What is the treatment for contact dermatitis on the face?

Treatment of Contact Dermatitis on the Face

For contact dermatitis on the face, the primary treatment approach involves identifying and avoiding the causative agent, applying topical corticosteroids for inflammation, and using moisturizers to repair the skin barrier. 1

Diagnosis and Assessment

• Pattern and morphology of facial dermatitis are unreliable in distinguishing between irritant, allergic, or endogenous dermatitis, making proper assessment crucial 1
• A detailed history should include initial location of symptoms, spread pattern, and relationship to specific products or activities 1
• Patch testing is recommended for persistent cases to identify specific allergens 2, 1

First-Line Treatment

Immediate Management

• Identify and completely avoid the triggering irritant or allergen 1
• Use gentle cleansers and soap substitutes instead of harsh soaps 1
• Apply moisturizers immediately after washing to repair the skin barrier 1

Topical Corticosteroids

• Apply mid-potency topical corticosteroids like hydrocortisone to reduce inflammation 3
• For facial application in adults and children over 2 years: apply to affected area no more than 3-4 times daily 3
• Children under 2 years: consult a doctor before application 3
• Caution: prolonged use of topical steroids on the face can cause steroid-induced skin damage 1

Special Considerations for Facial Contact Dermatitis

• The face is particularly sensitive to cosmetics, sunscreens, and fragrances which are common triggers 2
• Subjective irritancy (stinging and smarting reactions) often occurs on the face within minutes of contact with cosmetic or sunscreen constituents 2
• Use moisturizers packaged in tubes rather than jars to prevent contamination 1

Second-Line Treatments

• For severe or recalcitrant cases not responding to topical corticosteroids, consider:
  • Topical tacrolimus as an alternative to steroids 2
  • Systemic therapies such as azathioprine or ciclosporin for extensive or severe cases 2
  • Phototherapy (PUVA) for chronic cases, particularly for hand dermatitis 2

Preventive Measures

• Barrier creams alone have questionable value in protecting against irritants 2
• After-work creams have shown benefit in reducing irritant contact dermatitis 2
• Avoid products containing known irritants, topical antibiotics, and disinfectant wipes 1

Common Pitfalls to Avoid

• Overuse of topical corticosteroids on the face can lead to skin thinning, telangiectasia, and perioral dermatitis 1
• Failure to identify and avoid the causative agent will result in persistent dermatitis 2
• Using very hot water for washing can exacerbate irritant contact dermatitis 1
• Over-reliance on barrier creams may give a false sense of security 2

Prognosis

• If the patient can completely avoid the cause of contact dermatitis, the condition will clear 2
• Prognosis for occupational contact dermatitis is often poor, with only 25% of patients completely healing in some studies 2
• Allergic contact dermatitis carries a worse prognosis than irritant contact dermatitis unless the allergen is identified and avoided 2