What is the treatment for allergic contact dermatitis?

Treatment of Allergic Contact Dermatitis

The cornerstone of allergic contact dermatitis treatment is identification and complete avoidance of the causative allergen, followed by topical corticosteroids for symptomatic relief. 1

First-Line Treatment Approach

• Allergen identification and avoidance is the most critical step in managing allergic contact dermatitis 1
• Apply topical corticosteroids such as hydrocortisone 1% to affected areas up to 3-4 times daily to reduce inflammation and itching 2
• Use moisturizers immediately after washing to repair the skin barrier and prevent dryness 1
• For localized acute allergic contact dermatitis, mid- to high-potency topical steroids may be needed for effective symptom control 3
• If allergic contact dermatitis involves more than 20% of body surface area, systemic steroid therapy may be required, offering relief within 12-24 hours 3

Diagnostic Considerations

• Patch testing should be performed when:
  • The causative allergen is unknown 1
  • The dermatitis has an unusual distribution 1
  • The condition is persistent or recalcitrant despite treatment 1
  • There is later onset of disease or significant worsening 1
• The sensitivity of patch testing ranges from 60-80% 1
• Positive patch tests only indicate contact sensitization and need demonstrated relevance to the patient's active dermatitis 1

Special Considerations for Different Body Areas

• Hand dermatitis:
  • For glove-related allergic contact dermatitis, use accelerator-free gloves such as rubber-free neoprene or nitrile gloves 1
  • Consider cotton glove liners or loose plastic gloves 1
  • Apply moisturizer after washing hands and before wearing gloves 1
• Facial dermatitis:
  • Use lower potency topical corticosteroids to avoid skin thinning and telangiectasia 4
  • The face is particularly sensitive to cosmetics, sunscreens, and fragrances 4

Second-Line Treatments for Recalcitrant Cases

• Topical tacrolimus may be considered as an alternative to steroids, especially for facial dermatitis 5, 4
• Phototherapy can be beneficial for chronic cases, particularly for hand dermatitis 1, 4
• Systemic therapies such as azathioprine or cyclosporine may be necessary for extensive or severe cases 1, 4
• Occupational modification may be required if workplace exposure cannot be adequately controlled 1

Common Pitfalls to Avoid

• Continued exposure to allergens prevents healing and leads to persistent dermatitis 1
• Overuse of topical corticosteroids, especially on the face, can lead to skin thinning and other adverse effects 4
• Self-diagnosis of other conditions when the problem is actually contact dermatitis can lead to inappropriate treatment 6
• Over-reliance on barrier creams may give a false sense of security 4
• Using very hot water for washing can exacerbate irritant contact dermatitis 1

Prognosis

• Complete resolution is expected if the causative agent is identified and avoided 6, 4
• Prognosis for occupational contact dermatitis is often poorer, with only 25% of patients completely healing in some studies 4
• Chronic cases can develop if triggers are not identified or eliminated 5, 6