From the Guidelines
Contact dermatitis should be treated with corticosteroids to prevent progression to chronic dermatitis and reduce the risk of complications such as skin thickening, lichenification, and secondary bacterial infections. The presentation of contact dermatitis typically includes a localized skin reaction characterized by redness, itching, swelling, and sometimes blistering or oozing at the site of exposure to an irritant or allergen 1. The differential diagnosis includes atopic dermatitis, psoriasis, seborrheic dermatitis, tinea infections, and drug eruptions. When evaluating a patient, consider the distribution pattern, timing of onset, potential exposures, and associated symptoms.
Key considerations in the management of contact dermatitis include:
- Identifying and removing the offending agent to prevent recurrence
- Using medium-potency topical corticosteroids like triamcinolone 0.1% ointment applied twice daily for 1-2 weeks for mild to moderate cases
- Considering a short course of oral prednisone for severe or widespread reactions, starting at 40-60mg daily with a taper over 2-3 weeks
- Monitoring for signs of chronic dermatitis, such as skin thickening and lichenification, which can lead to significant quality of life impairment due to uncontrolled itching and discomfort 1.
If left untreated with corticosteroids, patients with contact dermatitis risk developing persistent hyperpigmentation or hypopigmentation, and prolonged inflammation can lead to significant morbidity and mortality 1. Therefore, prompt treatment with corticosteroids is essential to reduce the risk of complications and improve quality of life.
From the FDA Drug Label
The following local adverse reactions are reported infrequently when topical corticosteroids are used as recommended These reactions are listed in an approximately decreasing order of occurrence: burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy, striae, and miliaria The following local adverse reactions are reported infrequently with topical corticosteroids, but may occur more frequently with the use of occlusive dressings (reactions are listed in an approximate decreasing order of occurrence): burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy, striae, and miliaria
The presentation of contact dermatitis with differential diagnosis includes:
- Burning and/or stinging sensation
- Itching and tightness of the scalp
- Irritation and dryness
- Folliculitis and hypertrichosis
- Acneiform eruptions and hypopigmentation
- Perioral dermatitis and allergic contact dermatitis The risk if not treated with corticosteroid includes:
- Secondary infection
- Skin atrophy
- Striae and miliaria 2 and 3
From the Research
Presentation of Contact Dermatitis
- Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance 4.
- It can be categorized into two forms: irritant and allergic contact dermatitis, with the latter being a delayed hypersensitivity reaction 4, 5.
- The most common substances that cause contact dermatitis include poison ivy, nickel, and fragrances 4.
- Symptoms of contact dermatitis include erythema, scaling, itching, and discomfort, with acute cases potentially involving vesicles and bullae, and chronic cases involving lichenification and fissures 4.
Differential Diagnosis
- Contact dermatitis can mimic other skin diseases, such as atopic dermatitis, lichen planus, and angioedema 6.
- A complete medical history, including occupational history, is essential for diagnosis and can provide clues about the causative substance 6.
- Diagnostic tests, including patch testing, photopatch testing, and skin tests, can help identify the allergen and confirm the diagnosis 6.
Risk if Not Treated with Corticosteroid
- If left untreated or if treatment fails, contact dermatitis can lead to chronic changes in the skin, including lichenification and fissures 5.
- Failure to avoid the causative substance can result in a cycle of itching, scratching, and skin disruption, leading to persistent skin condition 5, 6.
- In severe cases, systemic corticosteroids may be required, and rapid discontinuation of steroids can cause rebound dermatitis 4.
- Topical corticosteroids are an essential treatment for contact dermatitis, but their use should be carefully managed to minimize the risk of adverse effects, such as atrophy and skin thinning 7.
- In rare cases, patients may develop contact allergy to topical corticosteroids, highlighting the need for careful selection and monitoring of treatment 8.