Derm Cases · Dermatology / Occupational Medicine / Allergy
OSCE — assessment of hand contact dermatitis with patch-test planning
An 8-minute OSCE station distinguishing irritant from allergic contact dermatitis, occupational hand eczema assessment, allergen history (nickel and others), ESCD patch-testing principles, and avoidance-centred management with barrier repair.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station distinguishing irritant from allergic contact dermatitis, occupational hand eczema assessment, allergen history (nickel and others), ESCD patch-testing principles, and avoidance-centred management with barrier repair.
Brief (to candidate)
A 32-year-old nurse has chronic itchy vesicular and fissured dermatitis of both hands for 8 months, worse after shifts with frequent handwashing and glove use. She also develops earlobe and under-ring dermatitis with costume jewellery. Emollients alone help only partially. You have 8 minutes to differentiate ICD vs ACD, plan investigation, and manage occupational hand eczema.
[8]Candidate instructions
- Distinguish irritant (ICD) from allergic contact dermatitis (ACD) mechanistically and clinically.
- Take an exposure history (occupation, gloves, cleansers, jewellery, plants, cosmetics).
- Explain patch testing indications, timing, and interpretation principles.
- Plan avoidance, barrier repair, and topical anti-inflammatory therapy.
- Address fitness for work, sick-leave, and prevention.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| ICD vs ACD | ICD: dose-dependent barrier injury from wet work/detergents, burns/stinging early, often dorsal hands/finger webs; ACD: type IV delayed hypersensitivity, may spread beyond contact site, prior sensitisation, re-exposure elicits rash at ~48 h[1][5] |
| History of exposure | Wet work, soaps, alcohol rubs, rubber accelerators in gloves, fragrances, preservatives; nickel jewellery pattern (lobes, under rings, jean-stud umbilicus)[11] |
| Examination | Morphology (vesicles, fissures, lichenification), laterality, foot/face if relevant, rule out tinea/psoriasis/AD hand variants |
| Patch testing | Gold standard for suspected ACD; baseline series ± occupation-specific allergens; apply 48 h, read at 48 and 72–96 h (ESCD best practice); test when acute flare controlled; relevance assessment essential (positive ≠ always causative)[8] |
| Acute & chronic Rx | Avoidance is definitive for ACD; ICD: reduce wet work, cotton glove liners, soap substitutes; emollients; short potent topical corticosteroid courses for hands; treat secondary infection if present |
| Occupational plan | Employer advice, barrier measures, possible temporary redeployment; document for occupational health; chronic hand eczema QoL impact |
| Communication | Explains delayed reading of patch tests; written allergen avoidance list if positive; safety-net for spreading facial/eyelid dermatitis from transfer |
Model key actions
- Frame dual wet-work ICD + likely nickel ACD (jewellery pattern) in a healthcare worker.[1][5][11]
- Arrange patch testing with correct timing/reads per ESCD guidance.[8]
- Emphasise avoidance + barrier repair + topical steroid; occupational prevention plan.
Common errors
- Treating only with steroids without exposure elimination.
- Ordering IgE RAST as primary test for contact allergy (patch test is type IV).
- Patch testing during acute widespread flare or on systemic immunosuppressants without planning.
- Missing rubber glove allergens in healthcare workers.
- Diagnosing pure ICD and never considering ACD when pattern suggests specific allergen (nickel).
References4ShowHide
- [1]Scheinman PL, Vocanson M, Thyssen JP, et al. Contact dermatitis. Nature Reviews Disease Primers, 2021.PMID 34045488
- [5]Bains SN, Nash P, Fonacier L. Irritant Contact Dermatitis. Clinical Reviews in Allergy & Immunology, 2019.PMID 30293200
- [8]Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing - recommendations on best practice. Contact Dermatitis, 2015.PMID 26179009
- [11]Ahlström MG, Thyssen JP, Wennervaldt M, et al. Nickel allergy and allergic contact dermatitis: A clinical review of immunology, epidemiology, exposure, and treatment. Contact Dermatitis, 2019.PMID 31140194