What is the treatment for contact dermatitis?

Treatment for Contact Dermatitis

The primary treatment for contact dermatitis consists of 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 dermatitis, especially on hands and face, is unreliable in distinguishing between irritant, allergic, or endogenous dermatitis 1
• Detailed history should include initial location of symptoms, spread pattern, relationship to specific products, and occupational exposures 1
• Patch testing is recommended for persistent cases to identify specific allergens 2, 1

First-Line Treatment

Avoidance of Causative Agent

• Complete avoidance of identified irritants or allergens is the cornerstone of treatment 1, 3
• For occupational dermatitis, workplace assessment may be necessary to identify all potential hazards 1

Topical Treatments

• Topical corticosteroids are the mainstay of treatment for established contact dermatitis 2, 1

  • Mid- to high-potency topical steroids (e.g., triamcinolone 0.1% or clobetasol 0.05%) are effective for localized acute allergic contact dermatitis 3
  • Long-term intermittent use of mometasone furoate has shown efficacy in chronic hand eczema 2

• Soap substitutes and emollients should be used alongside topical corticosteroids 2, 1

  • Moisturizers should be applied immediately after washing hands 1
  • Use moisturizers packaged in tubes rather than jars to prevent contamination 1

Protective Measures

• Appropriate gloves with cotton liners provide protection for hand dermatitis 1
• After-work creams have demonstrated benefit in reducing irritant contact dermatitis and should be made readily available in workplaces 2, 1
• Barrier creams alone have questionable value in protecting against irritants and should not be overpromoted 2, 1

Second-Line Treatments

• For extensive involvement (>20% body surface area), systemic steroids may be required 3

  • Oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 3

• For steroid-resistant chronic hand dermatitis, consider: 2, 1

  • Phototherapy (PUVA) 2, 4
  • Systemic immunosuppressants such as azathioprine or ciclosporin 2, 4
  • Topical tacrolimus has shown efficacy in allergic contact dermatitis models 2

Special Considerations

• Prognosis for occupational contact dermatitis is often poor, with studies showing only 25% of patients completely heal over a 10-year period 2
• Changing occupation does not necessarily improve prognosis 2
• Nickel-sensitive patients may benefit from low-nickel diets in some cases 2, 1

Common Pitfalls to Avoid

• Avoid washing hands with dish detergent or other known irritants 1
• Avoid very hot or very cold water, disinfectant wipes, and products containing topical antibiotics 1
• Avoid excessive occlusion without underlying moisturizer application 1
• Don't rely solely on barrier creams as they may give users a false sense of security 2

Treatment Algorithm

1. Identify and avoid the causative agent through history and patch testing if needed 1, 3
2. Apply mid- to high-potency topical corticosteroids for active inflammation 2, 3
3. Use gentle cleansers and apply moisturizers immediately after washing 1
4. For occupational exposure, implement protective measures (appropriate gloves, after-work creams) 2, 1
5. For severe or widespread cases, consider systemic steroids 3
6. For steroid-resistant cases, consider second-line treatments (PUVA, azathioprine, ciclosporin) 2, 4