From the Guidelines
Systemic steroids should not be given as first-line treatment for contact dermatitis, and their use should be reserved for severe, widespread, or debilitating cases that do not respond to topical treatments. The British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 support the efficacy of topical steroids and topical tacrolimus in the treatment of contact dermatitis 1. For mild to moderate cases, topical corticosteroids applied 2-3 times daily for 1-2 weeks are usually sufficient. These should be combined with identifying and avoiding the triggering allergen or irritant, and using gentle skin care with fragrance-free moisturizers. Some key points to consider when treating contact dermatitis include:
- Identifying and avoiding the triggering allergen or irritant
- Using gentle skin care with fragrance-free moisturizers
- Reserving systemic steroids for severe cases that do not respond to topical treatments
- Considering alternative second-line treatments, such as phototherapy and systemic immunomodulators like methotrexate and mycophenolate mofetil, as outlined in the guidelines 1. In cases where systemic steroids are considered necessary, oral prednisone at 0.5-1 mg/kg/day for 7-14 days with a gradual taper may be used, but their significant side effects, including mood changes, insomnia, increased blood glucose, fluid retention, and immunosuppression, must be carefully weighed against the potential benefits 1.
From the Research
Systemic Steroids for Contact Dermatitis
- Systemic steroid therapy is often required for allergic contact dermatitis that involves an extensive area of skin (greater than 20 percent) 2.
- Systemic steroids can offer relief within 12 to 24 hours for allergic contact dermatitis involving a large area of skin 2.
- In patients with severe rhus dermatitis, oral prednisone should be tapered over two to three weeks to avoid rebound dermatitis 2.
- Systemic corticosteroids are used in more severe cases of allergic contact dermatitis where topical steroids may prove insufficient 3.
- However, there are no systemic treatments indicated for the treatment of widespread recalcitrant contact dermatitis 3.
Considerations for Systemic Steroid Use
- Systemic side effects of corticosteroids include growth suppression in children, osteoporosis, osteonecrosis, adrenal insufficiency, and others 4.
- The use of systemic steroids should be limited to short courses as a bridge to steroid-sparing therapies 4.
- The optimal delivery or duration of systemic corticosteroids in contact dermatitis is not well established due to incomplete and heterogeneous reporting across studies 4.
Alternative Treatments
- Topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05%, are effective for localized acute allergic contact dermatitis lesions 2.
- Emollients, topical corticosteroids, and antihistamines can help restore the skin barrier and reduce skin inflammation 5.
- Avoiding the suspected irritants or allergens and promoting the metabolism and expulsion of absorbed allergens are important steps in treating contact dermatitis 5.