What is the treatment for contact dermatitis?

Treatment for Contact Dermatitis

The most effective treatment for contact dermatitis requires identifying and completely avoiding the causative agent, applying topical corticosteroids to control inflammation, and using moisturizers regularly to repair the skin barrier. 1

Immediate Management Approach

First-Line Treatment Strategy

• Apply topical corticosteroids as the cornerstone of acute treatment, with potency selected based on severity and location 1
• For localized allergic contact dermatitis, use mid- to high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% 2
• For irritant contact dermatitis, start with conservative measures (avoidance, moisturizers, soap substitutes) and escalate to topical corticosteroids only if these fail 1
• Apply moisturizers immediately after washing hands using two fingertip units, preferably from tubes rather than jars to prevent contamination 1

Systemic Therapy for Extensive Disease

• When allergic contact dermatitis involves greater than 20% body surface area, systemic steroid therapy is required and provides relief within 12-24 hours 2
• For severe rhus (poison ivy) dermatitis, taper oral prednisone over 2-3 weeks to prevent rebound dermatitis—rapid discontinuation causes flare 2
• Keep prednisolone ≤10 mg daily if patch testing is needed, as higher doses cause false negatives 1

Allergen Identification and Avoidance

Diagnostic Workup

• Perform patch testing for persistent cases to identify specific allergens, testing at minimum an extended standard series 1
• Obtain detailed history including initial symptom location, spread pattern, relationship to products or activities, and occupational/recreational exposures 1
• Do not apply potent topical steroids to the back within 2 days of patch testing, as this causes false negatives 1

Complete Avoidance Protocol

• Ensure complete avoidance of identified allergens through patch testing, as partial avoidance is insufficient for allergic contact dermatitis 1
• For occupational dermatitis, workplace assessment is necessary to identify all potential hazards 1
• Pattern and morphology alone are unreliable for distinguishing irritant from allergic dermatitis, particularly on hands and face 1

Protective Measures and Barrier Management

Glove Selection and Use

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

Barrier Cream Limitations

• Barrier creams alone have questionable value and should not be over-promoted, as they create false security 1
• After-work creams have demonstrated benefit in reducing irritant contact dermatitis incidence and should be available in workplace settings 1

Advanced Therapies for Refractory Cases

Second-Line Options

• For severe or recalcitrant allergic contact dermatitis, consider stronger topical steroids, phototherapy, or systemic immunosuppressants like azathioprine or ciclosporin 1
• For steroid-resistant chronic hand dermatitis, use psoralen plus UVA (PUVA), azathioprine, or ciclosporin, all supported by prospective clinical trials 1
• Topical tacrolimus has shown effectiveness in nickel-induced allergic contact dermatitis 1

Steroid-Sparing Agents

• Topical calcineurin inhibitors (tacrolimus or pimecrolimus) may be used as steroid-sparing agents in severe or recurrent cases 3
• Consider these alternatives when prolonged topical corticosteroid use risks steroid-induced skin barrier damage 1

Special Considerations and Monitoring

Genital/Sensitive Areas

• For vulvar or genital contact dermatitis, use only low to mid-potency steroids (hydrocortisone 1% or triamcinolone 0.1%) due to increased absorption risk 3
• Apply ointment formulations over creams, as they contain fewer preservatives and potential irritants 3
• Limit treatment duration to 1-2 weeks with gradual taper, not exceeding 4 weeks total 3

Prognosis and Long-Term Management

• Prognosis for occupational contact dermatitis 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
• For recalcitrant hand dermatitis, seek dermatology consultation 1
• Nickel-sensitive patients may benefit from low-nickel diets in some cases 1

Critical Pitfalls to Avoid

• Never wash hands with dish detergent or other known irritants, very hot or very cold water, or disinfectant wipes 1
• Avoid products containing topical antibiotics 1
• Do not apply excessive occlusion without underlying moisturizer application 1
• Be cautious with prolonged topical corticosteroid use, which can damage the skin barrier 1
• Combined topical corticosteroid/antibiotic combinations show only marginal benefit in infected eczema 1