What patient education should be provided for someone with contact dermatitis who will receive an intramuscular dexamethasone (Decadron) or methylprednisolone acetate (Solu‑Medrol) injection in the office, including topical steroid use, antihistamine therapy, wound care, side‑effect monitoring, and follow‑up?

Patient Education for Contact Dermatitis with In-Office Corticosteroid Injection

What to Expect from Your Injection

You will receive an intramuscular corticosteroid injection today that should provide relief within 12-24 hours, particularly if your contact dermatitis covers more than 20% of your body surface area. 1

• The injection (either dexamethasone or methylprednisolone) works systemically to reduce inflammation throughout your body 1
• Relief typically begins within the first day, with continued improvement over the following days 1
• This systemic approach is necessary because your dermatitis is too extensive for topical treatment alone 1

Essential Home Care Instructions

Immediate Skin Care (Starting Today)

Replace all soaps and detergents with emollients immediately—these are universal irritants that will perpetuate your inflammation even if they didn't cause the initial problem. 2

• Apply moisturizer liberally and frequently, using two fingertip units to affected areas after each washing 2, 3
• Use moisturizers packaged in tubes rather than jars to prevent contamination 2
• Consider the "soak and smear" technique nightly for 2 weeks: soak affected areas in plain water for 20 minutes, then immediately apply moisturizer to damp skin 2, 3

Topical Corticosteroid Use

Apply the prescribed topical corticosteroid (likely triamcinolone 0.1% or clobetasol 0.05%) to affected areas as directed, typically twice daily. 3, 1

• Mid-to-high potency topical steroids are the cornerstone of acute contact dermatitis treatment 2
• Continue application even as you improve to prevent rebound dermatitis 1
• Do not stop abruptly—follow your provider's tapering instructions 1

What to Avoid Completely

Stop using the following immediately, as they will worsen your condition: 2

• All dish detergents and known irritants for hand washing 2
• Very hot or very cold water 2
• Disinfectant wipes on skin 2
• Products containing topical antibiotics (especially neomycin and bacitracin) unless specifically prescribed 3
• Any suspected allergen or irritant that triggered your dermatitis 2

Protective Measures

Hand Protection (If Hands Are Affected)

Use rubber or PVC gloves with cotton liners for household tasks, but remove them regularly to prevent sweat accumulation. 4, 2

• Apply moisturizer before wearing gloves 2, 5
• No glove is completely impermeable—check exposure times for specific chemicals if work-related 2
• For latex allergy, use accelerator-free neoprene or nitrile gloves 2, 5

Barrier Creams

Do not rely on barrier creams alone—they have questionable value and may create false security. 2

• After-work creams applied at the end of the day have demonstrated benefit 2
• Regular moisturizers are equally or more effective than specialized barrier creams 5

Monitoring for Side Effects

Watch for These Injection-Related Effects

Be aware that systemic corticosteroids can cause temporary side effects: 1

• Increased appetite and mild weight gain
• Difficulty sleeping (insomnia)
• Mood changes or irritability
• Elevated blood sugar (particularly important if diabetic)
• Increased blood pressure

Skin-Related Concerns

Contact your provider immediately if: 3

• Your dermatitis worsens despite treatment (may indicate corticosteroid allergy) 3
• You develop new areas of rash or spreading beyond the original site 6
• Signs of infection appear (increased warmth, pus, fever) 2
• No improvement occurs within 2 weeks 3

Antihistamine Use

Take oral antihistamines as prescribed for itching relief. 2, 7

• These help control pruritus but do not treat the underlying inflammation 7
• Non-sedating antihistamines can be used during the day; sedating types may help with sleep 7

Follow-Up Care

When to Return

Schedule a follow-up appointment in 2 weeks to reassess your response to treatment. 3

• If no improvement occurs, you may need patch testing to identify specific allergens 2, 5
• Persistent cases may require escalation to phototherapy or systemic immunosuppressants 2

Long-Term Prognosis

Complete allergen avoidance after identification offers the best chance for resolution. 3

• Early identification and avoidance of the causative agent is critical 3
• Occupational contact dermatitis has a particularly poor prognosis, with only 25% achieving complete healing over 10 years 2
• Changing occupation does not improve prognosis in 40% of cases 2

Critical Pitfalls to Avoid

Do not make these common mistakes: 2, 5

• Continuing to use suspected allergens or irritants "just a little bit" 5
• Stopping treatment too early when symptoms improve 1
• Using prolonged high-potency steroids on facial skin without medical supervision (causes thinning, telangiectasia, perioral dermatitis) 2
• Excessive occlusion with wraps or adhesives without underlying moisturizer 5
• Washing hands excessively, even with gentle products 2

When Patch Testing May Be Needed

If your dermatitis persists beyond 2 weeks despite appropriate treatment, you will need patch testing to identify specific allergens. 5, 3

• Patch testing is the gold standard for diagnosing allergic contact dermatitis 5
• Clinical features alone cannot reliably distinguish between irritant and allergic types 5
• Testing requires stopping systemic steroids and avoiding UV exposure for specific periods 5
• An extended standard series of allergens will be tested 2