What is the recommended treatment for contact dermatitis?

Treatment for Contact Dermatitis

The first-line treatment for contact dermatitis is topical corticosteroids, soap substitutes, and emollients, with allergen identification and avoidance being essential for long-term management. 1

Initial Management Approach

Identify and Avoid Triggers

• The cornerstone of contact dermatitis management is identifying and avoiding irritants (detergents, frequent hand washing, hot water) and allergens 2
• Patch testing is recommended for persistent eczematous eruptions to identify specific allergens (Quality of evidence II.ii, Strength of recommendation A) 1
• For workplace-related dermatitis, a site visit may be necessary to identify potential allergens and irritants (Quality of evidence III, Strength of recommendation B) 1

Skin Protection and Hygiene

• Use lukewarm or cool water for hand washing to prevent skin barrier damage 2
• Pat dry hands gently rather than rubbing 2
• Use soaps/synthetic detergents without allergenic surfactants, preservatives, fragrances, or dyes 2
• After-work creams provide protection against developing irritant contact dermatitis (Quality of evidence I, Strength of recommendation A) 1
• Barrier creams alone have questionable value in protecting against irritants and should not be overpromoted (Quality of evidence I, Strength of recommendation E) 1

First-Line Treatments

Topical Corticosteroids

• Topical corticosteroids are widely accepted as the treatment of established contact dermatitis 1
• For localized acute allergic contact dermatitis, mid- or high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% are effective 3
• For adults and children 2 years and older, apply hydrocortisone to affected areas no more than 3-4 times daily 4
• Long-term intermittent use of mometasone furoate has been shown effective in chronic hand eczema (Quality of evidence I, Strength of recommendation B) 1

Moisturizers and Emollients

• Apply moisturizer immediately after hand washing 2
• For severe dryness, use "soak and smear" technique: soak hands in plain water for 20 minutes followed by immediate moisturizer application 2
• Soap substitutes and emollients should be used alongside topical corticosteroids 1

Second-Line Treatments

For Extensive or Resistant Cases

• If allergic contact dermatitis involves more than 20% of skin area, systemic steroid therapy is often required and offers relief within 12-24 hours 3
• For severe cases (e.g., rhus dermatitis), oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 3
• Topical tacrolimus has shown effectiveness in allergic contact dermatitis models 1

Advanced Therapies

• For steroid-resistant chronic hand dermatitis, consider psoralen plus UVA, azathioprine, or ciclosporin (Quality of evidence I, Strength of recommendation A) 1
• Consider advanced treatment when hand dermatitis doesn't improve after 6 weeks of treatment 2

Special Considerations

Occupational Dermatitis

• The long-term prognosis for occupational contact dermatitis is often poor, with studies showing only 25% of patients completely healed after 10 years 1
• For healthcare workers, use water-based moisturizers under gloves (oil-based moisturizers can break down latex and rubber) 2
• Consider occupational modification for recalcitrant cases 2

Common Pitfalls to Avoid

• Avoid applying gloves when hands are still wet from washing or sanitizer 2
• Avoid using very hot water for hand washing 2
• Do not wash hands with dish detergent or other known irritants 2
• Avoid increased duration of glove occlusion without underlying moisturizer 2

When to Refer to Dermatology

• Refer for suspected allergic contact dermatitis requiring patch testing 2
• Refer for recalcitrant dermatitis not responding to initial treatments 2
• Refer when there is a change in baseline hand dermatitis 2