What is the treatment for contact dermatitis related to cosmetics (cosmetic-induced contact dermatitis)?

From the Guidelines

Treatment for contact dermatitis related to cosmetics primarily involves removing the offending product and managing symptoms, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. The first step is to immediately discontinue use of all suspected cosmetic products. Wash the affected area with mild soap and water to remove any residual allergens or irritants. For symptom relief, apply over-the-counter 1% hydrocortisone cream to the affected area 2-3 times daily for up to 7 days to reduce inflammation and itching, as suggested by the guidelines 1. Cold compresses can also help reduce swelling and soothe the skin. Some key points to consider in the treatment of contact dermatitis include:

• The cause of contact dermatitis is frequently multifactorial, and patients may have irritant and/or atopic/endogenous dermatitis in addition to allergic contact dermatitis 1
• Patch testing is an important tool in the diagnosis and management of contact dermatitis, and should be considered for patients with chronic or persistent dermatitis 1
• The British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 provide a comprehensive overview of the diagnosis and management of contact dermatitis, including the use of patch testing and the treatment of symptoms 1 For more severe cases, prescription-strength topical corticosteroids like triamcinolone 0.1% cream may be needed, applied twice daily for 1-2 weeks. Oral antihistamines such as cetirizine 10mg daily or diphenhydramine 25mg every 6 hours can help control itching. If the rash is widespread, weeping, or not improving after 7 days of treatment, consult a healthcare provider as oral steroids might be necessary. Moving forward, perform patch testing before using new cosmetic products by applying a small amount behind the ear or on the inner forearm and waiting 24-48 hours to check for reactions, as recommended by the guidelines 1. Look for hypoallergenic, fragrance-free products labeled for sensitive skin. Contact dermatitis occurs when the skin's protective barrier is compromised by either direct irritation from chemicals (irritant contact dermatitis) or an allergic reaction (allergic contact dermatitis), causing inflammation, redness, and itching. The classification of contact dermatitis includes several reaction types, such as subjective irritancy, acute irritant contact dermatitis, and chronic (cumulative) irritant contact dermatitis, as outlined in the guidelines 1.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... cosmetics ...

• Treatment for contact dermatitis related to cosmetics may include the use of hydrocortisone (TOP) to temporarily relieve itching associated with minor skin irritations and rashes.
• The use of hydrocortisone (TOP) should be done under the advice and supervision of a doctor for other uses. 2

From the Research

Treatment of Contact Dermatitis Related to Cosmetics

• The first step in treating contact dermatitis is to identify and avoid the causative substance 3, 4, 5, 6, 7.
• Localized acute allergic contact dermatitis lesions can be treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 3.
• If the allergic contact dermatitis involves an extensive area of skin (greater than 20 percent), systemic steroid therapy may be required and can offer relief within 12 to 24 hours 3.
• In patients with severe rhus dermatitis, oral prednisone should be tapered over two to three weeks to avoid rebound dermatitis 3.
• Patch testing can be performed to identify the specific allergen and guide treatment 3, 4, 5, 6, 7.
• Emollients, topical corticosteroids, and antihistamines can be used to restore the skin barrier and reduce skin inflammation 6.
• Systemic corticosteroids and immunosuppressants may also be used in severe cases 6.

Management of Cosmetic-Induced Contact Dermatitis

• Empiric recommendations for low allergenicity products should be implemented until patch testing is performed 4.
• The American Contact Dermatitis Society's "Contact Allergen Management Program" app can be a helpful resource for patients to find safe products 4.
• Patients should be educated on how to avoid the offending products and use alternative products that are less likely to cause allergic reactions 4, 5, 7.