What is the treatment for contact dermatitis?

Treatment for Contact Dermatitis

The cornerstone of contact dermatitis treatment is complete avoidance of the causative allergen or irritant combined with mid-to-high potency topical corticosteroids and aggressive emollient therapy. 1

Immediate First-Line Management

Allergen/Irritant Avoidance

• Replace all soaps and detergents with emollients immediately, even if they are not the identified cause, as these are universal irritants that perpetuate inflammation 2, 1
• Substitute different materials both in workplace and home environments—examples include thiuram-free gloves, changing biocides in industrial coolant oils, and using isothiazolinone-free creams/cleansers 2
• For occupational cases, arrange workplace visits to identify hidden allergens, assess procedures causing accidental exposure, and review Material Safety Data Sheets 1

Topical Corticosteroids

• Apply mid-to-high potency topical corticosteroids such as triamcinolone 0.1% for localized acute lesions 3
• For more severe cases, use clobetasol 0.05% (very high potency), which achieves clear or almost clear skin in 67.2% of patients with severe dermatitis over 2 weeks 1
• Exercise extreme caution with topical corticosteroids on facial skin—prolonged use causes skin thinning, telangiectasia, perioral dermatitis, and red face syndrome due to increased percutaneous absorption 1, 4

Emollient Therapy

• Use moisturizers packaged in tubes rather than jars to prevent contamination 1, 4
• Apply two fingertip units of moisturizer to hands after each washing 1
• Use the "soak and smear" technique: soak hands in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks 1
• Apply moisturizers liberally—recommended amount is 100g per 2 weeks for trunk area 1

Systemic Corticosteroids for Extensive Disease

• If allergic contact dermatitis involves greater than 20% body surface area, systemic steroid therapy is required and offers relief within 12-24 hours 3
• For severe rhus (poison ivy) dermatitis, oral prednisone should be tapered over 2-3 weeks because rapid discontinuation causes rebound dermatitis 3
• Prednisone is FDA-approved for contact dermatitis and allergic states intractable to conventional treatment 5

Protective Measures

Glove Selection

• Use rubber or PVC gloves with cotton liners for household tasks 1, 4
• For latex allergy, use accelerator-free gloves such as neoprene or nitrile 1
• Remove gloves regularly to prevent sweat accumulation, which aggravates dermatitis 1
• Select gloves based on specific chemical exposures and check Material Safety Data Sheets for permeation times—no glove is completely impermeable 1
• Latex, vinyl, and nitrile gloves are resistant to breakdown from ethanol or isopropyl alcohol 1

Barrier Creams

• Do not over-rely on barrier creams alone—they have questionable clinical value and may create false security, reducing implementation of appropriate preventive measures 2, 1
• After-work creams (applied after exposure) have demonstrated benefit in reducing irritant contact dermatitis incidence 2, 1

Diagnostic Workup for Persistent Cases

• Refer for patch testing with an extended standard series of allergens if dermatitis persists despite treatment or if the causative agent remains unknown 1, 4
• Pattern and morphology alone are unreliable in distinguishing between irritant, allergic, or endogenous dermatitis, particularly on hands and face 2, 1
• Do not apply potent topical steroids to the back within 2 days of patch testing, as this causes false negatives 1, 4
• Avoid oral corticosteroids or immunosuppressants during patch testing; if unavoidable, keep prednisolone ≤10 mg daily 1, 4

Second-Line Therapies for Refractory Cases

Topical Calcineurin Inhibitors

• Consider topical tacrolimus 0.1% where topical steroids are unsuitable, ineffective, or when chronic facial dermatitis raises concerns about steroid-induced skin damage 2, 1, 4
• Topical tacrolimus has demonstrated effectiveness in allergic contact dermatitis models and avoids the atrophy risk of prolonged steroid use 1, 4

Phototherapy

• PUVA (psoralen plus UVA) therapy is an established second-line treatment for chronic hand eczema resistant to topical steroids, supported by prospective clinical trials 2, 1

Systemic Immunosuppressants

• Consider methotrexate, mycophenolate mofetil, azathioprine, or ciclosporin for steroid-resistant chronic contact dermatitis 2, 6
• Alitretinoin is specifically recommended for severe chronic hand eczema (strong recommendation) 2, 1

Critical Pitfalls to Avoid

• Do not wash hands with dish detergent or other known irritants 1
• Avoid very hot or very cold water for hand washing 1, 4
• Do not use disinfectant wipes to clean hands 1, 4
• Avoid products containing topical antibiotics without clear indication 1, 4
• Avoid prolonged occlusion without underlying moisturizer application 1
• Do not recommend exclusion diets—no good-quality studies support their use in contact dermatitis management 1

Patient Education and Prognosis

• Implement comprehensive educational programs for occupational contact dermatitis, which demonstrate improvements in established hand dermatitis and prevention of new cases 2, 1
• The long-term prognosis for occupational contact dermatitis is poor: only 25% achieve complete healing over 10 years, 50% have intermittent symptoms, and 25% have permanent symptoms 2, 1, 4
• Changing occupation does not improve prognosis in 40% of cases 2, 1
• Early identification and complete avoidance of allergens offers the best chance for resolution 1
• If the causative agent is completely avoided, contact dermatitis will clear 4