From the Guidelines
The treatment for contact dermatitis should primarily involve topical steroids and topical tacrolimus, as supported by recent guidelines 1. When managing contact dermatitis, it is essential to identify and avoid the triggering substance.
- For mild cases, over-the-counter treatments such as calamine lotion, hydrocortisone cream (1%), or antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours for itching can be used.
- For moderate cases, prescription-strength topical corticosteroids such as triamcinolone 0.1% applied twice daily for 1-2 weeks may be necessary, as well as topical tacrolimus, which has been shown to be effective in the treatment of contact dermatitis 1.
- Severe or widespread cases might require second-line treatments including phototherapy and systemic immunomodulators such as methotrexate and mycophenolate mofetil, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. It is also crucial to moisturize regularly with fragrance-free products to help repair the skin barrier and keep the affected area clean but avoid hot water and harsh soaps.
- Replacement of soaps and detergents with emollients is useful, even if they are not the cause of the dermatitis, as they are irritants which will compound the situation, as noted in the guidelines 1.
- Substitution of different materials both in the workplace and outside can help avoid the implicated allergen or irritant, such as using thiuram-free gloves or changing biocides in industrial coolant oils 1.
From the Research
Treatment Options for Contact Dermatitis
The treatment for contact dermatitis primarily involves avoiding the offending agent [(2,3,4)]. However, in cases where avoidance is not possible, various therapeutic options are available to manage the condition.
- Topical Treatments: Topical corticosteroids are commonly used to reduce inflammation and alleviate symptoms [(2,3)].
- Systemic Treatments: In severe cases of allergic contact dermatitis, systemic therapeutic agents such as cyclosporine may be used 5.
- Emollients and Skin Care: Restoring the skin barrier and reducing inflammation through the use of emollients, antihistamines, and other topical treatments is also important 3.
- Avoidance and Protection: Eliminating the offending agent and protecting the skin from further exposure is crucial in both diagnosis and management [(2,3,4)].
Management of Specific Types of Contact Dermatitis
Different types of contact dermatitis, such as irritant contact dermatitis and allergic contact dermatitis, may require distinct management approaches.
- Irritant Contact Dermatitis: The diagnosis is generally based on clinical appearance, history, and diagnostic patch testing to rule out an allergic component 4.
- Allergic Contact Dermatitis: Systemic treatments and immunomodulatory agents may be necessary in severe cases 5.
Additional Considerations
It is essential to note that the treatment of contact dermatitis should be tailored to the individual patient's needs and the specific characteristics of the condition [(2,3)].