What is the diagnosis and treatment for contact dermatitis?

From the Guidelines

Contact dermatitis should be treated with topical steroids and topical tacrolimus as first-line therapy, with consideration of patch testing to identify allergens, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. The treatment of contact dermatitis involves a multi-step approach, including:

• Identifying and avoiding the triggering substance
• Using mild soap-free cleansers
• Applying topical steroids, such as 1% hydrocortisone cream, to affected areas 2-3 times daily for up to 7 days
• Considering prescription-strength topical steroids, like triamcinolone 0.1%, for more severe cases
• Using oral antihistamines, such as cetirizine 10mg daily, to reduce itching
• Applying cool compresses with plain water for 15-20 minutes several times daily to soothe irritated skin
• Considering patch testing with a baseline series of allergens to identify potential allergens, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1
• Considering additional series dependent on allergen exposure and additional readings at day 6 or 7 if the results are unexpectedly negative at day 4, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1 For severe cases, alitretinoin should be offered to patients with severe chronic hand eczema, and PUVA therapy should be considered for treating patients with chronic hand eczema, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. It is essential to note that contact dermatitis occurs through two mechanisms: irritant contact dermatitis from direct skin damage by harsh substances like soaps or chemicals, and allergic contact dermatitis, which involves an immune response to allergens like nickel, fragrances, or poison ivy, as highlighted in the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. Identifying and eliminating the trigger is crucial for preventing recurrence and allowing the skin to heal properly. In cases where topical steroids are unsuitable or ineffective, topical tacrolimus should be considered, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1. Patient education is also essential in occupational contact dermatitis, as recommended by the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1.

From the FDA Drug Label

If irritation develops, clobetasol propionate should be discontinued and appropriate therapy instituted Allergic contact dermatitis with corticosteroids is usually diagnosed by observing failure to heal rather than noting a clinical exacerbation as with most topical products not containing corticosteroids.

• Contact dermatitis can occur with the use of clobetasol propionate, and if it does, the medication should be discontinued.
• The diagnosis of allergic contact dermatitis is usually made by observing a failure to heal rather than a clinical exacerbation.
• If irritation or allergic contact dermatitis develops, clobetasol propionate should be discontinued and appropriate therapy instituted 2

From the Research

Definition and Classification of Contact Dermatitis

• Contact dermatitis is a common inflammatory skin disease caused by exposure to contact allergens and irritants 3.
• It is classified into two major forms: allergic contact dermatitis and irritant contact dermatitis, with other subtypes including immediate skin reactions, photoinduced contact dermatitis, systemic contact dermatitis, and non-eczematous contact dermatitis 3.
• Allergic contact dermatitis is a delayed hypersensitivity reaction, while irritant contact dermatitis is caused by non-immune-modulated irritation of the skin by a substance 4.

Diagnosis of Contact Dermatitis

• A complete medical history, including occupational history, is important for diagnosis and can provide a list of suspected substances 3.
• Diagnostic tests include patch testing, photopatch test, skin tests for detecting immediate contact reactions, serum allergen-specific IgE test, and qualitative and quantitative testing of allergen in suspected materials 3.
• Avoidance of the suspected irritants or allergens is crucial before treatment, and restoration of the skin barrier and reduction of skin inflammation are important through multiple treatments 3.

Treatment and Management of Contact Dermatitis

• Treatment involves avoiding the suspected irritants or allergens, restoring the skin barrier, and reducing skin inflammation through emollients, topical corticosteroids, and antihistamines 3, 4.
• Systemic corticosteroids and immunosuppressants may be used in severe cases, and early and appropriate treatment is important to prevent further deterioration and persistence of the skin condition 3.
• Patient education is critical to the proper treatment and management of allergic contact dermatitis, and detailed education is imperative after patch testing has been performed 5.

Common Causes and Prevention of Contact Dermatitis

• Common substances that cause contact dermatitis include poison ivy, nickel, and fragrances 4.
• Allergic contact dermatitis can be caused by chemicals in personal care products, home, or work environment, and avoidance of the triggering allergen is the mainstay of treatment 6.
• Preventive strategies include using barrier creams, moisturizers, and avoiding exposure to known allergens, and online tools such as SkinSAFE and the Contact Allergen Management Program can help avoid allergens in commercial skin care products 7.