From the Guidelines
For treating allergic skin rash, first identify and avoid the trigger that caused the reaction, as emphasized by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. To manage allergic skin rash effectively, consider the following steps:
- Identify and avoid the allergen or irritant causing the reaction, which may involve substituting soaps and detergents with emollients and avoiding specific materials in the workplace or at home 1.
- For mild to moderate rashes, apply over-the-counter 1% hydrocortisone cream to affected areas 2-3 times daily for up to 7 days.
- Take oral antihistamines like cetirizine (10mg once daily), loratadine (10mg once daily), or diphenhydramine (25-50mg every 4-6 hours) to reduce itching.
- Cool compresses applied for 10-15 minutes several times daily can soothe inflammation.
- Keep the skin moisturized with fragrance-free lotions after bathing.
- For severe rashes with extensive involvement, blistering, or those accompanied by breathing difficulties, seek immediate medical attention as prescription-strength corticosteroids or epinephrine may be needed, as suggested by guidelines for the management of contact dermatitis: an update 1. It is essential to note that visiting the workplace can be crucial in identifying potential allergens and irritants, and thus, in the effective treatment and prevention of contact dermatitis 1. These treatments work by reducing inflammation, blocking histamine release, and repairing the skin barrier. Most allergic rashes improve within 1-2 weeks with proper treatment, but persistent or recurrent rashes warrant medical evaluation to identify underlying causes.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor
For the treatment of allergic skin rash, the guidelines are to apply hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older.
- For children under 2 years of age, a doctor should be consulted.
- For children under 12 years of age, a doctor should be consulted before applying the treatment. 2
From the Research
Guidelines for the Treatment of Allergic Skin Rash
- The treatment of allergic skin rash involves identifying the culprit corticosteroid agent and administering an alternative safe corticosteroid [ 3, 4, 5, 6 ].
- Prick and intradermal skin tests are useful diagnostic tools for immediate hypersensitivity reactions, while patch tests are useful for delayed hypersensitivity reactions [ 3, 4 ].
- A high index of suspicion is needed to identify the culprit corticosteroid, as it is often difficult to distinguish between hypersensitivity reactions and deterioration of the basic inflammatory disease [ 3 ].
- Cross-reactivity patterns have not been observed for immediate hypersensitivity reactions, but sensitization in contact dermatitis exhibits cross-reactivity patterns based on corticosteroid structure [ 4 ].
- The assessment of hypersensitivity reactions should be done when the patient's underlying condition is in a quiescent state [ 5 ].
- Clinicians should be aware that allergic reactions to corticosteroids are possible, and worsening of symptoms may not always mean treatment failure, but may indicate an allergic reaction [ 6 ].
- High doses of corticosteroids should be given over 30-60 minutes, and patients should be observed after administration for at least the same time period [ 6 ].
- Asthmatics, renal transplant patients, and hemodynamically unstable patients may be at higher risk for adverse events [ 6 ].