What is the treatment for contact dermatitis?

Treatment for Contact Dermatitis

Identify and completely avoid the causative allergen or irritant—this is the single most important intervention, followed immediately by topical corticosteroids for active inflammation and consistent use of emollients as soap substitutes. 1, 2

Immediate Management Steps

Allergen/Irritant Identification and Avoidance

• Stop all potential triggers immediately, including soaps, detergents, fragrances, and any new products that contacted the skin before symptom onset 1, 2
• Replace all soaps and detergents with emollients for cleansing—these irritants will perpetuate dermatitis even if they aren't the primary cause 1, 2
• For persistent cases (lasting >2-4 weeks despite avoidance), refer for patch testing to identify specific allergens 2, 3

Topical Corticosteroid Therapy

• For localized acute contact dermatitis: Apply mid-to-high potency topical corticosteroids such as triamcinolone 0.1% or clobetasol 0.05% twice daily 3
• For mild cases: Hydrocortisone 1% is FDA-approved for temporary relief of itching and inflammation from contact dermatitis 4
• For persistent dermatitis failing initial treatment: Escalate to very high potency corticosteroids like clobetasol propionate 0.05% for 2 weeks, which achieves clear or almost clear skin in 67% of severe cases 2

Systemic Therapy for Extensive Disease

• If contact dermatitis involves >20% body surface area: Oral prednisone is required and provides relief within 12-24 hours 3
• For severe rhus (poison ivy) dermatitis: Taper oral prednisone over 2-3 weeks—rapid discontinuation causes rebound dermatitis 3
• Prednisone is FDA-approved for contact dermatitis and allergic states intractable to conventional treatment 5

Skin Barrier Restoration

Emollient Application Protocol

• Apply moisturizers liberally and frequently—use 100g per 2 weeks for trunk area 2
• Use the "soak and smear" technique for severe cases: Soak affected area in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks 2
• Apply two fingertip units of moisturizer to hands after each washing 2
• Use moisturizers packaged in tubes rather than jars to prevent contamination 2

Protective Measures

Hand Protection (for hand dermatitis)

• Use rubber or PVC gloves with cotton liners for household tasks 1, 2
• Apply moisturizer before wearing gloves 2
• Remove gloves regularly to prevent sweat accumulation, which aggravates dermatitis 2
• For occupational exposures, select gloves based on specific chemical permeation times—no glove is completely impermeable 1
• Use accelerator-free gloves (neoprene or nitrile) if glove allergy is suspected 2

Second-Line Therapies for Refractory Cases

When First-Line Treatment Fails

• Topical tacrolimus 0.1%: Effective for contact dermatitis where topical steroids are unsuitable or ineffective, and avoids risk of corticosteroid allergy 2
• Phototherapy (PUVA): Established second-line treatment for chronic contact dermatitis 2
• Systemic immunosuppressants: Consider azathioprine or ciclosporin for severe, steroid-resistant chronic cases—all supported by prospective clinical trials 2
• Alitretinoin: Offer for severe chronic hand eczema 2

Critical Pitfalls to Avoid

• Never use dish detergent, disinfectant wipes, or very hot/cold water on affected skin 2
• Avoid topical antibiotics without clear indication—these are common sensitizers 2
• Do not over-rely on barrier creams alone—they have questionable value and create false security 1, 2
• Avoid prolonged occlusion without underlying moisturizer application 2
• Do not apply potent topical steroids within 2 days before patch testing—this causes false negatives 2

Occupational Contact Dermatitis Considerations

• Workplace assessment may be necessary to identify all potential hazards and hidden allergens 1
• Changing occupation does not improve prognosis in 40% of cases 1, 2
• Prognosis is often poor: Only 25% achieve complete healing over 10 years; 50% have intermittent symptoms and 25% have permanent symptoms despite treatment 1, 2
• Early identification and complete allergen avoidance offers the best chance for resolution 2

When to Refer

• Dermatitis persisting >7 days despite appropriate treatment 6
• Recalcitrant cases requiring patch testing to identify specific allergens 2, 3
• Consideration of systemic therapies or phototherapy 2
• Occupational dermatitis requiring workplace assessment 1