What is the treatment for contact dermatitis, including the use of antibiotics?

Treatment of Contact Dermatitis

The primary treatment for contact dermatitis is identification and avoidance of the causative allergen or irritant, followed by topical corticosteroids as the first-line therapy for established dermatitis. 1

Diagnosis and Classification

• Contact dermatitis can be classified as irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD), with irritant being more common but allergic carrying a worse prognosis unless the allergen is identified and avoided 2
• The pattern and morphology of dermatitis, particularly on the hands and face, is unreliable in predicting the cause or distinguishing between contact and atopic dermatitis 2
• Patients with suspected allergic contact dermatitis should be referred for patch testing to identify specific allergens 2, 1

First-Line Treatment

Allergen/Irritant Avoidance

• The most important step for successful treatment is identifying and avoiding the causative agent 1
• For hand dermatitis, avoid irritants such as frequent hand washing, use of dish detergents, very hot/cold water, and disinfectant wipes 2

Topical Corticosteroids

• Apply mid-potency topical corticosteroids to affected areas twice daily for acute cases 1, 3
• Select corticosteroid potency based on severity and location:
  • Lower potency for face, neck, and skin folds to avoid skin atrophy 1
  • Mid- or high-potency (triamcinolone 0.1% or clobetasol 0.05%) for localized acute allergic contact dermatitis 3

Skin Barrier Repair

• Replace soaps and detergents with emollients to restore the skin barrier 1
• Apply moisturizer after washing hands and before wearing gloves 2
• Use two fingertip units of moisturizer for adequate hand coverage 2

Second-Line Treatments

For Extensive or Severe Cases

• If allergic contact dermatitis involves more than 20% of skin surface, systemic steroid therapy is often required (provides relief within 12-24 hours) 3
• For severe poison ivy (rhus) dermatitis, oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 3

For Chronic or Recurrent Cases

• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are useful steroid-sparing agents, particularly for sensitive areas 1
• For steroid-resistant chronic hand dermatitis, consider:
  • Phototherapy (PUVA) 1
  • Systemic immunomodulators: azathioprine, ciclosporin, methotrexate, mycophenolate mofetil 1
  • Alitretinoin 1
• Proactive therapy with twice-weekly application of topical corticosteroids or calcineurin inhibitors to previously affected areas can help prevent recurrence 1

Important Considerations and Pitfalls

• Antibiotics are not indicated for uncomplicated contact dermatitis as it is not an infectious condition 2, 1
• Long-term application of topical antibiotics is not recommended due to increased risk of resistance and skin sensitization 1, 4
• Topical antibiotics (neomycin, bacitracin) are common allergens themselves and can cause allergic contact dermatitis 2, 4
• Barrier creams alone have questionable value in protecting against contact with irritants and may give a false sense of security 1
• Topical antihistamines have limited evidence supporting their efficacy and may increase the risk of contact dermatitis 1
• The prognosis for occupational contact dermatitis is often poor, with only 25% of patients completely healing over a 10-year period 1
• For recalcitrant cases where allergen avoidance is not possible (such as occupational exposure), advanced therapies may be needed 5

Special Situations

Hand Dermatitis

• Use rubber-free gloves (neoprene or nitrile) if latex allergy is suspected 2
• Consider cotton glove liners or loose plastic gloves 2
• Avoid washing hands with very hot water, as temperatures above 40°C can disrupt the stratum corneum 2
• Avoid applying gloves when hands are still wet from washing or sanitizing 2

Photocontact Dermatitis

• Requires simultaneous exposure to a contactant and light 6
• Common causes include sunscreens, topical NSAIDs (photo-allergic), plants, and psoralens (photo-irritant) 6
• Treatment involves identification and avoidance of the triggering chemical and photoprotection 6