Complaints & connections · borters.ch
Dermatitis contacta
The shape gives the trigger away, and the delay of one to three days is why nobody finds it.
Also known as: contact eczema · contact dermatitis · contact allergy · hand eczema
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The skin reacts to something it touches — and it does so with a delay. That is why the trigger so often stays hidden: in allergic contact eczema one to three days pass between contact and rash, so nobody thinks of the product used the day before yesterday. To be distinguished from the commoner irritant eczema, in which no immune system is involved but the barrier is simply used up — by water, soap, gloves, disinfectant. Both look similar: red, scaling, itchy, in severe cases weeping or with small blisters. The most important clue is not the appearance but the shape: an eczema that follows an edge — the shape of a watch on the wrist, the round of a button on the belly, the border of a plaster, the area an ointment covered — names its own trigger. The commonest are nickel, fragrances, preservatives in wet wipes and cosmetics, rubber components, hair dyes, plaster adhesives — and, often overlooked, precisely those ointments and disinfectants used against the rash. If an eczema gets worse under treatment, the treatment itself belongs on the list of suspects.
Everything that touched the area: soaps, creams, wipes, jewellery, clothing, detergents, work materials. Because of the delay the trigger is almost never from today.
Two to three weeks with everything dispensable dropped and only a plain, fragrance-free base. Keeping on applying new things means never finding the trigger.
Patches with the commonest substances on the back, read after two and three days. The only test that truly names an allergic trigger — you may bring your own products.
Grease rather than wash: lukewarm and brief, then a rich ointment on still-damp skin. For the hands, ointment at night under cotton gloves is the strongest lever.
Nickel in buttons, belt buckles, spectacle frames and phone cases; fragrances and preservatives in wet wipes; rubber in gloves and cuffs. They go unnoticed because they are always there.
A hand eczema that comes and goes with work is a recognised matter — reported early it can usually be managed with protection and adjusted routines rather than giving the job up.
In folds and the genital area a fungus looks like eczema. A steroid on it helps briefly and then makes it distinctly worse — a swab beforehand saves months.
Around the anus contact eczema arises especially easily, because the skin is thin and because that is where most is applied.
Hang a cup of fine oat flakes in a cloth in the lukewarm bath water, bathe for 10 to 15 minutes, then only dab dry and moisturise at once.
An eczema on the top of the foot or above the heel that comes back every winter belongs in the patch test with the shoe series: potassium dichromate, thiurams, mercaptobenzothiazole, cobalt and formaldehyde resins. Vegetable-tanned shoes and cotton socks are the everyday test.
A rash that comes every late winter in the same place can stem from a contact substance worn only at that time — or from the dried-out skin itself. The distinction decides whether to test or to cream.
A contact eczema infects no one. If the same itching rash appears in several people in the household and is worst at night, mites are looked for, not allergens.
Allergic contact eczema appears twenty-four to forty-eight hours after contact — that delay is why the trigger so often goes unfound. Irritant eczema appears within minutes to hours. After the trigger is dropped, the skin heals in two to four weeks. Patch tests stay on for forty-eight hours and are read at seventy-two and sometimes ninety-six hours.
Cortisone cream interrupts the inflammation — it changes nothing about the allergy, which stays for life. So the cream is the second step; the first is finding the substance and leaving it out. It is applied once a day; twice does no better in comparisons. The amount is measured in fingertips: one fingertip covers two palms. After the trigger is dropped, the skin heals in two to four weeks; the barrier takes longer.
After every hand wash and before every wet job, apply a fat-rich ointment — thickly in the evening, with cotton gloves over it for the night.
Round like a button, wide like a watch strap, exactly the size of the plaster: that border is the diagnosis.
In allergic eczema the reaction is late. Looking for yesterday’s trigger means looking on the wrong day.
An eczema that clears in time off and returns at work points at the workplace — hairdressing, care, building, kitchens are high on the list.
That is the single most important clue: the product — the ointment, the wipe, the disinfectant — is then very likely the trigger.
Eyelids, neck, armpits, groins and the area around the anus react earlier and more strongly than the hands — tiny amounts are enough there.
Irritant eczema is commoner than allergic: water, soap, gloves, disinfection wear the barrier away. No allergy is needed, only enough repetition.
That is the signature site of shoe allergy: potassium dichromate from chrome-tanned leather and rubber accelerators from soles, glues and socks. It gets worse in winter because the foot sweats in the closed shoe — and better in summer in sandals. The spaces between the toes usually stay clear; that tells it apart from athlete’s foot.
Says nothing about contact eczema. It does not run through the immediate type but through a slow reaction — the test for it is the patch test on the skin.
A low level goes with drier, more sensitive skin — not a trigger, but a circumstance that makes it easier.
Skin and lining renew themselves quickly and need zinc for it. With places that heal badly, cracked corners of the mouth and frequent skin infections a lack is a serious possibility.
Without vitamin C no stable collagen forms — the wound closes but holds less well. With a very one-sided diet, smoking and alcohol the intake is often tighter than assumed.
Steers the horn-forming of the skin. Too little makes it rough and dry, too much over longer periods harms liver and bone — and in pregnancy a strict upper limit applies.
Every healing needs building material. Anyone eating little during an illness loses exactly that — a sufficient amount spread across the day belongs to the treatment.
As long as the substance keeps being touched nothing heals off — and the commonest are nickel, fragrances, preservatives and hair dye. The patch test finds it; no supplement replaces that search.
In atopic dermatitis a small effect is described, above all with a low starting level. In contact eczema this is not studied — here it is a reaction to a particular substance, not a general tendency of the skin.
Zinc ointment on the skin dries and protects — that is something other than zinc in a capsule. Swallowed, zinc only works if a deficiency exists; from about 40 mg daily over months it displaces copper, and that makes complaints of its own.
Cortisone ointment is the treatment here — and the most common worry leads to applying it too thinly and too briefly. The harm comes from months of use on thin skin, not from two decisive weeks.
A nickel allergy affects women distinctly more often — mostly because pierced ears and jewellery make the first contact. That is not a hormone effect but a habit effect, and the distinction is worth making.
Focus on avoidance.
Traditionally used to care for healing skin — the actual lever stays avoiding the trigger.