From the Guidelines
The treatment for contact dermatitis is primarily topical corticosteroids and topical tacrolimus, with second-line treatment options including phototherapy and systemic immunomodulators such as methotrexate and mycophenolate mofetil 1.
First-line Treatment
- Topical corticosteroids: widely accepted as the treatment of established contact dermatitis, with studies demonstrating their efficacy 1
- Topical tacrolimus: shown to be effective in a nickel model of allergic contact dermatitis, and can be used as an alternative to topical corticosteroids 1
Second-line Treatment
- Phototherapy: can be used for persistent contact dermatitis, with options including psoralen plus UVA 1
- Systemic immunomodulators: such as methotrexate and mycophenolate mofetil, can be used for severe or chronic cases of contact dermatitis 1
Additional Measures
- Avoidance of irritants: protection of the skin from irritants, such as soaps and detergents, is crucial in the management of irritant contact dermatitis 1
- Emollients and soap substitutes: can be used to help manage symptoms and prevent further irritation 1
From the Research
Treatment Options for Contact Dermatitis
The treatment for contact dermatitis can be categorized into several options, including:
- Avoidance of the offending agent 2
- Topical steroids, such as triamcinolone 0.1% or clobetasol 0.05%, for localized acute allergic contact dermatitis lesions 3
- Systemic steroid therapy for extensive areas of skin (greater than 20 percent) 3
- Oral prednisone for severe cases, which should be tapered over two to three weeks to avoid rebound dermatitis 3
- Emollients, topical and oral corticosteroids, topical calcineurin inhibitors, azathioprine, and ciclosporin 4
- Methotrexate and alitretinoin, which are recent additions to the treatment options 4
- Immunomodulatory and anti-inflammatory agents, which are promising new therapies 2
Management of Contact Dermatitis
The management of contact dermatitis involves:
- Correct identification of triggers, which allows patients to reduce or avoid exposure to these agents in the future 4
- A good clinical history, examination, and immunological tests, including patch testing, to determine the cause of contact dermatitis 4, 3
- Treatment of the inflammatory component and its consequent objective and subjective findings 2
Systemic Treatments for Contact Dermatitis
Systemic treatments for contact dermatitis are often used in more severe cases, where topical steroids may prove insufficient 5. However, there are no systemic treatments indicated for the treatment of widespread recalcitrant contact dermatitis 5. Systemic therapeutic agents, such as cyclosporine, may lead to improvement, but withdrawal of these agents can be challenging and may lead to undesirable morbidities 5.