Topical Corticosteroid Dosing for Contact Dermatitis
For localized contact dermatitis in adults, apply a mid- to high-potency topical corticosteroid (such as triamcinolone 0.1% or clobetasol 0.05%) twice daily for 2-4 weeks. 1, 2
Treatment Algorithm Based on Disease Extent
Localized Disease (< 20% Body Surface Area)
- Apply mid- to high-potency topical corticosteroids twice daily for 2-4 weeks 1, 2
- Specific agents include triamcinolone 0.1% or clobetasol 0.05% 2
- Reassess after 2-4 weeks to determine if continued treatment is necessary 1
Extensive Disease (> 20% Body Surface Area)
- Systemic steroid therapy is required when allergic contact dermatitis involves more than 20% of body surface area 2
- Oral prednisone provides relief within 12-24 hours 2
- For severe rhus (poison ivy) dermatitis, taper oral prednisone over 2-3 weeks to prevent rebound dermatitis 2, 3
- The recommended duration of 2-3 weeks specifically prevents rebound dermatitis that occurs with rapid discontinuation 3
Site-Specific Dosing Guidance
Face, Genitals, and Intertriginous Areas
- Use only low-potency (Class 5-7) corticosteroids due to increased absorption and atrophy risk 1
- Recommended agents: hydrocortisone 1-2.5%, desonide 0.05%, or alclometasone 0.05% 1
- Never use Class 1 (high-potency) steroids on these sites - all users developed atrophy after only 8 weeks 1
Body and Extremities
- Mid- to high-potency agents (Class 1-3) are appropriate 1, 2
- Clobetasol propionate 0.05% or betamethasone dipropionate can be used 4
Critical Safety Limits
- Do not exceed 50 grams weekly of Class 1 corticosteroids 1
- Avoid continuous use of Class 1 corticosteroids beyond 2-4 weeks 1
- High-potency steroids used for 4 months on the face cause hypertrichosis and acne 1
Maintenance Strategy
- After achieving acute control, transition to lower potency agents for maintenance 1
- Consider tapering rather than abrupt discontinuation to prevent rebound 2, 3
Common Pitfalls to Avoid
The most critical error is using high-potency steroids on facial or intertriginous skin, which rapidly causes atrophy and other adverse effects 1. Additionally, prescribing systemic steroids for severe contact dermatitis (especially rhus) for less than 2 weeks leads to rebound dermatitis, requiring the full 2-3 week taper 2, 3. Finally, exceeding the 50-gram weekly limit for Class 1 steroids or using them continuously beyond 2-4 weeks increases systemic absorption risks 1.