What is the recommended treatment for contact dermatitis?

Treatment of Contact Dermatitis

The recommended first-line treatment for contact dermatitis includes topical corticosteroids, soap substitutes, and emollients, with allergen identification and avoidance as essential components of management. 1

Initial Management Algorithm

Step 1: Identify and Avoid Triggers

• Determine whether irritant or allergic contact dermatitis
• For allergic contact dermatitis: identify and completely avoid allergen exposure 2
• For irritant contact dermatitis: minimize exposure to irritants (soaps, detergents, water) 1
• Consider workplace assessment for occupational cases 1

Step 2: Acute Treatment

1. Mild cases:

   • Over-the-counter hydrocortisone 1% cream 3-4 times daily 3
   • Apply to affected areas for up to 7 days

2. Moderate cases:

   • Mid to high-potency topical corticosteroids (e.g., triamcinolone 0.1%, betamethasone dipropionate) 2, 4
   • Apply thinly twice daily for 5-7 days

3. Severe cases (>30% body surface area or severely limiting daily activities):

   • Oral prednisone 0.5-1 mg/kg/day for 1-2 weeks with 4-6 week taper 2, 5
   • Important: Rapid discontinuation may cause rebound dermatitis 4, 5
   • Consider proton pump inhibitor for GI prophylaxis during systemic steroid use 2

Step 3: Skin Barrier Repair

• Use soap substitutes for washing 1
• Apply fragrance-free, dye-free moisturizers in tubes (not jars) 2
• "Soak and smear" technique for hands: soak in plain water for 20 minutes then immediately apply moisturizer to damp skin nightly for up to 2 weeks 2

Special Considerations

For Chronic or Recurrent Cases

• Consider patch testing if persistent or recurrent 1, 4
• Second-line treatments for steroid-resistant cases:
  • Topical calcineurin inhibitors (tacrolimus) 1, 2
  • For chronic hand dermatitis: psoralen plus UVA, azathioprine, or ciclosporin 1

For Children

• Use lower potency corticosteroids in children due to increased risk of side effects 6
• Avoid potent agents in pediatric patients 6
• For children under 2 years: consult a doctor before using hydrocortisone 3

For Occupational Cases

• After-work creams provide protection against developing irritant contact dermatitis 1
• Make moisturizers readily available in the workplace 1
• Note: Barrier creams alone have questionable value in protecting against irritants 1

Prevention Strategies

• Apply moisturizer after washing hands and before wearing gloves 2
• Use gentle skin care practices and avoid known irritants 2
• For healthcare workers (high-risk group): minimize exposure to harsh chemicals and frequent hand washing 2

When to Refer to a Specialist

• Failure to respond to appropriate first-line treatment
• Recurrent episodes despite preventive measures
• Suspicion of allergic contact dermatitis requiring patch testing
• Uncertainty about diagnosis 2

Prognosis

The prognosis for contact dermatitis depends on allergen avoidance. For milder cases with successful avoidance, dermatitis will clear. However, occupational contact dermatitis often has a poor long-term prognosis, with studies showing only 25% of patients completely healed after 10 years 1.