What is the treatment for contact dermatitis caused by metal exposure?

From the Guidelines

Treatment for metal contact dermatitis involves first identifying and avoiding the triggering metal, and applying topical corticosteroids like hydrocortisone 1% cream to reduce inflammation and itching. The most recent and highest quality study 1 suggests that topical corticosteroids are widely accepted as the treatment of established contact dermatitis.

Key Treatment Strategies

• Avoiding the triggering metal, typically nickel, chromium, cobalt, or gold, is crucial in managing metal contact dermatitis.
• Topical corticosteroids, such as hydrocortisone 1% cream applied 2-3 times daily for 1-2 weeks, can reduce inflammation and itching.
• More severe cases may require prescription-strength steroids like triamcinolone 0.1% or fluocinonide 0.05%.
• Oral antihistamines like cetirizine 10mg daily or diphenhydramine 25mg every 6 hours can help control itching.
• Cool compresses with plain water for 15-20 minutes several times daily can soothe irritated skin.

Prevention Strategies

• Using protective barriers like clear nail polish on metal jewelry can help prevent metal contact dermatitis.
• Wearing gloves when handling metals can also reduce the risk of developing metal contact dermatitis.
• Choosing hypoallergenic alternatives like surgical stainless steel, titanium, or plastic-coated items can minimize the risk of metal contact dermatitis, as suggested by 1.

Important Considerations

• Metal contact dermatitis occurs when the immune system recognizes certain metal ions as allergens, triggering a delayed hypersensitivity reaction that causes the characteristic rash, redness, and itching.
• In cases of widespread or persistent reactions, a healthcare provider may prescribe oral corticosteroids like prednisone, typically starting at 40-60mg daily with a tapering schedule over 2-3 weeks, as mentioned in the example treatment plan.

From the FDA Drug Label

Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Contact dermatitis The treatment for metal contact dermatitis may include topical corticosteroids such as hydrocortisone butyrate, or systemic corticosteroids like prednisone for more severe cases 2 3.

• Mild cases may be managed with topical corticosteroids.
• Severe cases may require systemic corticosteroids. It is essential to follow the prescribed treatment and instructions from a physician to ensure proper management of the condition.

From the Research

Metal Contact Dermatitis Treatment

• The treatment of metal contact dermatitis involves avoiding the suspected irritants or allergens, removing the patient from the environment that contains those substances, and promoting the metabolism and expulsion of the allergens that have been absorbed by the body 4.
• Restoring the skin barrier and reducing skin inflammation through multiple treatments, such as emollients, topical corticosteroids, and antihistamines, as well as systemic corticosteroids and immunosuppressants, is also important 4.
• Early and appropriate treatments are crucial to prevent further deterioration and persistence of the skin condition 4.
• Diagnostic tools, such as patch testing, lymphocyte stimulation test (LST), and evaluation of cytokine production by primary cultures of peripheral blood mononuclear cells, can help identify the causative allergens and guide treatment 5, 6, 7.
• In some cases, treatment may involve the removal of internal metal devices, such as orthopedic implants, that are causing sensitization and an inflammatory response 7.

Common Metals Causing Contact Dermatitis

• Nickel, cobalt, chromium, and zinc are common metals that can cause allergic contact dermatitis and systemic contact dermatitis (SCD) 5, 6, 8.
• Other metals, such as gold, palladium, and mercury, can also cause contact dermatitis, although the incidence of clinical relevance may vary 6, 8.
• The clinical symptoms of contact dermatitis caused by these metals can include local skin rash, itching, redness, swelling, and lesions 6.

Diagnostic Tests

• Patch testing is a common diagnostic test used to identify the causative allergens in contact dermatitis 5, 6, 4.
• Other diagnostic tests, such as photopatch test, skin tests for detecting immediate contact reactions, serum allergen-specific IgE test, and qualitative and quantitative testing of allergen in the suspected materials, can also be used to help diagnose contact dermatitis and identify the causative allergens 4.