From the Guidelines
Contact dermatitis treatment should primarily involve the use of topical steroids and topical tacrolimus, as these have been shown to be effective in managing the condition, especially in cases where allergen or irritant removal and skin protection are insufficient 1. When managing contact dermatitis, it's crucial to first identify and avoid the causative irritant or allergen. For treatment, the following steps can be taken:
- For mild cases, washing the affected area with mild soap and water, followed by the application of cool compresses, can help reduce inflammation and itching.
- Topical steroids, such as 1% hydrocortisone cream, can be applied 2-3 times daily for up to two weeks to reduce inflammation.
- In more severe cases, prescription-strength topical steroids like triamcinolone 0.1% or fluocinonide 0.05% may be necessary, applied twice daily for 1-2 weeks as directed.
- Topical tacrolimus is also an effective option, especially for cases not responding to topical steroids, as evidenced by the British Association of Dermatologists' guidelines 1.
- Second-line treatments may include phototherapy and systemic immunomodulators such as methotrexate and mycophenolate mofetil for persistent cases.
- Regular application of moisturizers, preferably fragrance-free products containing ceramides or petrolatum, is essential to help repair the skin barrier. It's important to monitor the condition's response to treatment and seek medical attention if the rash doesn't improve within 1-2 weeks, shows signs of infection, or is accompanied by fever or severe discomfort.
From the FDA Drug Label
Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Contact dermatitis Pimecrolimus (TOP) is indicated for the treatment of mild to moderate atopic dermatitis.
- Contact dermatitis treatment: Prednisone (PO) is indicated for the control of severe or incapacitating allergic conditions, including contact dermatitis 2.
- Atopic dermatitis treatment: Pimecrolimus (TOP) is indicated for the treatment of mild to moderate atopic dermatitis 3. Note that these are two different conditions, and the treatments may not be interchangeable.
From the Research
Contact Dermatitis Treatment
- Contact dermatitis is a common inflammatory skin disease caused by exposure to contact allergens and irritants 4
- The treatment of contact dermatitis involves avoiding the suspected irritants or allergens, restoring the skin barrier, and reducing skin inflammation through multiple treatments 4
- Topical corticosteroids are frequently used in the treatment of irritant contact dermatitis (ICD) and have been shown to improve healing of ICD 5
- Topical corticosteroids are classified by strength and the risk of adverse effects, and the choice of topical corticosteroid depends on the severity of the condition, the location of the affected area, and the patient's age and medical history 6
Topical Corticosteroid Application
- Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 6
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 6
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 6
Potential Risks and Considerations
- Topical corticosteroids can cause adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions, especially with prolonged use or application to large areas of skin 6
- Some patients may develop allergic contact dermatitis to topical corticosteroids, and patch tests can be used to identify the causative allergen 7, 8
- In rare cases, systemic contact dermatitis can occur after oral treatment with corticosteroids, and a safe corticosteroid should be identified for such patients 7, 8