What is the treatment for contact dermatitis?

Treatment of Contact Dermatitis

The first-line treatment for contact dermatitis includes allergen/irritant avoidance, topical corticosteroids, and skin barrier repair measures, with systemic corticosteroids reserved for severe or widespread cases. 1

Diagnosis and Classification

Contact dermatitis presents in two main forms:

• Irritant contact dermatitis: Non-immune mediated reaction to irritating substances
• Allergic contact dermatitis: Delayed hypersensitivity reaction to specific allergens

Other subtypes include:

• Phototoxic/photoallergic contact dermatitis
• Systemic contact dermatitis
• Protein contact dermatitis 1, 2

Treatment Algorithm

Step 1: Identify and Avoid the Causative Agent

• Take a detailed history of symptoms, products used, and occupational exposures
• For workplace-related dermatitis, investigate work practices and review safety data sheets
• Offer patch testing for chronic or persistent dermatitis to distinguish allergic from irritant forms 1

Step 2: Acute Management

For localized contact dermatitis:

• Apply mid- to high-potency topical corticosteroids (e.g., triamcinolone 0.1% or clobetasol 0.05%) 3
• Consider topical tacrolimus as an alternative when topical steroids are unsuitable or ineffective 1

For extensive contact dermatitis (>20% body surface area):

• Systemic corticosteroids (e.g., prednisone) may be required
• Taper over 2-3 weeks to prevent rebound dermatitis 3

Step 3: Skin Barrier Repair and Protection

• Use regular emollients and soap substitutes to maintain skin barrier function
• Consider skin protection creams for preventing occupational dermatitis
• For hand protection, use appropriate gloves based on chemical exposure, removing them regularly to prevent sweating 1, 4

Step 4: Management of Chronic or Recurrent Cases

• Consider alitretinoin for severe chronic hand eczema
• Consider PUVA therapy for chronic hand eczema
• For extremely resistant cases, immunosuppressants may be considered 1

Special Considerations

Hand Dermatitis

Hand dermatitis has a point prevalence of 2% with a lifetime risk of 20%. For chronic hand eczema:

• Alitretinoin is strongly recommended
• PUVA therapy can be considered
• Use clinical assessment tools like the Hand Eczema Severity Index to monitor treatment response 1

Occupational Contact Dermatitis

• Patient education is crucial
• Workplace assessment may be necessary
• Implement appropriate protective measures and skin care routines 1, 2

Potential Pitfalls

• Misdiagnosis: Clinical features alone are unreliable in distinguishing allergic contact from irritant and endogenous dermatitis, particularly with hand and facial dermatitis. Patch testing is essential for accurate diagnosis 1

• Inadequate allergen identification: Failure to identify and avoid causative allergens leads to treatment failure 4

• Overreliance on barrier creams: These are insufficient without proper avoidance and protection measures 4

• Premature discontinuation of oral steroids: Can lead to rebound dermatitis, especially in severe cases 4

• Ineffective corticosteroid use in certain cases: Some studies suggest corticosteroids may be ineffective for certain surfactant-induced irritant dermatitis 5

When to Refer to a Specialist

Consider referral when:

• Treatment fails despite appropriate first-line management
• Allergic contact dermatitis is suspected and requires patch testing
• Diagnosis remains uncertain
• Dermatitis is severe or recurrent despite preventive measures 1, 4