What is the treatment for allergic dermatitis?

Treatment for Allergic Dermatitis

For allergic contact dermatitis, immediately identify and eliminate the triggering allergen, then apply mid- to high-potency topical corticosteroids (triamcinolone 0.1% or clobetasol 0.05%) twice daily to affected areas for acute flares. 1, 2

Immediate Management Steps

Allergen Identification and Avoidance

• Complete avoidance of the causative allergen is essential - treatment will fail without removing the trigger 1
• Confirm the diagnosis by determining whether symptoms resolve with avoidance of the suspected substance 2
• Consider patch testing in patients with persistent or recalcitrant disease to identify specific allergens 3

First-Line Topical Corticosteroid Therapy

For localized disease:

• Apply mid- to high-potency topical corticosteroids (triamcinolone 0.1% or clobetasol 0.05%) twice daily 1, 2
• Use the minimal effective amount to control symptoms 1
• Treatment duration typically 1-2 weeks with gradual taper 4

For facial or genital lesions:

• Use low to mid-potency steroids (hydrocortisone 1% or triamcinolone 0.1%) to avoid skin atrophy 4
• Avoid high-potency topical steroids in these areas due to increased absorption risk 5, 4
• Apply only a thin layer (approximately one fingertip unit) 4
• Prefer ointment formulations over creams as they contain fewer preservatives and irritants 4

For extensive disease (>20% body surface area):

• Systemic corticosteroid therapy is often required, providing relief within 12-24 hours 2
• For severe cases, oral prednisone should be tapered over 2-3 weeks to prevent rebound dermatitis 2

Adjunctive Skin Care Measures

Barrier repair and maintenance:

• Apply moisturizers packaged in tubes (not jars) after washing to repair the skin barrier 1
• Use gentle cleansers and soap substitutes instead of harsh soaps 4, 1
• Apply emollients regularly after washing and between steroid applications 4

For hand lesions specifically:

• Consider "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks 1
• For nighttime use, apply moisturizer followed by cotton gloves for occlusion 1

Alternative and Steroid-Sparing Options

Topical calcineurin inhibitors:

• Consider tacrolimus or pimecrolimus as steroid-sparing agents for facial lesions or chronic disease 1, 6
• These agents avoid steroid-induced skin damage and can be used long-term 7
• Pimecrolimus is FDA-approved as second-line therapy for mild to moderate atopic dermatitis in patients 2 years and older who have failed other topical treatments 8
• Main adverse effect is burning sensation at application site, typically only during first days of treatment 9

Critical Pitfalls to Avoid

• Never use topical corticosteroids long-term without tapering - this leads to skin thinning, telangiectasia, and rebound dermatitis 5, 1
• Do not use high-potency steroids on the face or genitals - increased absorption causes atrophy and striae 5, 4
• Avoid very hot water for washing - this exacerbates irritant contact dermatitis 1
• Do not rely solely on barrier creams - they provide false security without addressing the underlying allergen 1
• Total duration of topical steroid treatment should generally not exceed 4 weeks without reassessment 4

When to Reassess

• Discontinue use if symptoms worsen or no improvement after 7 days 4
• If no improvement after 2 weeks of appropriate therapy, perform patch testing to identify specific allergens 4, 2
• Monitor for signs of skin atrophy, striae, or secondary infection during treatment 4