From the Guidelines
The treatment for contact dermatitis should primarily involve topical steroids and topical tacrolimus, as supported by recent guidelines. When considering the management of contact dermatitis, it's crucial to prioritize treatments that have shown efficacy in reducing symptoms and improving quality of life. According to the British Association of Dermatologists' guidelines for the management of contact dermatitis 1, therapy for contact dermatitis persisting despite allergen/irritant removal and skin protection largely follows the management of atopic/endogenous dermatitis, with topical steroids and topical tacrolimus being key treatments.
Key Treatment Approaches
- Topical steroids: Effective for reducing inflammation and immune response.
- Topical tacrolimus: Useful for its immunomodulatory effects without the steroid side effects.
- Second-line treatments: Include phototherapy and systemic immunomodulators such as methotrexate and mycophenolate mofetil for more severe cases.
- Specific treatments for chronic conditions: Psoralen plus UVA, ciclosporin, and alitretinoin have been demonstrated to be useful in chronic hand dermatitis, and azathioprine in chronic actinic dermatitis, as noted in the guidelines 1.
Considerations for Treatment
- Identifying and avoiding the triggering substance is the first step in managing contact dermatitis.
- For mild cases, over-the-counter treatments can provide relief, but for moderate to severe cases, prescription-strength treatments are necessary.
- Regular application of moisturizers and consideration of wet dressings or oatmeal baths can soothe inflamed skin and aid in the healing process.
- Monitoring for signs of infection and adjusting treatment accordingly is crucial for preventing complications.
Given the evidence, the most recent and highest quality study 1 supports the use of topical steroids and topical tacrolimus as the primary treatment for contact dermatitis, emphasizing the importance of evidence-based practice in guiding treatment decisions.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis
Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Contact dermatitis
The treatment for contact dermatitis includes hydrocortisone (TOP) to temporarily relieve itching associated with minor skin irritations and inflammation, and prednisone (PO) for control of severe or incapacitating allergic conditions, including contact dermatitis 2 3.
- Topical hydrocortisone may be used for mild cases of contact dermatitis.
- Oral prednisone may be used for more severe cases of contact dermatitis, under the advice and supervision of a doctor.
From the Research
Treatment for Contact Dermatitis
The treatment for contact dermatitis involves several steps, including:
- Avoidance of the causative substance or allergen [(4,5,6,7)]
- 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% 4
- Antihistamines
- Systemic corticosteroids and immunosuppressants [(4,5)]
- Patch testing to identify the specific allergen and confirm the diagnosis [(4,5,7)]
- Treatment of acute cases with mid- or high-potency topical steroids, and systemic steroid therapy for extensive areas of skin involvement 4
Specific Treatment Options
- For localized acute allergic contact dermatitis, mid- or high-potency topical steroids are effective 4
- For severe cases, such as rhus dermatitis, oral prednisone may be necessary, and should be tapered over two to three weeks to avoid rebound dermatitis 4
- In cases where avoidance of the allergen is not possible, advanced therapies may be necessary 6
Diagnostic Tests
- Patch testing is the gold standard for diagnosing allergic contact dermatitis 7
- 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 suspected materials, may also be used 5