What is the appropriate treatment for irritant contact dermatitis?

Treatment of Irritant Contact Dermatitis

The most effective treatment for irritant contact dermatitis is complete avoidance of the offending irritant combined with aggressive emollient therapy and mid-to-high potency topical corticosteroids for active inflammation. 1, 2, 3

Immediate First-Line Management

Irritant Identification and Avoidance

• Identify and completely eliminate all irritants including soaps, detergents, water (excessive contact), solvents, oils, coolants, alkalis, and acids 1, 3
• Replace all soaps and detergents with emollients immediately—these are universal irritants that perpetuate inflammation even if not the primary cause 2, 3
• For occupational cases, arrange workplace visits to identify hidden irritants not apparent from history alone, assess procedures causing accidental exposure, and review Material Safety Data Sheets 2, 3

Aggressive Moisturization Protocol

• Apply two fingertip units of moisturizer to affected areas immediately after every hand wash 1, 2
• Use the "soak and smear" technique: soak affected skin in plain water for 20 minutes, then immediately apply moisturizer to still-damp skin nightly for up to 2 weeks 1, 2, 3
• Select moisturizers packaged in tubes rather than jars to prevent contamination 1, 2
• Look for moisturizers containing humectants (urea, glycerin), petrolatum, or mineral oil to restore barrier function 1
• Regular use of emollients can increase handwashing compliance by 50% by improving skin condition 4

Topical Corticosteroid Therapy

• Apply mid-to-high potency topical corticosteroids (such as triamcinolone 0.1% or betamethasone valerate 0.1%) to areas of active inflammation 1, 2, 5
• If conservative measures fail after 7-10 days, escalate to very high potency steroids (clobetasol propionate 0.05%) for 2 weeks 2, 5
• Use lower potency steroids (hydrocortisone 1%) on facial skin to minimize risk of steroid-induced atrophy, telangiectasia, and perioral dermatitis 1
• Caution: Prolonged topical steroid use can damage the skin barrier itself—monitor for steroid-induced barrier impairment 1, 2

Protective Measures During Treatment

Hand Protection Strategy

• Apply moisturizer before donning gloves to reduce occlusion-related irritation 2
• Use rubber or PVC gloves with cotton liners for household tasks, removing them regularly to prevent sweat accumulation 2, 3
• Select gloves based on specific chemical exposures and check Material Safety Data Sheets for permeation times—no glove is completely impermeable 2
• For latex allergy, use accelerator-free neoprene or nitrile gloves 2

Critical Avoidance Strategies

• Do not wash hands with dish detergent or other known irritants 1, 2
• Use lukewarm or cool water only—temperatures >40°C increase lipid fluidization and worsen dermatitis 2
• Do not use disinfectant wipes on skin—these contain harsh antimicrobials designed for surfaces 2
• Avoid washing hands immediately before or after using alcohol-based hand sanitizer, as this unnecessarily increases dermatitis risk 2
• Do not apply topical antibiotics (neomycin, bacitracin) without clear indication—these are frequent contact allergens 2

When Conservative Treatment Fails

Second-Line Therapies for Refractory Cases

• Consider topical tacrolimus 0.1% where topical steroids are unsuitable, ineffective, or when chronic facial dermatitis raises concerns about steroid-induced damage 2
• Topical tacrolimus and calcineurin inhibitors lead to more complete barrier repair than corticosteroids for long-term treatment 6
• PUVA (psoralen plus UVA) phototherapy is an established second-line treatment for chronic hand dermatitis resistant to topical steroids, supported by prospective clinical trials 2
• For severe chronic hand eczema specifically, offer alitretinoin (strong recommendation) 2
• Consider systemic immunosuppressants (methotrexate, mycophenolate mofetil, azathioprine, or ciclosporin) for steroid-resistant chronic cases 2

Special Considerations

Occupational Irritant Contact Dermatitis

• Avoidance is the foundation of managing occupational cases—assess safety procedures to eliminate exposure sources 3
• Personal protective equipment may be adequate; moving to a different work area is preferable to changing jobs entirely 3
• Implement comprehensive educational programs, which demonstrate improvements in established hand dermatitis and prevention of new cases 2
• The prognosis for occupational irritant contact dermatitis is poor: only 25% achieve complete healing over 10 years, 50% have intermittent symptoms, and 25% have permanent symptoms 2, 3
• Changing occupation does not improve prognosis in 40% of cases 2, 3

Barrier Creams: Limited Value

• Do not over-rely on barrier creams alone—they have questionable clinical value and may create false security, reducing implementation of appropriate preventive measures 4, 2
• After-work creams have demonstrated benefit in reducing irritant contact dermatitis incidence and should be readily available in workplace settings 4, 2

Common Pitfalls to Avoid

• Failing to identify and remove the causative irritant prevents healing—this is the most critical error 1
• Do not continue topical steroids long-term, which damages the skin barrier 1
• Avoid very hot or very cold water for washing, as extreme temperatures exacerbate barrier disruption 2
• Do not apply gloves while hands are still wet from washing or sanitizer 2
• Do not recommend exclusion diets—no good-quality studies support their use in contact dermatitis management 2

When to Escalate Care

• Re-evaluate if symptoms persist for more than 7-10 days despite appropriate treatment 1
• Consider referral to dermatology if the condition is recalcitrant or if allergic contact dermatitis is suspected 1
• Obtain patch testing with an extended baseline series of allergens for any persistent or chronic dermatitis, as clinical features alone cannot reliably distinguish between irritant and allergic contact dermatitis 2