What is the treatment for contact dermatitis?

Treatment of Contact Dermatitis

The first-line treatment for contact dermatitis is identifying and avoiding the causative agent, applying topical corticosteroids for inflammation, and using moisturizers to repair the skin barrier. 1

Diagnosis and Assessment

• Contact dermatitis presents as erythematous and pruritic skin lesions with visible borders, occurring after contact with a foreign substance 2
• Pattern and morphology of dermatitis, especially on hands and face, is unreliable in distinguishing between irritant, allergic, or endogenous dermatitis 1
• Detailed history should include:
  • Initial location and spread pattern
  • Relationship to specific products or activities
  • Occupational and recreational exposures 1
• Patch testing is recommended for persistent cases to identify specific allergens 3, 1

Treatment Algorithm

Step 1: Avoidance of Causative Agent

• Identify and completely avoid the offending allergen or irritant 1, 4
• For occupational dermatitis, workplace assessment may be necessary 1
• Prognosis improves significantly if the patient can avoid the cause of contact dermatitis 3

Step 2: Topical Treatments

• First-line treatment:
  • Topical corticosteroids for inflammation 3, 1
  • Soap substitutes and gentle cleansers 3
  • Emollients/moisturizers to repair skin barrier 1
• For localized acute allergic contact dermatitis:
  • Mid- or high-potency topical steroids (e.g., triamcinolone 0.1% or clobetasol 0.05%) 2
• For infected or potentially infected eczema:
  • Combined topical corticosteroid/antibiotic combinations may provide marginal benefit 3

Step 3: Systemic Treatments (for extensive or severe cases)

• If contact dermatitis involves >20% of skin surface area:
  • Systemic steroid therapy (offers relief within 12-24 hours) 2
  • For severe poison ivy/oak/sumac dermatitis (rhus dermatitis), oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 5, 2
• For steroid-resistant chronic hand dermatitis:
  • Second-line treatments include psoralen plus UVA, azathioprine, and ciclosporin 3, 1

Special Considerations

Protective Measures

• Appropriate gloves provide protection for hand dermatitis 1
  • Use rubber or PVC gloves with cotton liners for household tasks
  • Remove gloves regularly and apply moisturizer before wearing gloves 1

Moisturizers and Barrier Creams

• Apply moisturizers immediately after washing hands 1
• Use moisturizers packaged in tubes rather than jars to prevent contamination 1
• Barrier creams alone have questionable value in protecting against irritants (Strength of recommendation E) 3
• After-work creams have shown benefit in reducing irritant contact dermatitis (Strength of recommendation A) 3

Specific Types of Contact Dermatitis

• For nickel-sensitive patients:
  • Low nickel diets may benefit some patients (Quality of evidence IV, Strength of recommendation C) 3
• For chronic hand eczema:
  • Long-term intermittent use of mometasone furoate has shown benefit (Quality of evidence I, Strength of recommendation B) 3
• For recalcitrant cases:
  • Topical tacrolimus has been shown effective in allergic contact dermatitis 3

Prognosis and Follow-up

• Long-term prognosis for occupational contact dermatitis is often poor:
  • Only 25% of patients completely heal
  • 50% have periodic symptoms
  • 25% have permanent symptoms 3
• Changing occupation does not necessarily improve prognosis 3
• Milder cases have better prognosis if causative agent can be avoided 3

Common Pitfalls to Avoid

• Over-promoting barrier creams, which may give false sense of security 3, 1
• Washing hands with dish detergent or other known irritants 1
• Using very hot or very cold water 1
• Using disinfectant wipes and products containing topical antibiotics 1
• Excessive occlusion without underlying moisturizer application 1
• Discontinuing systemic steroids too quickly in severe cases 2