What is the treatment for contact dermatitis caused by a new facial wash?

Treatment for Contact Dermatitis from New Facial Wash

The first-line treatment for contact dermatitis caused by a new facial wash is to immediately discontinue the offending product and apply a topical corticosteroid such as hydrocortisone to the affected area up to 3-4 times daily. 1, 2

Immediate Management

1. Stop using the facial wash immediately

   • Complete avoidance of the irritant/allergen is essential for resolution 2, 3
   • Switch to a gentle, fragrance-free cleanser without allergenic surfactants or preservatives 2

2. Apply topical corticosteroids

   • For mild to moderate cases: Use over-the-counter hydrocortisone 1% cream 3-4 times daily 1
   • For more severe or extensive cases (>20% body surface area): Mid to high-potency prescription topical steroids may be needed 4
   • Apply to affected areas for 1-2 weeks, tapering as symptoms improve 2

3. Moisturize frequently

   • Apply moisturizer immediately after cleansing 2
   • Use fragrance-free, dye-free moisturizers in tubes (not jars) 2
   • For severe dryness: "Soak and smear" technique - soak skin in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks 2

Distinguishing Between Types of Contact Dermatitis

• Irritant Contact Dermatitis (ICD)

  • More common type 2
  • Rapid onset (minutes to hours after exposure) 3
  • Caused by direct skin damage from irritating substances in the facial wash 2
  • Treatment focuses on barrier repair and anti-inflammatory therapy 2

• Allergic Contact Dermatitis (ACD)

  • Delayed onset (24-72 hours after exposure) 3
  • Immune-mediated response requiring prior sensitization 2
  • May require patch testing if recurrent or severe 2
  • More likely to persist even after allergen avoidance 2

For Persistent or Severe Cases

1. Systemic therapy options

   • For extensive involvement (>20% body surface): Short course of oral prednisone, tapered over 2-3 weeks 4
   • Rapid discontinuation of steroids can cause rebound dermatitis 4

2. Specialist referral indications

   • Recalcitrant cases not responding to initial treatment 2
   • Suspected allergic contact dermatitis requiring patch testing 2
   • Widespread or severe reactions 4

Prevention of Recurrence

• Use facial products that are free of:

  • Fragrances
  • Dyes
  • Allergenic preservatives
  • Harsh surfactants 2, 5

• Look for products with added moisturizers 2

• Consider using barrier creams (humectants) before potential exposures 2

Common Pitfalls to Avoid

• Continuing to use the offending product "to see if it gets better" 3
• Using hot water for cleansing (increases irritation) - use lukewarm or cool water instead 2
• Applying topical antibiotics (e.g., neomycin, bacitracin) which can cause secondary allergic reactions 2
• Failing to recognize that facial dermatitis may be caused by products used elsewhere (e.g., shampoo, hand products transferred to face) 5
• Inadequate duration of treatment leading to recurrence 4

Remember that contact dermatitis can mimic other skin conditions, so if symptoms persist despite appropriate treatment, further evaluation may be necessary 6.