What cream is recommended for contact dermatitis?

Management of Contact Dermatitis

For contact dermatitis, topical corticosteroids are recommended for inflammation, while moisturizers should be used to repair the skin barrier after identifying and avoiding the causative agent. 1

Types of Contact Dermatitis

• Contact dermatitis presents in two main forms: irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD), both characterized by erythematous and pruritic skin lesions 2
• Irritant contact dermatitis is caused by non-immune-mediated irritation of the skin, while allergic contact dermatitis is a delayed hypersensitivity reaction 2

First-Line Treatment Approach

For Irritant Contact Dermatitis:

• Identify and avoid irritants completely, including switching to less-irritating products 3
• Use gentle cleansers and soap substitutes that are free of allergenic surfactants, preservatives, fragrances, or dyes 3
• Apply moisturizers immediately after washing hands to repair the skin barrier 3
• Moisturizers should be packaged in tubes rather than jars to prevent contamination 3
• For nighttime treatment, consider the "soak and smear" technique: soak hands in plain water for 20 minutes and immediately apply moisturizer to damp skin nightly for up to 2 weeks 3

For Allergic Contact Dermatitis:

• Identify allergens through patch testing and ensure complete avoidance 3
• Application of topical corticosteroids is recommended to mitigate flares of dermatitis 3
• Mid- to high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% are effective for localized acute allergic contact dermatitis 2
• For extensive involvement (>20% body surface area), systemic steroids may be required 2

Topical Corticosteroid Selection

• For mild-to-moderate cases, use low to medium potency topical corticosteroids 3
• For severe or recalcitrant cases, stronger topical steroids may be needed 3
• Clobetasol propionate (0.05%) is a highly potent topical corticosteroid but should not be used for more than 2 weeks at a time due to risk of HPA axis suppression 4
• Apply topical corticosteroids only if conservative measures fail; consider potential steroid-induced damage to skin barrier with prolonged use 3

Protective Measures

• For hand dermatitis, use appropriate gloves with cotton liners for household tasks 1
• Remove gloves regularly and apply moisturizer before wearing gloves to prevent dermatitis 1
• For glove-related allergic contact dermatitis, use accelerator-free gloves such as rubber-free neoprene or nitrile gloves 3
• Consider cotton glove liners or loose plastic gloves to create a protective barrier 3

Important Cautions and Considerations

• Barrier creams alone have questionable value in protecting against irritants and may give a false sense of security 3
• After-work creams have shown benefit in reducing irritant contact dermatitis and should be encouraged 3
• Avoid washing hands with dish detergent, very hot or cold water, and disinfectant wipes 3
• Avoid products containing topical antibiotics (e.g., neomycin, bacitracin) as they can cause allergic reactions 3
• For recalcitrant cases that don't respond to topical treatments, consider phototherapy, azathioprine, or ciclosporin 3
• Clobetasol propionate should not be used on the face, groin, or axillae, and is not recommended for treating rosacea or perioral dermatitis 4

When to Refer to Dermatology

• Patients with recalcitrant hand dermatitis should seek dermatology consultation 3
• Individuals with suspected allergic contact dermatitis should be patch tested to evaluate for clinically relevant causal allergens 3
• If treatment fails and the specific allergen remains unknown, patch testing should be performed 2