It may be an irritant (concentration dependent) or allergic (idiosyncratic) reaction to specific chemicals such as metals, rubber etc. In contrast to the endogenous types, the skin reaction is confined to the areas directly in contact with the offending chemical. Closed patch testing may be used for identification of allergens.

TREATMENT

Therapeutic objectives

• To eliminate symptoms
• To identify and avoid predisposing factors

Non-Pharmacological Treatment

• Avoidance of identifiable precipitating factors

Pharmacological Treatment

(Evidence rating: C)

• Use emollients in atopic eczema e.g. Aqueous cream and 2% Salicylic acid ointment
• Use topical steroids, limiting to 1% Hydrocortisone cream for not more than 2 weeks
• Topical Clotrimazole with or without steroids (1% Hydrocortisone) in seborrhoeic eczema
• Topical antiseptics and/or oral antibiotics when secondary infection is suspected.

CAUTION

More potent steroid creams e.g. Clobetasol propionate should only be used under specialist supervision

REFER

• Non-response to 1% Hydrocortisone cream
• For identification of allergen