Does contact dermatitis resolve spontaneously?

Does Contact Dermatitis Go Away on Its Own?

Contact dermatitis rarely resolves completely on its own without intervention, with studies showing only 25% of occupational contact dermatitis cases completely heal even over a 10-year period. 1

Prognosis of Contact Dermatitis

The natural course of contact dermatitis depends on several factors:

• Long-term outcomes: According to a Swedish study, only 25% of 555 patients with occupational contact dermatitis completely healed over a 10-year period, while 50% had intermittent symptoms and 25% had permanent symptoms 1
• Persistence despite occupation change: In 40% of patients who changed their occupation, the overall prognosis was not improved 1
• Two-year outcomes: An Australian study showed that 55% of 949 patients still had dermatitis after 2 years from diagnosis 1
• Severity correlation: The prognosis for milder cases depends upon the ease of allergen/irritant avoidance 1

Management Approach for Contact Dermatitis

1. Allergen/Irritant Identification and Avoidance

The cornerstone of treatment is identifying and avoiding the causative agent:

• Workplace assessment: May be necessary to identify all potential skin hazards 1
• Complete avoidance: The first step in confirming diagnosis is determining whether the problem resolves with avoidance of the suspected substance 2

2. Skin Protection Measures

When complete avoidance is not possible:

• Gloves: For hand protection, with specific types based on chemical exposure 1

  • For household tasks: Rubber or polyvinyl chloride gloves with cotton liners
  • For occupational exposure: Specific gloves based on chemical permeation time

• Regular glove removal: Important to prevent sweating that may aggravate existing dermatitis 1

• Substitution: Replace harsh soaps and detergents with emollients, even if they're not the direct cause of dermatitis 1

3. Treatment of Persistent Contact Dermatitis

When dermatitis persists despite avoidance and protection:

• First-line treatment:

  • Localized cases: Mid- or high-potency topical steroids (triamcinolone 0.1% or clobetasol 0.05%) 2
  • Extensive cases (>20% body surface): Systemic steroid therapy, which offers relief within 12-24 hours 2
  • Severe cases: Oral prednisone tapered over 2-3 weeks to prevent rebound dermatitis 2

• Second-line treatment for persistent cases:

  • Topical tacrolimus 1
  • Phototherapy 1
  • Systemic immunomodulators (methotrexate, mycophenolate mofetil) 1
  • For chronic hand dermatitis: Psoralen plus UVA, ciclosporin, and alitretinoin 1

Important Considerations and Pitfalls

• Barrier creams: While they show promise in vitro and improve skin quality scores, their workplace efficacy is less certain and may not translate to significant clinical difference 1

• Exclusion diets: There are no good-quality studies supporting exclusion diets in contact dermatitis management, except some evidence for low nickel diets in nickel-sensitive patients 1

• Educational programs: May help in secondary prevention and outcomes for chronic occupational contact dermatitis, but compliance with skin-protection programs is often poor 1

• Economic impact: Contact dermatitis represents a substantial economic burden, with costs of approximately €2300 per patient per annum for occupational contact dermatitis 1

• Diagnostic challenges: If treatment fails and the specific allergen remains unknown, patch testing should be performed 2

In summary, while mild cases of contact dermatitis may improve with allergen avoidance, most cases require active intervention for complete resolution, and many will have a chronic or relapsing course despite appropriate management.