What is the treatment for contact dermatitis?

Treatment of Contact Dermatitis

The first-line treatment for contact dermatitis involves allergen identification and avoidance, followed by topical corticosteroids to control inflammation, with systemic steroids reserved for extensive cases involving >20% of body surface area. 1, 2

Types of Contact Dermatitis

Contact dermatitis presents in two main forms:

• Allergic Contact Dermatitis (ACD): A delayed hypersensitivity reaction
• Irritant Contact Dermatitis (ICD): Non-immune-mediated skin irritation

Treatment Algorithm

1. Allergen/Irritant Identification and Avoidance

• Identify and completely avoid the causative agent 3, 4
• Workplace assessment may be necessary to identify sources of exposure 3
• For nickel allergy, consider low-nickel diets in some patients 3

2. Acute Management

• For localized mild-moderate contact dermatitis:

  • Mid to high-potency topical corticosteroids (e.g., triamcinolone 0.1% or clobetasol 0.05%) twice daily for up to 2 weeks 1, 2
  • Hydrocortisone is indicated for minor skin irritations and rashes due to various causes including contact dermatitis 5

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

  • Systemic corticosteroids (prednisone) with relief within 12-24 hours 2
  • For severe cases (e.g., rhus dermatitis), oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 2

3. Skin Barrier Repair

• Regular use of emollients and soap substitutes 3, 1
• Apply moisturizers immediately after cleansing and throughout the day 1
• Choose products free of allergenic surfactants, preservatives, fragrances, or dyes 1

4. Additional Measures

• For hand dermatitis: Consider testing for type I hypersensitivity to natural rubber latex (NRL) 3
• For infected or potentially infected eczema: Consider topical corticosteroid/antibiotic combinations 3

When to Consider Patch Testing

• Recurrent or persistent symptoms despite treatment 1
• Uncertainty about the causative allergen 2
• Treatment failure 4

Cautions and Pitfalls

• Barrier creams alone are of questionable value in protecting against irritants and may give a false sense of security 3
• Avoid overuse of topical corticosteroids, which can lead to skin atrophy and telangiectasia 1
• Monitor for signs of topical steroid side effects during treatment 1
• For systemic steroids, rapid discontinuation can cause rebound dermatitis 2
• Long-term prognosis may be poor, especially for occupational contact dermatitis, with studies showing only 25% of patients completely healing 3

Follow-up

• Reassess after 2 weeks of treatment to evaluate effectiveness 1
• Refer to a specialist if there is failure to respond to appropriate first-line treatment or uncertainty about diagnosis 1