What medications are used to treat contact dermatitis?

Medications for Contact Dermatitis

Topical corticosteroids are the first-line treatment for established contact dermatitis, along with soap substitutes and emollients. 1

First-Line Treatments

Topical Corticosteroids

• Topical corticosteroids are widely accepted as the primary treatment for established contact dermatitis due to their anti-inflammatory, antipruritic, and vasoconstrictive actions 1, 2
• The potency should be selected based on severity and location:
  • Mid- to high-potency steroids (e.g., triamcinolone 0.1% or clobetasol 0.05%) for localized acute allergic contact dermatitis 3
  • Lower potency steroids for face, neck, and skin folds to avoid skin atrophy 1
• Long-term intermittent use of mometasone furoate has shown efficacy in chronic hand eczema (Quality of evidence I) 1
• For extensive areas (>20% of skin surface), systemic steroid therapy may be required 3

Emollients and Soap Substitutes

• Replacement of soaps and detergents with emollients is beneficial even if they are not the direct cause of dermatitis 1
• Soap substitutes and emollients help restore the skin barrier and prevent further irritation 1
• After-work creams provide some protection against developing irritant contact dermatitis (Quality of evidence I) 1

Second-Line Treatments

Topical Calcineurin Inhibitors

• Topical tacrolimus has demonstrated effectiveness in allergic contact dermatitis models 1
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are useful steroid-sparing agents, particularly for sensitive areas 1

Systemic Treatments for Resistant Cases

• For steroid-resistant chronic hand dermatitis, second-line treatments include:
  • Phototherapy (PUVA) 1
  • Systemic immunomodulators: azathioprine, ciclosporin, methotrexate, mycophenolate mofetil 1
  • Alitretinoin has shown efficacy in chronic hand dermatitis 1

Treatment Algorithm

1. Identify and avoid the causative allergen/irritant - This is the most important step for successful treatment 1
2. For mild to moderate cases:
   • Apply mid-potency topical corticosteroids to affected areas twice daily 1, 3
   • Use emollients and soap substitutes regularly 1
3. For severe or extensive cases:
   • Consider short-term systemic corticosteroids (taper over 2-3 weeks to prevent rebound) 3
   • If treatment fails, consider patch testing to identify specific allergens 1
4. For chronic or recurrent cases:
   • Consider proactive therapy with twice-weekly application of topical corticosteroids or calcineurin inhibitors to previously affected areas 1
   • For steroid-resistant cases, consider second-line treatments like phototherapy or systemic immunomodulators 1

Important Considerations and Pitfalls

• Barrier creams alone have questionable value in protecting against contact with irritants and may give a false sense of security (Quality of evidence I) 1
• Long-term application of topical antibiotics is not recommended due to increased risk of resistance and skin sensitization 1
• Topical antihistamines have limited evidence supporting their efficacy and may increase the risk of contact dermatitis themselves 1
• The prognosis for occupational contact dermatitis is often poor - studies show only 25% of patients completely heal over a 10-year period 1
• If the causative agent can be completely avoided, milder cases of contact dermatitis have a better prognosis 1