What is the treatment for contact dermatitis?

Treatment of Contact Dermatitis

The most effective treatment for contact dermatitis is identifying and completely avoiding the triggering irritant or allergen, applying appropriate topical corticosteroids for inflammation, and using moisturizers to repair the skin barrier. 1, 2

First-Line Management

• Identify and completely avoid the causative agent (allergen or irritant) - this is the cornerstone of successful treatment 3, 1, 2
• Apply mid- to high-potency topical corticosteroids (triamcinolone 0.1% or clobetasol 0.05%) twice daily for acute flares 1, 4
• For facial lesions, use lower potency steroids like hydrocortisone 1% to minimize side effects 1, 5
• Replace soaps and detergents with gentle cleansers and soap substitutes 3, 2
• Apply moisturizers packaged in tubes (not jars) immediately after washing to repair the skin barrier 1, 2

Protective Measures

• Use rubber or polyvinylchloride gloves with cotton liners for household tasks 3, 2
• Remove gloves regularly to prevent prolonged occlusion which may impair skin barrier function 3, 2
• Apply moisturizers before wearing gloves for extended periods 2
• Be cautious with barrier creams as they have questionable value in protecting against irritants and may give a false sense of security 3, 2

For Persistent or Severe Cases

• If localized contact dermatitis doesn't respond to topical treatments, consider patch testing to identify specific allergens 3, 2
• For extensive involvement (>20% body surface area), systemic steroids like prednisone may be required 6, 4
• For severe cases, taper oral prednisone over 2-3 weeks to prevent rebound dermatitis 4
• Second-line treatments for chronic cases include phototherapy (PUVA), azathioprine, methotrexate, mycophenolate mofetil, or ciclosporin 3

Special Considerations

• For hand dermatitis, consider "soak and smear" technique - soak hands in plain water for 20 minutes and immediately apply moisturizer to damp skin 1
• For nighttime use, apply moisturizer followed by cotton gloves for occlusion 1
• For nickel-sensitive patients, low-nickel diets may provide some benefit 3, 2
• For occupational contact dermatitis, workplace assessment may be necessary to identify all potential hazards 2

Common Pitfalls to Avoid

• Overuse of topical corticosteroids can lead to skin thinning, telangiectasia, and perioral dermatitis 1
• Failure to identify and remove the causative agent will result in persistent dermatitis 1, 2
• Using very hot water for washing can exacerbate irritant contact dermatitis 2
• Prolonged glove use without breaks can impair skin barrier function 3
• Prognosis for occupational contact dermatitis is often poor - only 25% of patients completely heal over a 10-year period 3

Treatment Algorithm

1. Identify and remove causative agent
2. Apply appropriate topical corticosteroid based on location and severity
3. Implement protective measures and moisturizing regimen
4. If no improvement after 2 weeks, consider patch testing or dermatology referral
5. For severe or widespread cases, consider systemic therapy