What are the home treatment instructions for a patient with contact dermatitis who was given Benadryl (diphenhydramine) and Decadron (dexamethasone) in the office?

Home Treatment Instructions for Contact Dermatitis After Office Treatment

Continue oral Benadryl (diphenhydramine) 25-50 mg every 6 hours as needed for itching, and apply a mid-to-high potency topical corticosteroid twice daily to affected areas while aggressively moisturizing and identifying/avoiding the causative trigger. 1

Immediate Actions at Home

Allergen/Irritant Avoidance:

• Identify and completely avoid the substance that triggered your rash—this is the single most important step for resolution 2
• Replace all soaps and detergents with fragrance-free emollients immediately, as these are universal irritants that perpetuate inflammation even if they didn't cause the initial reaction 2
• For hand dermatitis, use rubber or PVC gloves with cotton liners for all household tasks 2

Topical Corticosteroid Application

Steroid Use:

• Apply a mid-to-high potency topical corticosteroid (such as triamcinolone 0.1% or clobetasol 0.05%) twice daily to affected areas 3
• You should see improvement within 12-24 hours if the trigger is avoided 3
• Critical warning: The Decadron (dexamethasone) injection you received in the office provides systemic steroid coverage for several days, but you'll need topical steroids for ongoing control 3

Aggressive Moisturization Protocol

Moisturizer Application:

• Apply moisturizer from a tube (not a jar) immediately after every hand washing to prevent contamination 2, 1
• Use the "soak and smear" technique nightly: soak affected areas in plain water for 20 minutes, then immediately apply moisturizer to damp skin for up to 2 weeks 2, 1
• At night, apply moisturizer followed by cotton gloves to create an occlusive barrier 2
• Reapply moisturizer frequently throughout the day—keep pocket-sized tubes with you 2

Oral Antihistamine Management

Benadryl (Diphenhydramine) Instructions:

• Take 25-50 mg every 6 hours as needed for itching 1
• Important caveat: While rare, diphenhydramine itself can cause contact dermatitis in some patients 4
• If your rash worsens after starting Benadryl, stop it immediately and contact your provider, as you may need to avoid all ethanolamine antihistamines (including Dramamine, Tavist, and Clistin-D) 4

Critical Pitfalls to Avoid

What NOT to Do:

• Do not wash hands with dish detergent, very hot or very cold water, or disinfectant wipes 2, 1
• Do not apply products containing topical antibiotics (neomycin, bacitracin) unless specifically prescribed—these commonly cause allergic reactions 2, 5
• Do not use barrier creams alone as protection—they provide false security and are no better than regular moisturizers 2
• Do not occlude affected areas with adhesive bandages without underlying moisturizer 2
• Avoid prolonged glove use without breaks—remove gloves regularly to prevent sweat accumulation, which worsens dermatitis 2

When to Escalate Care

Return to Office If:

• No improvement after 2 weeks of treatment despite trigger avoidance 1
• Rash involves more than 20% of body surface area—you may need a longer course of oral steroids 3
• Severe symptoms develop (extensive blistering, oozing, or spreading despite treatment) 3

Consider Patch Testing:

• If the rash persists despite treatment or you cannot identify the trigger, you need patch testing to identify specific allergens 2, 1, 6
• Clinical appearance alone cannot distinguish between allergic and irritant contact dermatitis 2, 6

Prognosis and Long-Term Management

Realistic Expectations:

• With complete allergen avoidance and proper treatment, most acute contact dermatitis resolves within 2-3 weeks 3
• However, if the trigger is occupational or difficult to avoid, only 25% of patients achieve complete healing long-term 2
• If symptoms persist beyond 2 weeks despite avoidance, you likely need patch testing and possibly second-line therapies (phototherapy, topical tacrolimus, or systemic immunosuppressants) 2, 1, 7

Product Selection Guidelines

Safe Product Choices:

• Look for soaps/cleansers devoid of fragrances, dyes, preservatives, and allergenic surfactants 2
• Choose synthetic detergents with added moisturizers 2
• Use hand sanitizers with at least 60% alcohol but avoid those with fragrances or dyes 2
• Select moisturizers in tubes rather than jars, preferably water-based formulations 2, 1