What is the treatment for contact dermatitis?

Treatment for Contact Dermatitis

The most effective treatment for contact dermatitis involves identifying and completely avoiding the causative agent, applying mid- to high-potency topical corticosteroids (such as triamcinolone 0.1% or clobetasol 0.05%) for inflammation, and using moisturizers immediately after hand washing to repair the skin barrier. 1, 2

Immediate Management Approach

First-Line Treatment Strategy

• Apply topical corticosteroids as the cornerstone of acute treatment, with soap substitutes and emollients forming the foundation of established contact dermatitis management 3
• For localized allergic contact dermatitis, use mid- or high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% 2
• For extensive involvement (>20% body surface area), systemic corticosteroids are required, providing relief within 12-24 hours 2
• In severe rhus (poison ivy) dermatitis, taper oral prednisone over 2-3 weeks to prevent rebound dermatitis from rapid discontinuation 2

Allergen/Irritant Identification and Avoidance

• Complete avoidance of the identified allergen or irritant is essential and non-negotiable 1
• Pattern and morphology alone are unreliable for distinguishing irritant from allergic dermatitis, particularly on hands and face 1
• Obtain detailed history including initial symptom location, spread pattern, relationship to specific products or activities, and occupational/recreational exposures 1
• For persistent or unclear cases, perform patch testing to identify specific allergens 3, 1

Type-Specific Treatment Protocols

Irritant Contact Dermatitis

• Use soap substitutes and gentle cleansers instead of traditional soaps and detergents 1
• Apply moisturizers immediately after every hand washing using two fingertip units 1
• Use moisturizers packaged in tubes rather than jars to prevent contamination 1
• If conservative measures fail, apply topical corticosteroids, though be aware of potential steroid-induced barrier damage with prolonged use 1
• After-work creams have demonstrated benefit in reducing irritant contact dermatitis incidence and should be readily available in workplace settings 3

Allergic Contact Dermatitis

• Identify allergens through patch testing and ensure complete avoidance 1
• Apply topical corticosteroids to mitigate dermatitis flares 1
• For severe or recalcitrant cases, consider stronger topical steroids, phototherapy, or systemic immunosuppressants like azathioprine or ciclosporin 3, 1
• Long-term intermittent use of mometasone furoate has demonstrated efficacy in chronic hand eczema 3

Protective Measures and Prevention

Hand Protection

• Use rubber or PVC gloves with cotton liners for household tasks 1
• Remove gloves regularly to prevent sweat accumulation, which can aggravate dermatitis 3, 1
• Apply moisturizer before wearing gloves 1
• In occupational settings, select gloves based on specific chemical exposures and consider permeation time, as "impervious" gloves have finite protection duration 3

Barrier Cream Considerations

• Barrier creams alone have questionable value and should not be over-promoted, as they may create false security and reduce implementation of appropriate preventive measures 3, 1
• After-work creams, however, do confer protection and should be encouraged 3

Second-Line and Advanced Therapies

• For steroid-resistant chronic hand dermatitis, consider psoralen plus UVA (PUVA), azathioprine, or ciclosporin, all supported by prospective clinical trials 3
• Topical tacrolimus has shown effectiveness in nickel-induced allergic contact dermatitis models 3
• Combined topical corticosteroid/antibiotic combinations show marginal benefit in infected or potentially infected eczema 3

Special Populations and Situations

Occupational Contact Dermatitis

• Workplace visits are essential for identifying potential allergens and irritants and are critical for effective treatment and prevention 3
• Contact manufacturers to determine allergen presence in products and identify suitable substitutes 3
• Prognosis for occupational contact dermatitis is often poor: only 25% of patients achieve complete healing, with 50% having periodic symptoms and 25% having permanent symptoms 3
• Changing occupation does not improve prognosis in 40% of cases 3

Nickel-Sensitive Patients

• Low nickel diets may benefit some nickel-sensitive patients 3, 1

Critical Pitfalls to Avoid

• Never wash hands with dish detergent or other known irritants 1
• Avoid very hot or very cold water 1
• Do not use disinfectant wipes or products containing topical antibiotics 1
• Avoid excessive occlusion without underlying moisturizer application 1
• Do not apply potent topical steroids to the back within 2 days of patch testing, as this causes false negatives 3
• Avoid oral corticosteroids or immunosuppressants during patch testing; if unavoidable, keep prednisolone ≤10 mg daily 3

When to Escalate Care

• Refer to dermatology for recalcitrant hand dermatitis 1
• If treatment fails and the diagnosis or specific allergen remains unknown, perform patch testing 2
• Patients should be patch tested to at least an extended standard series of allergens 3