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 allergen or irritant, followed by topical corticosteroids for symptom management. 1

Types of Contact Dermatitis

• Contact dermatitis can be classified as allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD), each requiring specific management approaches 1
• Allergic contact dermatitis is a delayed hypersensitivity reaction to a foreign substance, while irritant contact dermatitis is caused by non-immune-mediated irritation of the skin 2

Treatment Algorithm

Step 1: Identification and Avoidance

• Identify and completely avoid the suspected allergen or irritant - this is the cornerstone of treatment 1
• Perform patch testing when allergic contact dermatitis is suspected to identify specific allergens 1
• Replace soaps and detergents with emollients, as they are irritants that can compound the dermatitis even if not the primary cause 1

Step 2: Topical Treatments

• Apply topical corticosteroids to affected areas to mitigate flares of dermatitis 1
• For localized acute allergic contact dermatitis, use mid- to high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% 2
• For milder cases, hydrocortisone 1% can be applied to affected areas not more than 3-4 times daily 3
• Use moisturizers regularly after hand washing to prevent dryness 1
• 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 1

Step 3: For Persistent or Severe Cases

• If contact dermatitis involves more than 20% of body surface area, systemic steroid therapy may be required 2
• For recalcitrant cases, consider stronger topical steroids, phototherapy, or systemic immunomodulators such as methotrexate and mycophenolate mofetil 1
• Psoralen plus UVA, ciclosporin, and alitretinoin have demonstrated usefulness in chronic hand dermatitis 1

Special Considerations

• For hand dermatitis, use appropriate protective gloves based on the specific allergen or irritant involved 1
• For glove allergic contact dermatitis, use accelerator-free gloves such as rubber-free neoprene or nitrile gloves 1
• Apply moisturizer after washing hands and before wearing gloves 1
• Avoid moisturizers in jars to prevent contamination; use tubes instead 1

Common Pitfalls to Avoid

• Continuing use of irritants or allergens prevents healing - comprehensive questioning about hygiene practices and product use is essential 4
• Prolonged glove use may impair stratum corneum barrier function, though the clinical relevance is unclear 1
• Self-diagnosis of other conditions (like yeast infections) when the problem is actually contact dermatitis can lead to inappropriate treatment 4
• Exclusion diets are not supported by good-quality studies in the management of contact dermatitis 1

Prognosis

• The long-term prognosis for occupational contact dermatitis is often poor, with only 25% of patients completely healed over a 10-year period in one study 1
• Early identification and avoidance of triggers, combined with appropriate treatment, is critical to prevent chronic dermatitis 5, 6