From the Guidelines
Management of allergic contact dermatitis should prioritize allergen identification and avoidance, followed by treatment with topical corticosteroids and skin barrier repair, as these approaches have been shown to be effective in reducing morbidity and improving quality of life 1.
Key Considerations
- Allergen identification through patch testing is crucial when the cause of allergic contact dermatitis is not obvious, as it allows for targeted avoidance and treatment 1.
- Topical corticosteroids, such as mid-potency triamcinolone 0.1%, are the mainstay of treatment for acute flares, with application twice daily for 1-2 weeks being a common regimen.
- For severe or widespread cases, a short course of oral prednisone may be necessary, typically starting at 40-60mg daily and tapering over 2-3 weeks.
- Skin barrier repair using fragrance-free moisturizers is essential, applied multiple times daily, even after symptoms resolve.
- Patient education about allergen avoidance and proper skin care is crucial for long-term management.
Treatment Options
- Topical calcineurin inhibitors like tacrolimus 0.1% ointment can be used for chronic cases, especially in sensitive areas like the face.
- Wet wraps with moisturizers can provide relief for severe cases.
- Secondary bacterial infections may require antibiotics.
- Antihistamines such as hydroxyzine 25mg three times daily or cetirizine 10mg daily can help manage itching but do not treat the underlying inflammation.
Importance of Patch Testing
- Patch testing should be considered in cases where a history and/or physical exam is suggestive of allergic contact dermatitis, such as disease aggravated by topical medications or emollients, or patterns that reflect application of, or exposure to, a consistent item 1.
- The sensitivity of patch testing ranges from 60-80% in reports, and positive patch tests only indicate contact sensitization, requiring demonstrated relevance to the patient's active dermatitis.
From the Research
Diagnosis of Allergic Contact Dermatitis
- The diagnosis of allergic contact dermatitis is based on a thorough history, physical examination, and patch testing 2, 3.
- A complete medical history, including occupational history, is very important to give a clue of contact dermatitis and provide a list of suspected substances 4.
- Patch testing is a well-known diagnostic test, and other diagnostic tests such as photopatch test, skin tests, serum allergen-specific IgE test, and qualitative and quantitative testing of allergen can be used to help diagnosis and identify the causative allergens 4.
Treatment of Allergic Contact Dermatitis
- The mainstay of treatment is avoidance of the allergen, and databases like Contact Allergen Management Program and Contact Allergen Replacement Database can help patients to select products that do not contain allergens to which they are sensitized 3.
- Topical corticosteroids can be used to treat exacerbations, but should be avoided in long-term treatment 3.
- Localized acute allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 2.
- If allergic contact dermatitis involves an extensive area of skin (greater than 20 percent), systemic steroid therapy is often required and offers relief within 12 to 24 hours 2.
- Emollients, topical and oral corticosteroids, topical calcineurin inhibitors, azathioprine, and ciclosporin can be used for further management 5.
- Methotrexate and alitretinoin are recent additions to the armamentarium of dermatologists who manage contact dermatitis 5.
Patient Education and Management
- Patient education is critical to the proper treatment and management of the patient, and detailed education is imperative 6.
- After the causative allergens have been identified, patient education must occur if the dermatitis is to resolve 6.
- Photoallergic contact dermatitis and occupational contact dermatitis are other considerations a clinician must keep in mind 6.