From the Guidelines
Treatment for facial contact dermatitis should prioritize topical steroids and topical tacrolimus as first-line therapy, as supported by the British Association of Dermatologists' guidelines 1. When managing contact dermatitis of the face, it is crucial to identify and avoid the triggering substance to prevent further irritation.
- For mild cases, topical corticosteroids such as 1% hydrocortisone cream can be applied twice daily for up to 7 days to reduce inflammation and itching.
- More severe cases may require prescription-strength topical corticosteroids, but due to the sensitive nature of facial skin, medium-potency steroids are recommended to avoid skin thinning.
- Topical tacrolimus is a steroid-free alternative that can be particularly useful for facial application, as it has been shown to be effective in the treatment of contact dermatitis 1. Key considerations in the treatment of facial contact dermatitis include:
- Using gentle, fragrance-free cleansers and moisturizers to support skin barrier repair
- Applying cool compresses to provide temporary relief from itching and burning
- Monitoring for signs of infection, such as increased redness, warmth, or pus, which may require medical attention and stronger treatments or antibiotics In cases where symptoms persist despite first-line treatment, second-line options such as phototherapy and systemic immunomodulators like methotrexate and mycophenolate mofetil may be considered, as outlined in the British Association of Dermatologists' guidelines 1.
From the Research
Contact Dermatitis of the Face Treatment
- The treatment of contact dermatitis of the face involves avoiding the causative substance and using topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05% 2.
- For acute cases, mid- or high-potency topical steroids can be used, while systemic steroid therapy may be required for extensive areas of skin involvement 2.
- In cases where the diagnosis or specific allergen remains unknown, patch testing should be performed to identify the offending agent 2, 3.
- Topical corticosteroids can be classified by strength and the risk of adverse effects, and their use should be carefully considered, especially on the face and in children 4.
- The treatment of contact dermatitis also involves restoring the skin barrier and reducing skin inflammation through multiple treatments, such as emollients, topical corticosteroids, and antihistamines 5.
Treatment Options
- Topical corticosteroids, such as clobetasone butyrate 0.05% cream, have been shown to have better healing properties than hydrocortisone 1% cream in nickel-induced contact dermatitis 6.
- The emollient base of a topical corticosteroid can also have moisturizing properties, which can be a useful treatment adjunct 6.
- Antihistamines and oral steroids may also be used in the treatment of contact dermatitis, especially in more severe cases 3, 5.
Important Considerations
- A complete medical history, including occupational history, is important in identifying the causative substance and diagnosing contact dermatitis 3, 5.
- Avoiding the suspected irritants or allergens is crucial in the treatment of contact dermatitis, and this includes both removal from the environment and promotion of metabolism and expulsion of the allergens 5.
- Early and appropriate treatment is important to prevent further deterioration and persistence of the skin condition 5.