Severe bilateral irritant contact dermatitis following detergent exposure in an elderly male

A 62-year-old elderly male presented to the Dermatology Outpatient Department with complaints of painful swelling, redness, burning sensation, itching, and skin lesions involving both hands for 10 days. The patient reported a history of repeated exposure to detergent solution during manual washing activities before the onset of symptoms. Initially, mild erythema and itching developed over both hands, which progressively worsened into diffuse swelling, excoriative lesions, and difficulty in performing daily routine activities. Dermatological examination revealed bilateral diffuse erythema, marked oedema, shiny inflamed skin, scaling, and excoriative erosions predominantly involving the dorsal surfaces of the hands and fingers. Mild crusting was noted over the knuckles and interdigital regions. The lesions were associated with tenderness and localised warmth. No grouped vesicular lesions or dermatomal distribution suggestive of herpes zoster were observed. Based on the characteristic clinical presentation and definite history of detergent exposure, a diagnosis of severe bilateral irritant contact dermatitis secondary to detergent exposure was established. The patient was advised strict avoidance of detergent exposure and treated with oral Levocetirizine 5mg once daily, oral Cefixime 200mg twice daily, Pantoprazole 40mg before meals, topical Betamethasone valerate cream, liquid paraffin-based emollient therapy, and supportive skin care measures. Significant symptomatic improvement with reduction in erythema, oedema, burning sensation, and inflammatory skin changes was observed on follow-up.