protect it from further damage.
• The distribution pattern of the reaction needs to be determined to differentiate between allergic type and irritant type.
• The offending irritant should be identified and removed; soap is generally not used on the site until healed.
• Barrier cream that contains ceramide (e.g., Impruv, Cerave) or dimethicone (e.g., Cetaphil) can be used for small patches of erythema; cool, wet dressings can be applied over small areas of vesicular dermatitis; a corticosteroid ointment may be used.
• Medicated baths at room temperature are prescribed for larger areas of dermatitis.
• In severe, widespread conditions, a short course of systemic steroids may be prescribed.

• Assess detailed history and have patient think about what may have caused the problem.
• Instruct patient to adhere to the following instructions for at least 4 months, until the skin appears completely healed:
  • Avoid contact with known irritants, or wash skin thoroughly immediately after exposure to them.
  • Avoid heat, soap, and rubbing the skin.
  • Choose bath soaps, detergents, and cosmetics that do not contain fragrance; avoid using a fabric softener dryer sheet.
  • Avoid topical medications, lotions, or ointments, except when prescribed.
  • When wearing gloves (e.g., for washing dishes, cleaning), make sure they are cotton-lined; do not wear for more than 15 to 20 minutes at a time.
• Educate patient on ways to treat and prevent further bouts of irritant dermatitis.

For more information, see Chapter 61 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.