From the Guidelines
The most effective topical cream for contact dermatitis is a topical corticosteroid, such as mometasone furoate, as it has been shown to be effective in chronic hand eczema with long-term intermittent use 1. When managing contact dermatitis, it's crucial to identify and avoid the triggering substance. For mild cases, cool compresses, calamine lotion, and over-the-counter hydrocortisone cream (1%) applied 2-3 times daily for up to two weeks can provide relief. Some key points to consider in the management of contact dermatitis include:
- Avoiding irritants and allergens
- Using soap substitutes and emollients to protect the skin
- Applying topical corticosteroids, such as mometasone furoate, for chronic cases
- Considering oral antihistamines, like diphenhydramine or cetirizine, to control itching
- Evaluating the need for patch testing in chronic or persistent cases, as recommended by the British Association of Dermatologists' guidelines 1. In moderate to severe cases, prescription-strength topical corticosteroids may be necessary, and in extensive or severe cases, oral corticosteroids like prednisone might be prescribed. Moisturizing regularly with fragrance-free products helps repair the skin barrier, reducing inflammation and improving quality of life for patients with contact dermatitis 1.
From the Research
Treatment for Contact Dermatitis
The recommended treatment for contact dermatitis includes:
- Avoiding the causative substance or allergen [(2,3)]
- Using topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05%, for localized acute allergic contact dermatitis lesions 2
- Systemic steroid therapy for extensive areas of skin involvement (greater than 20 percent) 2
- Oral prednisone for severe cases, tapered over two to three weeks to prevent rebound dermatitis 2
- Emollients, antihistamines, and immunosuppressants to restore the skin barrier and reduce inflammation 3
Topical Corticosteroids
Topical corticosteroids are classified by strength and potential for adverse effects 4
- High-potency corticosteroids, such as clobetasol 0.05%, are effective for treating contact dermatitis but may have a higher risk of adverse effects [(2,4)]
- Lower-potency corticosteroids, such as triamcinolone 0.1%, may be safer for long-term use or for application to sensitive areas [(2,4)]
- The quantity of corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated 4
Allergic Contact Dermatitis to Topical Corticosteroids
Some individuals may develop allergic contact dermatitis to topical corticosteroids, particularly those belonging to corticosteroid groups A and D 5
- Patch testing and intradermal testing can be used to identify the causative allergen and determine a safe alternative [(5,6)]
- Cross-reactivities between different corticosteroid classes and compounds should be considered when selecting a topical corticosteroid 6