From the Guidelines
The primary treatment for contact dermatitis involves identifying and avoiding the triggering substance, followed by the use of topical steroids and topical tacrolimus for persistent cases, as supported by the British Association of Dermatologists' guidelines 1. When managing contact dermatitis, it is crucial to first remove or avoid the allergen or irritant causing the reaction. For cases that persist despite these measures, the treatment approach largely mirrors that of atopic or endogenous dermatitis. Key treatment options include:
- Topical steroids, which have been shown to be effective in reducing inflammation and suppressing the immune response in contact dermatitis 1.
- Topical tacrolimus, which is also supported by studies as an effective treatment for contact dermatitis, particularly for its ability to modulate the immune response without the long-term side effects associated with prolonged steroid use 1. For more severe or persistent cases, second-line treatments may be considered, including:
- Phototherapy, which can help in reducing inflammation and immune responses in the skin.
- Systemic immunomodulators such as methotrexate and mycophenolate mofetil, which are used to suppress the immune system in cases of severe contact dermatitis. Specific treatments for chronic hand dermatitis include psoralen plus UVA, ciclosporin, and alitretinoin, while azathioprine has been found useful in chronic actinic dermatitis 1. It's essential to tailor the treatment approach to the individual patient's condition, considering the severity of the dermatitis, the presence of any secondary infections, and the patient's overall health status.
From the Research
Treatment Guidelines for Contact Dermatitis
The treatment guidelines for contact dermatitis involve a combination of avoiding the causative substance, restoring the skin barrier, and reducing inflammation.
- Avoiding the suspected irritants or allergens is the first step in treating contact dermatitis, as stated in 2.
- Topical corticosteroids, such as triamcinolone 0.1% or clobetasol 0.05%, are effective in treating localized acute allergic contact dermatitis lesions, according to 3.
- For extensive areas of skin involvement (greater than 20 percent), systemic steroid therapy may be required, as mentioned in 3.
- In cases of severe rhus dermatitis, oral prednisone should be tapered over two to three weeks to prevent rebound dermatitis, as recommended in 3.
- Emollients, antihistamines, and immunosuppressants may also be used to restore the skin barrier and reduce inflammation, as stated in 2.
- Patch testing is an important diagnostic tool to identify the causative allergen and guide treatment, as mentioned in 3, 2, and 4.
Special Considerations
- Patients with allergic contact dermatitis may exhibit cross-reactivity to other corticosteroids, making it essential to identify a safe alternative, as reported in 5.
- Photoallergic contact dermatitis and occupational contact dermatitis require special consideration and management, as noted in 4.
- Facial contact dermatitis can be challenging to diagnose and treat, and identifying the underlying cause is crucial, as discussed in 6.