From the Guidelines
Treatment for contact dermatitis should begin with identifying and avoiding the triggering substance, followed by the use of topical steroids and topical tacrolimus for persistent cases, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. The treatment approach for contact dermatitis involves a step-wise strategy, starting with mild cases and progressing to more severe ones. For mild cases, cool compresses, calamine lotion, and over-the-counter hydrocortisone cream (0.5-1%) applied 2-3 times daily for up to two weeks can provide relief.
- Key considerations in treatment include:
- Avoiding the triggering substance
- Using topical steroids for mild to moderate cases
- Considering topical tacrolimus for persistent cases
- Reserving oral antihistamines and oral corticosteroids for more severe reactions
- Using wet dressings with saline or Burow's solution for weeping lesions
- Prescribing antibiotics only if secondary infection develops According to the British Association of Dermatologists' guidelines, therapy for contact dermatitis persisting despite allergen/irritant removal and skin protection largely follows the management of atopic/endogenous dermatitis, with studies supporting the efficacy of topical steroids and topical tacrolimus in the treatment of contact dermatitis 1.
- Second-line treatment options include:
- Phototherapy
- Systemic immunomodulators such as methotrexate and mycophenolate mofetil
- Psoralen plus UVA, ciclosporin, and alitretinoin for chronic hand dermatitis
- Azathioprine for chronic actinic dermatitis The British Association of Dermatologists' guidelines also emphasize the need for standardized methodology and reporting of results of future patch test studies, as well as high-quality studies to address the efficacy of interventions for contact dermatitis, including topical tacrolimus vs. topical corticosteroids and combination of tacrolimus and topical corticosteroids 1.
- The guidelines highlight the importance of a multifaceted approach to treatment, considering the potential for irritant and/or atopic/endogenous dermatitis in addition to allergic contact dermatitis, particularly in occupations such as hairdressing 1.
From the Research
Treatment Guidelines for Contact Dermatitis
The treatment guidelines for contact dermatitis involve a combination of avoiding the causative substance, restoring the skin barrier, and reducing skin inflammation.
- Avoiding the causative substance is the first step in treating contact dermatitis, as it can help prevent further irritation and allow the skin to heal 2, 3, 4, 5.
- Topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05%, can be used to treat localized acute allergic contact dermatitis lesions 2.
- Systemic steroid therapy may be required for extensive areas of skin involvement (greater than 20 percent) and can offer relief within 12 to 24 hours 2.
- Patch testing can be performed to identify the specific allergen causing the contact dermatitis, especially if the diagnosis or specific allergen remains unknown 2, 4, 5.
- Other treatments, such as emollients, antihistamines, and immunosuppressants, can be used to restore the skin barrier and reduce skin inflammation 6, 5.
Subtypes of Contact Dermatitis and Their Management
There are several subtypes of contact dermatitis, including:
- Allergic contact dermatitis: a delayed hypersensitivity reaction that occurs after exposure to a specific allergen 2, 3, 4, 5.
- Irritant contact dermatitis: a non-immune-modulated irritation of the skin caused by a substance 2, 3, 4, 5.
- Immediate skin reactions: a type of contact dermatitis that occurs immediately after exposure to a substance 5.
- Photoinduced contact dermatitis: a type of contact dermatitis that occurs after exposure to sunlight or other forms of radiation 5.
- Systemic contact dermatitis: a type of contact dermatitis that occurs after systemic exposure to a substance 5.
- Non-eczematous contact dermatitis: a type of contact dermatitis that does not present with the typical eczematous lesions 5.
Diagnostic Tests for Contact Dermatitis
Several diagnostic tests can be used to help diagnose contact dermatitis and identify the causative allergens, including:
- Patch testing: a test that involves applying small amounts of potential allergens to the skin and observing for a reaction 2, 4, 5.
- Photopatch test: a test that involves applying small amounts of potential allergens to the skin and exposing the skin to sunlight or other forms of radiation 5.
- Skin tests for detecting immediate contact reactions: tests that involve applying small amounts of potential allergens to the skin and observing for an immediate reaction 5.
- Serum allergen-specific IgE test: a test that measures the levels of IgE antibodies in the blood in response to specific allergens 5.
- Qualitative and quantitative testing of allergen in the suspected materials: tests that involve analyzing the suspected materials for the presence of specific allergens 5.
- Challenge test: a test that involves exposing the patient to the suspected allergen and observing for a reaction 5.