Q I would like your advice for the son of a friend of mine. James, 22, had eczema as a child. His passion in life is motorcycles and, thus, he comes into contact with cleaning chemicals as well as oil, grease and the like.
He has now been diagnosed with contact dermatitis, and the steroid cream has made the skin on his hands very thin, which prevents him working with his hands (even with gloves). James is now unable to find a job, which is making him more and more depressed. I hope you can help him.- DVE, Haywards Heath, West Sussex
A Contact dermatitis is a catch-all phrase which basically means a skin inflammation caused by being ‘in contact’ with something that triggers an irritation or allergic reaction. There are two types of contact dermatitis: primary irritant contact dermatitis refers to a condition caused by contact with a substance that is irritating or harsh; allergic contact dermatitis is an allergic reaction to a substance.
The body part involved is almost always a clue to the offending substance. Dermatitis of the hands usually means a detergent, an oil, tar or rubber compound, latex, chemical soap or something else he was handling.
As James had eczema, it sounds as though he has a predilection to allergy and the chemicals he is coming into contact with are now the final straw - pushing his body into toxic overload.
It’s impossible to know exactly what James is allergic to, but with machinery, it could be the grease or oil, the chemicals, or even the hand cleansers and detergents to clean them off.
Many of those whose occupation involves extensive cleaning and soaping of the skin develop dehydration or shrivelling of the keratin layers of the skin of the hands, which can lead to the primary irritant type of contact dermatitis.
Fair-skinned people working in lots of water can often develop dermatitis, as skin is acidic and water is alkaline, particularly ‘hard’ water containing high concentrations of calcium and magnesium.
When skin is continuously exposed to soaps and detergents, this can impair the skin’s alkaline neutralisation process, causing drying and fissuring of the keratin layer, thus allowing increased permeability and then allergy to even ordinarily well-tolerated substances. So what began as a primary irritant contact dermatitis may sensitise an individual, triggering off a chronic allergy to an increasing array of substances.
According to the Dermatology Society, even hand soaps, which contain tiny particles of talc, borax, cornmeal or pumice to make them more effective, can be irritating and sensitising. Other triggers include fabric finishes, dyes, cosmetics, perfume, wood resins, insecticides, plastics, paints, glue, metals, polishes and fibreglass. Yet other culprits are the solvents found in many cleaning solutions.
Another common sensitiser is paraphenylenediamine, a chemical used in hair dyes. Women can also be sensitised by eyeliner, nail polish, contact lens wetting solutions, lipsticks, perfumes, sunscreen preparations containing PABA and toothpaste.
To make matters worse, all these chemicals can interact with other chemicals. Methyleneparaphenylenediamine, for example, crossreacts with sulphonamides and thiazides, PABA in sunscreens, the oral antidiabetics tolbutamide and chlorpropamide, and even the artificial sweetener saccharin.
It is likely that the chemicals James has worked with have triggered this type of progressive sensitisation, making an already allergic individual hypersensitive to a variety of substances (see our article on multiple chemical sensitivity, WDDTY, vol 8 no 8).