What is the first line treatment for contact dermatitis?

First-Line Treatment for Contact Dermatitis

The first-line treatment for contact dermatitis is identification and avoidance of the causative agent, followed by topical corticosteroids for inflammation and moisturizers to repair the skin barrier. 1

Initial Management Approach

• Identify and completely avoid the irritant or allergen that is causing the dermatitis 2, 1
• Replace soaps and detergents with emollients, as they can compound irritation even if they are not the primary cause 2
• Apply moisturizers immediately after washing to repair the skin barrier 1
• Use mid- to high-potency topical corticosteroids for localized acute allergic contact dermatitis 3

Treatment Based on Type of Contact Dermatitis

Irritant Contact Dermatitis

• Use gentle cleansers and soap substitutes to prevent further irritation 1
• Apply moisturizers packaged in tubes (rather than jars) to prevent contamination 1
• Apply two fingertip units of moisturizer to hands after washing 1
• Use topical corticosteroids if conservative measures fail 1, 4

Allergic Contact Dermatitis

• Complete allergen avoidance is essential after identification through patch testing 1
• Apply topical corticosteroids to mitigate flares of dermatitis 1
• For extensive involvement (>20% of skin surface), systemic steroid therapy may be required 3
• For severe cases involving poison ivy (rhus dermatitis), oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 3

Protective Measures

• For hand dermatitis, use appropriate gloves based on the specific allergen or irritant 2
• For household tasks, use rubber or PVC gloves with cotton liners 1
• Remove gloves regularly and apply moisturizer before wearing gloves 1
• After-work creams have demonstrated benefit in reducing irritant contact dermatitis 2
• Barrier creams alone have questionable value in protecting against irritants 2, 1

Treatment for Persistent Contact Dermatitis

• For dermatitis that persists despite allergen/irritant removal and skin protection, treatment follows management of atopic/endogenous dermatitis 2
• Second-line treatments include:
  • Topical tacrolimus, which has shown efficacy in contact dermatitis 2
  • Phototherapy 2
  • Systemic immunomodulators such as methotrexate and mycophenolate mofetil 2
  • Psoralen plus UVA, ciclosporin, and alitretinoin for chronic hand dermatitis 2
  • Azathioprine for chronic actinic dermatitis 2

Common Pitfalls to Avoid

• Overpromotion of barrier creams, which may give users a false sense of security 1
• Washing hands with dish detergent or other known irritants 1
• Using very hot or very cold water for washing 1
• Using disinfectant wipes and products containing topical antibiotics 1
• Excessive occlusion without underlying moisturizer application 1
• Prolonged glove use, which may impair stratum corneum barrier function 2

Special Considerations

• For occupational dermatitis, workplace assessment may be necessary to identify all potential hazards 1
• Educational programs may help in secondary prevention and outcomes for chronic occupational contact dermatitis 2
• The prognosis for occupational contact dermatitis is often poor, with studies showing only 25% of patients completely healed over a 10-year period 2
• If treatment fails and the diagnosis or specific allergen remains unknown, patch testing should be performed 3