From the Guidelines
Treatment of contact dermatitis should primarily involve topical steroids and topical tacrolimus, as these have been shown to be effective in managing the condition. According to the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1, therapy for contact dermatitis persisting despite allergen/irritant removal and skin protection largely follows the management of atopic/endogenous dermatitis.
Key treatment options include:
- Topical steroids, which can help reduce inflammation and immune response
- Topical tacrolimus, which has been demonstrated to be effective in treating contact dermatitis
- Second-line treatment options, such as phototherapy and systemic immunomodulators like methotrexate and mycophenolate mofetil, may be considered for more severe cases
- Other treatments, including psoralen plus UVA, ciclosporin, and alitretinoin, have been shown to be useful in chronic hand dermatitis, while azathioprine may be used in chronic actinic dermatitis 1.
It is essential to note that prevention is crucial in managing contact dermatitis, and identifying triggers through patch testing and using protective measures like gloves when handling potential irritants can help prevent future reactions. Regular moisturizing with fragrance-free products can also help maintain skin barrier function and promote healing.
From the FDA Drug Label
ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. The provided drug labels do not directly address contact dermatitis treatment guidelines. They discuss the treatment of atopic dermatitis using pimecrolimus cream.
- The labels mention the use of pimecrolimus cream for atopic dermatitis, not contact dermatitis.
- There is no information provided about the treatment of contact dermatitis. 2 2
From the Research
Treatment Guidelines for Contact Dermatitis
- The treatment of contact dermatitis involves identifying and eliminating the responsible agent, as well as reducing skin inflammation and restoring the skin barrier 3, 4.
- Antihistamines, topical and oral steroids, and physical measures such as cold water compresses may be used to treat contact dermatitis 3.
- Topical corticosteroids, such as clobetasol propionate, are commonly used to treat various skin diseases, including contact dermatitis, but their use must be carefully considered due to potential side effects 5, 6.
- The efficacy of topical corticosteroids in irritant contact dermatitis is controversial, and their use may reduce skin barrier recovery while allowing further penetration of irritants if exposure continues 7.
- Emollients, topical corticosteroids, and antihistamines, as well as systemic corticosteroids and immunosuppressants, may be used to restore the skin barrier and reduce skin inflammation 4.
- Patch testing and other diagnostic tests, such as photopatch testing and skin tests for detecting immediate contact reactions, may be used to identify the causative allergens and guide treatment 3, 4.
Important Considerations
- A careful history, including occupational exposures and distribution of the rash, is important in identifying the offending agent 3, 4.
- The suspected irritants or allergens should be avoided completely, and the skin barrier should be restored and skin inflammation reduced through multiple treatments 4.
- Early and appropriate treatments are important to prevent further deterioration and persistence of the skin condition 4.
- Patients applying topical corticosteroids, such as clobetasol propionate, must be well instructed in how to use them, and physicians prescribing these medications should consider a diversity of factors 5.