From the Guidelines
For widespread dermatitis, the most effective approach is to use a combination of topical therapies, such as emollients and prescription topical corticosteroids, and consider phototherapy or systemic therapies, including biologics and Janus kinase inhibitors, for more severe cases, as recommended by the 2024 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1.
Initial Management
When managing widespread dermatitis, it is essential to start with gentle, fragrance-free cleansers like Cetaphil or CeraVe and apply moisturizers, such as Vanicream, Eucerin, or Aquaphor, immediately after bathing to lock in moisture. Over-the-counter 1% hydrocortisone cream can be applied to affected areas twice daily for up to two weeks to reduce inflammation.
Severe Cases
For more severe cases, prescription-strength topical corticosteroids like triamcinolone 0.1% or fluocinonide 0.05% may be necessary. Oral antihistamines, such as cetirizine (10mg daily) or diphenhydramine (25-50mg every 6 hours), can help control itching.
Advanced Therapies
If these measures do not improve the condition within 1-2 weeks, or if signs of infection (increased redness, warmth, pus, or fever) develop, a healthcare provider may prescribe stronger medications like oral corticosteroids, immunosuppressants, or biologics for severe cases, as supported by the guidelines 1.
Key Considerations
The decision to initiate these more advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions, as emphasized in the guidelines 1.
Treatment Goals
Dermatitis often results from an overactive immune response in the skin, causing inflammation, and proper treatment aims to calm this response while restoring the skin barrier. The goal is to achieve disease control and improve quality of life, as highlighted in the 2024 guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies 1.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily
For widespread dermatitis, the recommended course of action is to:
- Apply hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older.
- For children under 2 years of age, ask a doctor.
- For children under 12 years of age with external anal and genital itching, ask a doctor 2 2.
From the Research
Treatment Options for Widespread Dermatitis
- Topical corticosteroids are an essential tool for treating inflammatory skin conditions such as atopic dermatitis 3
- The American Academy of Dermatology recommends the use of topical corticosteroids as the first-line treatment for atopic dermatitis flare-ups 4
- Maintenance therapy for atopic dermatitis consists of liberal use of emollients and daily bathing with soap-free cleansers 4
- Pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids as first-line treatment 4
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 4
Systemic Treatments
- Systemic corticosteroids should generally be avoided but can be used rarely for severe atopic dermatitis under certain circumstances, including a lack of other treatment options or as a bridge to other systemic therapies 5
- There are no systemic treatments indicated for the treatment of widespread recalcitrant contact dermatitis 6
- Cyclosporine is a systemic therapeutic agent that can be used for severe cases of allergic contact dermatitis, but withdrawal of this agent can be challenging and lead to undesirable morbidities 6
Combination Therapy
- H1-antihistamines may have a synergistic effect when combined with topical corticosteroids by influencing various associative factors of chronic pruritus in atopic dermatitis 7
- The combination of H1-antihistamines and topical corticosteroids has been shown to result in statistically significant clinical improvement compared to antihistamine monotherapy 7