What is the treatment for contact dermatitis?

Treatment of Contact Dermatitis

The most effective treatment for contact dermatitis involves identifying and avoiding the causative agent, applying topical corticosteroids for inflammation, and using moisturizers to repair the skin barrier. 1

Types of Contact Dermatitis

• Contact dermatitis can be classified into two main types: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) 1
• Irritant contact dermatitis results from direct damage to the skin by irritants without immune involvement 1
• Allergic contact dermatitis involves a delayed hypersensitivity reaction requiring prior sensitization 1
• Other subtypes include immediate skin reactions, photoinduced contact dermatitis, and systemic contact dermatitis 2

Diagnosis and Assessment

• Pattern and morphology of dermatitis, especially on hands and face, is unreliable in distinguishing between irritant, allergic, or endogenous dermatitis 1
• Detailed history should include:
  • Initial location of symptoms and spread pattern 1
  • Relationship to specific products or activities 1
  • Occupational and recreational exposures 1
• Patch testing is recommended for persistent cases to identify specific allergens 1
• Patients with suspected allergic contact dermatitis should be evaluated with patch testing to identify clinically relevant allergens 1

Treatment of Irritant Contact Dermatitis

First-line Management:

• Identify and avoid irritants - most common are soaps, detergents, and water 1
• Use soap substitutes and gentle cleansers without harsh surfactants 1
• Apply moisturizers immediately after washing hands to repair skin barrier 1
• For nighttime treatment, use "soak and smear" technique:
  • Soak hands in plain water for 20 minutes 1
  • Immediately apply moisturizer to damp skin 1
  • Continue nightly for up to 2 weeks 1

Topical Treatments:

• Apply topical corticosteroids if conservative measures fail 1
• Consider potential steroid-induced damage to skin barrier with prolonged use 1
• For recalcitrant cases, consider phototherapy, systemic therapy, or occupational modification 1

Treatment of Allergic Contact Dermatitis

First-line Management:

• Identify allergens through patch testing and ensure complete avoidance 1
• Apply topical corticosteroids to mitigate flares of dermatitis 1
• Mid- to high-potency topical steroids (e.g., triamcinolone 0.1% or clobetasol 0.05%) are effective for localized lesions 3

Systemic Treatment:

• For extensive involvement (>20% body surface area), systemic steroids may be required 3
• Oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 3
• For severe or recalcitrant cases, consider:
  • Stronger topical steroids 1
  • Phototherapy 1
  • Systemic immunosuppressants like azathioprine or ciclosporin 1

Protective Measures

• For hand dermatitis, appropriate gloves provide protection 1
• For household tasks, use rubber or PVC gloves with cotton liners 1
• Remove gloves regularly as sweating may worsen dermatitis 1
• For glove-related allergic contact dermatitis, use accelerator-free gloves (neoprene or nitrile) 1
• Apply moisturizer before wearing gloves 1

Moisturizers and Barrier Creams

• Use moisturizers packaged in tubes rather than jars to prevent contamination 1
• Apply two fingertip units of moisturizer to hands after washing 1
• Barrier creams alone have questionable value in protecting against irritants 1
• After-work creams have shown benefit in reducing irritant contact dermatitis 1
• Water-based moisturizers are safe under all gloves; oil-based moisturizers can break down latex and rubber 1

Special Considerations

• For occupational dermatitis, workplace assessment may be necessary to identify all potential hazards 1
• Prognosis for occupational contact dermatitis is often poor, with many patients having persistent symptoms even after changing occupation 1
• Patients with recalcitrant hand dermatitis should seek dermatology consultation 1
• Nickel-sensitive patients may benefit from low-nickel diets in some cases 1

Common Pitfalls to Avoid

• Avoid washing hands with dish detergent or other known irritants 1
• Avoid very hot or very cold water for washing 1
• Avoid disinfectant wipes for cleaning hands 1
• Avoid products containing topical antibiotics (e.g., neomycin, bacitracin) which can cause allergic reactions 1
• Avoid excessive occlusion without underlying moisturizer application 1
• Do not over-promote barrier creams as they may give false sense of security 1