Treatment of Mild Contact Dermatitis
For mild contact dermatitis, apply mid-potency topical corticosteroids (such as hydrocortisone cream) 3-4 times daily to affected areas, combined with aggressive emollient therapy and immediate replacement of all soaps with soap-free substitutes. 1, 2
First-Line Topical Treatment
Apply topical corticosteroids as the cornerstone of acute treatment, with hydrocortisone specifically FDA-approved for minor skin irritations, inflammation, and rashes due to eczema, poison ivy/oak/sumac, insect bites, detergents, jewelry, cosmetics, and soaps 1, 2
Use hydrocortisone on affected areas not more than 3-4 times daily for adults and children 2 years and older 2
Replace all soaps and detergents with emollients immediately—these are universal irritants that perpetuate inflammation even in mild cases 1
Apply moisturizers immediately after washing hands or affected areas to repair the skin barrier, using products packaged in tubes rather than jars to prevent contamination 1
Use soap-free shower gel and/or bath oil, avoiding alcoholic solutions entirely 3
Apply urea- or glycerin-based moisturizers liberally to restore barrier function 3
Critical Identification and Avoidance
Complete avoidance of the causative allergen or irritant is essential—topical treatment alone will fail if exposure continues 1
Take a detailed history focusing on initial symptom location, spread pattern, and relationship to specific products or activities 1
Common triggers include nickel (jewelry, belt buckles), fragrances (cosmetics, detergents), preservatives (isothiazolinones in creams), rubber chemicals (gloves), and poison ivy 1, 4
Pattern and morphology alone are unreliable in distinguishing irritant from allergic contact dermatitis, particularly on hands and face 1
Protective Measures for Hands
Use appropriate gloves based on exposure: rubber or PVC gloves with cotton liners for household tasks 1
Remove gloves regularly to prevent sweat accumulation, which aggravates dermatitis 1
Apply moisturizer before wearing gloves to enhance barrier protection 1
Avoid washing hands with dish detergent, very hot or very cold water, and disinfectant wipes 1
Reassessment Protocol
Reassess after 2 weeks—if worsening or no improvement occurs, escalate to moderate-grade treatment protocols 3
Continue EGFR inhibitor therapy (if applicable) during mild skin reactions while implementing topical management 3
Consider oral antihistamines (cetirizine, fexofenadine, desloratadine) for pruritus associated with mild contact dermatitis 3
When to Escalate or Refer
If dermatitis persists despite avoidance and topical treatment after 2 weeks, refer for patch testing with an extended standard series of allergens 1
Patch testing is essential when the causative agent remains unknown or when clinical features suggest allergic rather than irritant contact dermatitis 1, 4
For occupational cases, arrange workplace visits to identify hidden allergens and assess procedures causing accidental exposure 1
Common Pitfalls to Avoid
Do not over-rely on barrier creams alone—they have questionable clinical value and may create false security 1
Avoid products containing topical antibiotics without clear indication 1
Do not use very hot or very cold water for washing affected areas 1
Avoid prolonged occlusion without underlying moisturizer application 1
For facial involvement, exercise extreme caution with topical corticosteroids—the face has increased percutaneous absorption and is more susceptible to steroid-induced atrophy, telangiectasia, and perioral dermatitis 5