What is the initial management of contact dermatitis?

From the Guidelines

Initial management of contact dermatitis should focus on removing the offending substance and treating symptoms with topical steroids, as supported by the British Association of Dermatologists' guidelines 1. When managing contact dermatitis, it is essential to:

• Remove the offending substance to prevent further irritation
• Wash the affected area with mild soap and water to remove any remaining irritants or allergens
• Apply cool, wet compresses for 15-30 minutes several times daily to reduce inflammation and itching
• Use topical steroids, such as 1% hydrocortisone cream, applied thinly to affected areas 2-3 times daily for up to 7 days, as they have been shown to be effective in treating contact dermatitis 1
• Consider oral antihistamines, like cetirizine or loratadine, to help control itching
• Keep the area clean and avoid scratching to prevent secondary infection
• For more severe cases, prescription-strength topical steroids or systemic steroids may be necessary, but these should be used under the guidance of a healthcare professional Key considerations in managing contact dermatitis include:
• Identifying and avoiding the triggering substance to prevent recurrence
• Monitoring for signs of infection, such as increased redness, swelling, or pus, and seeking medical attention if symptoms worsen or do not improve within a week
• Using topical tacrolimus as an alternative to topical steroids, as it has been shown to be effective in treating contact dermatitis 1
• Considering second-line treatments, such as phototherapy or systemic immunomodulators, for persistent cases of contact dermatitis, as outlined in the British Association of Dermatologists' guidelines 1

From the FDA Drug Label

5 Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Contact dermatitis The initial management of contact dermatitis may include prednisone (PO), as it is indicated for the control of severe or incapacitating allergic conditions, including contact dermatitis, that are intractable to adequate trials of conventional treatment 2.

From the Research

Initial Management of Contact Dermatitis

The initial management of contact dermatitis involves several key steps, including:

• Avoidance of the offending agent, as identified through a complete medical history and diagnostic tests such as patch testing 3, 4
• Restoration of the skin barrier and reduction of skin inflammation through multiple treatments, such as:
  • Emollients to moisturize and protect the skin
  • Topical corticosteroids to reduce inflammation
  • Antihistamines to relieve itching and reduce the allergic response
  • Systemic corticosteroids and immunosuppressants in more severe cases 3, 4, 5
• Identification and elimination of the responsible agent, which can be achieved through a careful history and physical examination 4

Treatment Options

Treatment options for contact dermatitis may vary depending on the severity and type of dermatitis, but may include:

• Topical corticosteroids, such as those used to treat eczema 6, 5
• Immunomodulatory and anti-inflammatory agents, which have shown promise in recent studies 7
• Phototherapy, which can be used to treat various types of dermatitis, including atopic and contact dermatitis 5
• Systemic medications, including biologics, which may be used in more severe or difficult-to-treat cases 6, 5

Importance of Early Treatment

Early and appropriate treatment is crucial to prevent further deterioration and persistence of the skin condition, and to reduce the risk of chronic changes in the skin 3, 4