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 topical corticosteroids to control inflammation, and using moisturizers to repair the skin barrier. 1

Immediate Management Approach

First-Line Treatment Strategy

• Identify and eliminate the trigger through detailed history focusing on initial symptom location, spread pattern, relationship to specific products or activities, and occupational/recreational exposures 1
• Apply mid- to high-potency topical corticosteroids (such as triamcinolone 0.1% or clobetasol 0.05%) for localized acute allergic contact dermatitis 2
• Use soap substitutes and gentle cleansers instead of harsh soaps, as these form the foundation of established contact dermatitis management 1
• Apply moisturizers immediately after washing hands using two fingertip units to repair the skin barrier 1

Systemic Therapy for Extensive Disease

• For allergic contact dermatitis involving greater than 20% body surface area, systemic steroid therapy is required and provides relief within 12-24 hours 2
• In severe rhus (poison ivy) dermatitis, taper oral prednisone over 2-3 weeks rather than rapid discontinuation to prevent rebound dermatitis 2

Distinguishing Irritant vs. Allergic Contact Dermatitis

Clinical Approach

• Pattern and morphology alone are unreliable for distinguishing between irritant, allergic, or endogenous dermatitis, particularly on hands and face 1
• Patch testing is recommended for persistent cases to identify specific allergens and should include at least an extended standard series 1
• Avoid applying potent topical steroids to the back within 2 days of patch testing, as this causes false negatives 1
• Keep prednisolone ≤10 mg daily if oral corticosteroids cannot be avoided during patch testing 1

Specific Treatment Protocols

For Irritant Contact Dermatitis

• Conservative measures first: identify and avoid irritants, use soap substitutes, apply moisturizers after each hand washing 1
• Apply topical corticosteroids only if conservative measures fail, with awareness that prolonged use may cause steroid-induced damage to the skin barrier 1
• Use after-work creams, which have demonstrated benefit in reducing irritant contact dermatitis incidence 1

For Allergic Contact Dermatitis

• Complete allergen avoidance is essential after identification through patch testing 1
• Apply topical corticosteroids to mitigate flares 1
• For severe or recalcitrant cases, escalate to stronger topical steroids, phototherapy (PUVA), or systemic immunosuppressants like azathioprine or ciclosporin 1
• Topical tacrolimus has shown effectiveness in nickel-induced allergic contact dermatitis 1

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 aggravates dermatitis 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 1

Moisturizer Application

• Use moisturizers packaged in tubes rather than jars to prevent contamination 1
• Apply two fingertip units to hands after each washing 1
• Barrier creams alone have questionable value and should not be over-promoted, as they may create false security 1

Critical Pitfalls to Avoid

• Never wash hands with dish detergent or other known irritants 1
• Avoid very hot or very cold water, disinfectant wipes, and products containing topical antibiotics 1
• Do not apply excessive occlusion without underlying moisturizer application 1
• Avoid over-reliance on barrier creams, which may reduce implementation of appropriate preventive measures 1

Special Considerations

Occupational Contact Dermatitis

• Workplace assessment is necessary to identify all potential hazards 1
• Prognosis is often poor: only 25% achieve complete healing, 50% have periodic symptoms, and 25% have permanent symptoms 1
• Changing occupation does not improve prognosis in 40% of cases 1
• Patients with recalcitrant hand dermatitis should seek dermatology consultation 1

Refractory Cases

• For steroid-resistant chronic hand dermatitis, consider PUVA, azathioprine, or ciclosporin, all supported by prospective clinical trials 1
• Nickel-sensitive patients may benefit from low-nickel diets in some cases 1
• If treatment fails and the diagnosis or specific allergen remains unknown, patch testing should be performed 2