What is the management plan for contact dermatitis, with references to support the treatment approach, according to the American Psychological Association (APA) citations?

From the Guidelines

Management of contact dermatitis should prioritize the use of topical corticosteroids and topical tacrolimus, as supported by the British Association of Dermatologists' guidelines 1. The treatment approach involves several key steps, including:

• Identifying and avoiding the causative agent through a detailed history and possibly patch testing
• Providing symptomatic relief with topical corticosteroids, such as hydrocortisone 1% for the face and intertriginous areas, and higher potency preparations like triamcinolone 0.1% for thicker skin areas 1
• Using topical tacrolimus, which has been shown to be effective in a nickel model of allergic contact dermatitis 1
• Considering second-line treatment options, such as phototherapy and systemic immunomodulators like methotrexate and mycophenolate mofetil, for persistent cases 1
• Implementing preventive measures, including patient education on identifying potential triggers, proper skin care, and the importance of adherence to treatment
• Maintaining good skin care practices to prevent flare-ups, including the use of moisturizers and protective measures like gloves when exposure is unavoidable. For severe or widespread cases, a short course of oral prednisone may be necessary, typically starting at 40-60 mg daily and tapering over 2-3 weeks. Antihistamines such as diphenhydramine 25-50 mg every 6 hours or cetirizine 10 mg daily can help manage pruritus. Wet dressings with cool water or aluminum acetate solution (Burow's solution) can provide relief for vesicular or weeping lesions. Moisturizers should be used regularly to repair the skin barrier, with fragrance-free, hypoallergenic products preferred.

From the Research

Diagnosis and Management 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 2.
• The diagnosis relies on clinical presentation, thorough exposure assessment, and evaluation with techniques such as patch testing and skin-prick testing 3.
• Management is based on patient education, avoidance strategies of specific substances, and topical treatments; in severe or recalcitrant cases, systemic medications may be needed 3.

Treatment Options

• Localized acute allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 2.
• Topical corticosteroids are an essential tool for treating inflammatory skin conditions, but their use should be carefully considered due to the risk of adverse effects 4.
• The efficacy of corticosteroids in irritant contact dermatitis therapy is controversial, and their use may reduce skin barrier recovery while allowing further penetration of irritants if exposure continues 5.

Avoidance and Prevention

• When a possible causative substance is known, the first step in confirming the diagnosis is determining whether the problem resolves with avoidance of the substance 2.
• Before treatment, the suspected irritants or allergens should be avoided completely, including removal of the patient from the environment and promotion of metabolism and expulsion of the allergens 6.
• Patient education and avoidance strategies are crucial in managing contact dermatitis, and early and appropriate treatments are important to prevent further deterioration and persistence of the skin condition 6.