What is the treatment for contact dermatitis?

Treatment for Contact Dermatitis

The cornerstone of contact dermatitis management is identifying and avoiding the causative allergen or irritant, followed by topical corticosteroids for symptom management and emollients to repair the skin barrier. 1, 2

Diagnosis and Identification of Triggers

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

First-Line Treatment

Avoidance of Triggers

• Identification and complete avoidance of the causative allergen or irritant is the first and most important step in treatment 1, 2
• Workplace assessment may be necessary to identify all potential hazards for occupational dermatitis 2
• Substitution of different materials or products to avoid the implicated allergen is often possible 1

Topical Corticosteroids

• Apply topical corticosteroids such as hydrocortisone 1% to the affected area not more than 3-4 times daily for adults and children over 2 years of age 3
• For localized acute allergic contact dermatitis, mid- or high-potency topical steroids may be needed 4
• If allergic contact dermatitis involves an extensive area of skin (greater than 20%), systemic steroid therapy may be required 4

Skin Protection and Repair

• Replace harsh soaps and detergents with emollients as soap substitutes 1, 2
• Apply moisturizers immediately after washing hands to repair the skin barrier 2
• For hand dermatitis, use appropriate gloves (rubber or PVC with cotton liners for household tasks) 1, 2
• Remove gloves regularly and apply moisturizer before wearing gloves to prevent dermatitis 2

Second-Line and Advanced Treatments

• For persistent cases, consider second-line treatments such as topical tacrolimus 5
• For severe or recalcitrant cases, stronger topical steroids, phototherapy, or systemic immunosuppressants like azathioprine or ciclosporin may be considered 2
• In cases where avoidance is not possible (e.g., necessary medical devices or occupational exposures), advanced therapies may be required 6

Special Considerations

For Genital Contact Dermatitis

• Avoid harsh soaps and irritants in the genital area 5
• For external anal and genital itching in adults: clean the affected area with mild soap and warm water, rinse thoroughly, gently dry by patting, and apply hydrocortisone not more than 3-4 times daily 3
• Children under 12 years of age with genital itching should consult a doctor 3

For Occupational Contact Dermatitis

• Protection of the skin against contact with an allergen most commonly involves the use of appropriate gloves 1
• Educational programs may help in secondary prevention and outcomes for chronic occupational contact dermatitis 1
• The prognosis for occupational contact dermatitis is often poor - only 25% of patients completely heal over a 10-year period 1

Common Pitfalls to Avoid

• Barrier creams alone have questionable value in protecting against irritants and may give a false sense of security 2
• Prolonged glove use may impair stratum corneum barrier function 1
• Continuing use of irritants or allergens prevents healing 5
• Self-diagnosis of other conditions (e.g., yeast infection) when the problem is actually contact dermatitis can lead to inappropriate treatment 5
• Not considering occupational exposures that might be transferred to other body areas via hands can prevent healing 5
• Exclusion diets are not supported by good-quality studies in the management of contact dermatitis 1