From the Guidelines
Contact dermatitis can cover large areas of the body through various mechanisms, including direct contact, cross-contamination, airborne allergens, systemic exposure, auto-eczematization, and blood-borne spread of inflammatory mediators. When managing contact dermatitis that covers large areas of the body, it is essential to consider the most recent and highest quality evidence-based treatments. According to the British Association of Dermatologists' guidelines for the management of contact dermatitis 2017 1, therapy for persistent contact dermatitis largely follows the management of atopic/endogenous dermatitis, with topical steroids and topical tacrolimus being effective treatments. Some key points to consider in treatment include:
- Identifying and removing the triggering substance
- Applying topical corticosteroids
- Using topical tacrolimus
- Considering second-line treatments such as phototherapy and systemic immunomodulators like methotrexate and mycophenolate mofetil for severe cases, as supported by the guidelines 1. It is crucial to prioritize treatments that have been demonstrated to be effective in managing widespread contact dermatitis, focusing on reducing morbidity, mortality, and improving quality of life.
From the Research
Contact Dermatitis Coverage
- Contact dermatitis can cover large areas of the body, with some cases involving more than 20 percent of the skin's surface 2.
- When contact dermatitis covers a large area, systemic steroid therapy may be required to provide relief within 12 to 24 hours 2.
- In severe cases, such as rhus dermatitis, oral prednisone may be prescribed and should be tapered over two to three weeks to avoid rebound dermatitis 2.
Types of Contact Dermatitis
- There are several types of contact dermatitis, including allergic, irritant, photoallergic, and phototoxic contact dermatitis 3, 4.
- Each type has different immunological mechanisms and requisite exposures, and clinical manifestations can vary widely 3.
- Irritant contact dermatitis is often caused by cumulative exposure to weak irritants and accounts for 80% of all cases of contact dermatitis 5.
Diagnosis and Management
- Diagnosis of contact dermatitis relies on clinical presentation, thorough exposure assessment, and evaluation with techniques such as patch testing and skin-prick testing 3, 4.
- Management is based on patient education, avoidance strategies of specific substances, and topical treatments, with systemic medications used in severe or recalcitrant cases 3, 4.
- Topical corticosteroids may be used to reduce inflammation, but their efficacy in irritant contact dermatitis is controversial and may depend on the specific circumstances of the case 6.