What are the recommended medications and doses for treating moderate contact allergy?

Treatment of Moderate Contact Allergy

For moderate contact dermatitis, use mid- to high-potency topical corticosteroids such as triamcinolone 0.1% or clobetasol 0.05% applied to affected areas, combined with aggressive emollient therapy and strict avoidance of the causative allergen. 1, 2

First-Line Topical Corticosteroid Therapy

Mid- to high-potency topical corticosteroids are the cornerstone of treatment for moderate contact dermatitis:

• Triamcinolone 0.1% cream or ointment is effective for moderate disease on the body 2
• Clobetasol 0.05% (Class I topical corticosteroid) can be used for body areas with more severe involvement 3, 2
• Lower potency options for facial involvement: Use Class V/VI corticosteroids such as hydrocortisone 2.5%, desonide, or aclometasone for face and sensitive areas 3
• Prednicarbate cream 0.02% is another option for moderate inflammatory skin conditions 3

Essential Adjunctive Measures

Allergen avoidance is as critical as medication:

• Identification and complete avoidance of the causative allergen or irritant is the primary treatment strategy 1
• Consider patch testing referral if the allergen is unknown or symptoms persist despite treatment 1, 2

Skin barrier restoration with emollients:

• Apply moisturizers at least once daily to the entire affected area 3
• Use oil-in-water creams or ointments rather than alcohol-containing lotions 3
• Replace soaps and detergents with emollients 1
• Apply moisturizer after each hand washing and before wearing gloves 1

Symptom Management

For pruritus associated with moderate contact dermatitis:

• Oral H1-antihistamines: Cetirizine or loratadine 10 mg daily (non-sedating), or hydroxyzine 10-25 mg four times daily or at bedtime 3
• Topical anti-itch agents: Polidocanol-containing lotions or urea-based preparations 3

When to Escalate Treatment

Consider systemic corticosteroids if:

• The contact dermatitis involves >20-30% body surface area 3, 2
• Topical therapy fails after 2 weeks of appropriate treatment 3
• Systemic dosing: Prednisone 0.5-1 mg/kg/day (or equivalent methylprednisolone dose) 3
• For severe rhus (poison ivy) dermatitis, taper oral prednisone over 2-3 weeks to prevent rebound dermatitis 2

Critical Pitfalls to Avoid

Do NOT use topical antibiotics:

• Antibiotics are not indicated for uncomplicated contact dermatitis as it is not infectious 1
• Topical antibiotics like neomycin and bacitracin are common allergens themselves and can worsen allergic contact dermatitis 3, 1
• Neomycin causes contact sensitivity in 13-30% of patients with chronic dermatitis 3

Beware of corticosteroid allergy:

• Paradoxically, topical corticosteroids themselves can cause allergic contact dermatitis in some patients 4, 5, 6
• If a patient fails to respond to topical corticosteroid treatment, consider patch testing with a corticosteroid series, as 22% of non-responders may have corticosteroid allergy 6
• Cross-reactivity between different corticosteroid groups can occur 5

Treatment Algorithm for Moderate Contact Dermatitis

1. Identify and eliminate the allergen (consider patch testing if unknown) 1, 2
2. Start mid-potency topical corticosteroid (triamcinolone 0.1%) for body; lower potency (hydrocortisone 2.5%) for face 3, 2
3. Add aggressive emollient therapy at least daily 3, 1
4. Add oral antihistamine for pruritus (cetirizine 10 mg daily) 3
5. Reassess after 2 weeks: If no improvement, escalate to high-potency topical steroid (clobetasol 0.05%) or consider systemic corticosteroids 3, 2
6. If still failing: Refer to dermatology for patch testing and evaluation for corticosteroid allergy 1, 6