What is the recommended treatment for contact dermatitis?

Contact Dermatitis Treatment

The recommended first-line treatment for contact dermatitis is avoidance of the causative agent, use of gentle emollients as soap substitutes, and application of topical corticosteroids appropriate to the severity and location of the dermatitis. 1, 2

Diagnosis and Classification

Contact dermatitis presents in two main forms:

• Irritant contact dermatitis: Non-immune mediated skin irritation caused by direct damage from substances
• Allergic contact dermatitis: Delayed hypersensitivity reaction requiring prior sensitization 2

Common triggers include:

• Poison ivy
• Nickel
• Fragrances
• Soaps and detergents
• Workplace chemicals 2, 3

Treatment Algorithm

Step 1: Avoidance and Prevention

• Identify and completely avoid the suspected irritant or allergen 1, 3
• Replace soaps and detergents with gentle emollients 1
• For occupational cases, consider workplace assessment 1
• Use appropriate protective gloves based on chemical exposure, removing regularly to prevent sweating 1

Step 2: Restore Skin Barrier

• Apply emollients and soap substitutes regularly to maintain skin barrier function 1
• Use white soft paraffin (petroleum jelly) for affected lips, reapplying every 2 hours 1

Step 3: Reduce Inflammation Based on Severity

For localized, mild to moderate cases:

• Apply mid- to high-potency topical corticosteroids such as:
  • Triamcinolone 0.1%
  • Clobetasol 0.05% 2

For extensive cases (>20% body surface area):

• Systemic corticosteroid therapy (provides relief within 12-24 hours)
• For severe cases (e.g., rhus dermatitis from poison ivy), oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 2

For facial or intertriginous areas:

• Consider tacrolimus 0.1% ointment twice daily for up to 4 weeks as an alternative to corticosteroids 1

Step 4: Symptomatic Relief

• Oral antihistamines for pruritus control 3
• Topical anesthetics for pain relief in specific cases 1

Special Considerations

Hand Dermatitis

• Use cotton glove liners under protective gloves
• Apply emollients frequently throughout the day
• Consider nighttime occlusion therapy with emollients under cotton gloves 1

Facial Dermatitis

• Use only mild, fragrance-free products
• Apply lower potency corticosteroids (hydrocortisone 1%) or non-steroidal alternatives like tacrolimus 1, 3

Monitoring and Follow-up

• Reassess after 2 weeks of treatment to evaluate effectiveness 1
• If no improvement, consider:
  • Patch testing to identify specific allergens
  • Referral to dermatologist 2, 3

Treatment Efficacy Evidence

The evidence regarding topical corticosteroid efficacy in irritant contact dermatitis is mixed:

• A 2001 study found low- and medium-potency corticosteroids ineffective in treating SLS-induced irritant dermatitis compared to vehicle 4
• However, a 1995 study demonstrated that potent topical corticosteroids (betamethasone-17-valerate) significantly improved healing of irritant skin reactions compared to vehicle 5

The most recent evidence (2024) continues to support corticosteroids as the main treatment option for contact dermatitis 6.

Potential Pitfalls to Avoid

• Overuse of topical corticosteroids leading to skin atrophy, telangiectasia, and HPA axis suppression 1
• Inadequate allergen identification resulting in treatment failure 1
• Misdiagnosis of other conditions like psoriasis or fungal infections 1
• Reliance on barrier creams alone without proper avoidance measures 1
• Premature discontinuation of oral steroids causing rebound dermatitis 1, 2

Indications for Specialist Referral

Refer to a dermatologist if:

• Treatment fails despite appropriate first-line therapy
• Recurrent episodes occur despite preventive measures
• Allergic contact dermatitis is suspected requiring patch testing
• Diagnosis is uncertain 1