What is the treatment for generalized contact dermatitis?

From the Guidelines

The treatment of generalized contact dermatitis should primarily involve the use of topical steroids and topical tacrolimus, as supported by recent guidelines. The management of contact dermatitis persisting despite allergen/irritant removal and skin protection largely follows the management of atopic/endogenous dermatitis, with studies supporting the efficacy of these treatments 1.

Key approaches to treatment include:

• Identifying and removing the offending allergen or irritant to prevent continued exposure
• Using topical corticosteroids, with options ranging from low-potency to high-potency, applied twice daily for 1-2 weeks
• Considering oral antihistamines like cetirizine or diphenhydramine to control itching
• Using cool compresses with saline or Burow's solution to soothe inflamed skin
• Applying moisturizers frequently to repair the skin barrier, preferably fragrance-free products

In cases unresponsive to standard therapy, second-line treatment options such as phototherapy and systemic immunomodulators like methotrexate and mycophenolate mofetil should be considered 1. Additionally, treatments like psoralen plus UVA, ciclosporin, and alitretinoin have been demonstrated to be useful in chronic hand dermatitis, and azathioprine in chronic actinic dermatitis 1.

It's worth noting that while older guidelines also support the use of topical corticosteroids and topical tacrolimus 1, the most recent guidelines provide the strongest evidence for these treatments, and should be prioritized in clinical decision-making.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: Apply a thin layer of clobetasol propionate gel, cream or ointment to the affected skin areas twice daily and rub in gently and completely. INDICATIONS AND USAGE PredniSONE Tablets are indicated in the following conditions: ... 5 Allergic States Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment: ... Contact dermatitis

• Treatment options for generalized contact dermatitis include:
  • Topical corticosteroids like clobetasol propionate (2)
  • Systemic corticosteroids like prednisone (3) for severe or incapacitating cases
• Key considerations:
  • Clobetasol propionate is a super-high potency topical corticosteroid, and treatment should be limited to 2 consecutive weeks
  • Prednisone can be used as an adjunctive therapy for short-term administration to control severe or incapacitating allergic conditions, including contact dermatitis

From the Research

Treatment of Generalized Contact Dermatitis

• The treatment of generalized contact dermatitis involves avoiding the causative substance and using topical or systemic steroids to reduce inflammation and itching 4, 5, 6.
• For localized acute allergic contact dermatitis, mid- or high-potency topical steroids such as triamcinolone 0.1% or clobetasol 0.05% are effective 4.
• If the affected area is extensive (greater than 20 percent), systemic steroid therapy may be required, and oral prednisone can be used, but it should be tapered over two to three weeks to avoid rebound dermatitis 4.
• Antihistamines, cold water compresses, and treatment of secondary infections may also be necessary 5.
• Emollients, topical corticosteroids, and antihistamines can help restore the skin barrier and reduce inflammation, while systemic corticosteroids and immunosuppressants may be used in severe cases 6.
• Patch testing can be used to identify the causative allergen and guide treatment 4, 5, 6, 7.

Important Considerations

• A complete medical history, including occupational history, is crucial in diagnosing contact dermatitis and identifying suspected substances 6.
• Avoiding the suspected irritants or allergens is essential, and promoting the metabolism and expulsion of absorbed allergens can help prevent further deterioration of the skin condition 6.
• Early and appropriate treatment can prevent persistence of the skin condition and reduce the risk of complications 6.
• Topical corticosteroids, such as clobetasol propionate, can also cause allergic contact dermatitis in some cases, highlighting the importance of patch testing and careful selection of treatments 8.