What is the initial treatment for a patient presenting with purpuric rashes and crusts due to contact dermatitis?

From the Guidelines

The initial treatment for a patient presenting with purpuric rashes and crusts due to contact dermatitis involves removing the offending allergen or irritant, followed by topical corticosteroids, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1.

Key Treatment Steps

• Remove the offending allergen or irritant to prevent further irritation and allow the skin to heal.
• Apply medium to high-potency topical corticosteroids, such as triamcinolone 0.1% or fluocinonide 0.05%, twice daily to affected areas for 1-2 weeks.
• For facial involvement, use lower potency options like hydrocortisone 1% or desonide 0.05% to minimize side effects.
• Oral antihistamines, such as cetirizine 10mg daily or diphenhydramine 25-50mg every 6 hours, can help manage pruritus and reduce the risk of further irritation.
• Gently cleanse crusted areas with mild soap and water, and apply wet dressings with saline or aluminum acetate (Burow's solution) to help remove crusts and reduce inflammation.

Additional Considerations

• For severe or widespread cases, a short course of oral prednisone may be necessary, starting at 0.5-1mg/kg/day for 5-7 days with a taper, to suppress the inflammatory response.
• Patients should be advised to avoid scratching, wear loose cotton clothing, and identify and avoid the triggering substance to prevent recurrence.
• Patch testing may be considered for patients with chronic or persistent dermatitis to identify potential allergens and guide treatment, as recommended by the British Association of Dermatologists' guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Initial Treatment for Purpuric Rashes and Crusts due to Contact Dermatitis

The initial treatment for a patient presenting with purpuric rashes and crusts due to contact dermatitis involves several steps:

• Avoidance of the suspected irritants or allergens is crucial, including removal from the environment and promotion of metabolism and expulsion of absorbed allergens 2
• Restoration of the skin barrier and reduction of skin inflammation through multiple treatments, such as:
  • Emollients
  • Topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05% for localized acute allergic contact dermatitis lesions 3
  • Antihistamines
  • Systemic corticosteroids for extensive areas of skin involvement (greater than 20 percent) 3
• Patch testing may be necessary to identify the specific allergen causing the reaction, especially if the diagnosis or specific allergen remains unknown 3, 4

Considerations for Specific Cases

• In cases of severe rhus dermatitis, oral prednisone should be tapered over two to three weeks to avoid rebound dermatitis 3
• For patients with a history of severe allergic reactions to suspected allergens, generalized active dermatitis, or extensive eczema, patch testing may be contraindicated 4
• Topical medicaments, such as antibiotics, steroids, anesthetics, and antifungals, can be common causes of allergic contact dermatitis and should be considered in the diagnosis and treatment plan 5, 6