What cream is recommended for contact dermatitis?

Management of Contact Dermatitis: Recommended Creams and Treatments

For contact dermatitis, topical corticosteroids are the first-line treatment, with medium to high-potency formulations recommended for moderate to severe cases, along with regular use of moisturizers in tubes for barrier repair. 1

First-Line Treatment Options

Topical Corticosteroids

• For mild cases: Low-potency corticosteroids (e.g., hydrocortisone 1%)
• For moderate to severe cases: Medium to high-potency corticosteroids 1
  • Apply thinly twice daily to affected areas for 5-7 days
  • For severe cases: Clobetasol propionate 0.05% cream/ointment or betamethasone dipropionate cream/ointment 1
  • Caution: High-potency corticosteroids should not be used for more than 2 weeks at a time due to risk of HPA axis suppression 2

Moisturizers/Emollients

• Apply moisturizers in tubes (not jars) to prevent contamination 3
• Use after washing hands and before wearing gloves 3
• Choose fragrance-free, dye-free formulations 1
• Apply to damp skin for better absorption
• "Soak and smear" technique: Soak hands in plain water for 20 minutes and immediately apply moisturizer to damp skin nightly for up to 2 weeks 3, 1

Treatment Based on Type of Contact Dermatitis

For Irritant Contact Dermatitis (ICD)

1. Identify and avoid irritants (soaps, detergents, water exposure) 3, 1
2. Apply moisturizers/barrier creams regularly
3. Consider topical steroids if conservative measures fail 3
4. Note: Some studies show conflicting results on corticosteroid efficacy for ICD 4, 5, but clinical guidelines still recommend their use

For Allergic Contact Dermatitis (ACD)

1. Identify and avoid allergens through patch testing if necessary 3, 1
2. Apply topical steroids to mitigate flares 3
3. For recalcitrant cases, consider:
   • Stronger topical steroids
   • Topical calcineurin inhibitors (e.g., tacrolimus) as second-line treatment 1

Special Considerations

For Hand Dermatitis

• Apply moisturizer followed by cotton or loose plastic gloves at night for occlusion 3
• For healthcare workers: Use water-based moisturizers under gloves (oil-based moisturizers can break down latex and rubber) 3
• For glove-related ACD: Use accelerator-free gloves (rubber-free neoprene or nitrile) 3

For Severe or Widespread Cases

• If affecting >30% body surface area or severely limiting activities:
  • Consider oral prednisone 0.5-1 mg/kg/day for 1-2 weeks with a 4-6 week taper 1
  • Add proton pump inhibitor for GI prophylaxis during systemic steroid use 1

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 1

Common Pitfalls to Avoid

• Using moisturizers in jars (risk of contamination) 3
• Applying known allergens or irritants (e.g., products containing topical antibiotics) 3
• Prolonged use of high-potency corticosteroids (>2 weeks) 2
• Misdiagnosis - consider other conditions like psoriasis or fungal infections 1
• Using oil-based moisturizers under latex gloves 3

Remember that early identification and avoidance of triggers, combined with appropriate topical therapy, is essential for successful management of contact dermatitis.