What is the treatment for acute allergic contact dermatitis?

From the Guidelines

The treatment of acute allergic contact dermatitis should focus on relieving symptoms and reducing inflammation, with first-line treatment including topical corticosteroids and topical tacrolimus, as supported by the British Association of Dermatologists' guidelines 1.

Key Treatment Strategies

• Topical corticosteroids, such as triamcinolone 0.1% or betamethasone 0.05%, applied twice daily to affected areas for 1-2 weeks, are effective in reducing inflammation and relieving symptoms 1.
• Topical tacrolimus has been shown to be effective in a nickel model of allergic contact dermatitis, making it a viable alternative or adjunct to topical corticosteroids 1.
• For severe or widespread cases, a short course of oral prednisone may be prescribed, typically starting at 40-60mg daily and tapering over 2-3 weeks.
• Oral antihistamines, such as cetirizine 10mg daily or diphenhydramine 25-50mg every 6 hours, can help control itching.
• Cool compresses with plain water or Burow's solution (aluminum acetate) for 15-20 minutes several times daily can soothe inflamed skin.

Additional Considerations

• Avoiding the triggering allergen is crucial to prevent recurrence, so identifying and eliminating the causative agent is essential.
• Patients should keep the affected area clean but avoid harsh soaps, and wear loose-fitting clothing to prevent further irritation.
• Moisturizers, such as petroleum jelly or ceramide-containing products, should be applied after bathing to help restore the skin barrier.

Evidence-Based Recommendations

The British Association of Dermatologists' guidelines 1 provide evidence-based guidance for the management of contact dermatitis, including the use of topical corticosteroids and topical tacrolimus as first-line treatments. These guidelines are supported by studies demonstrating the efficacy of these treatments in reducing inflammation and relieving symptoms 1.

From the FDA Drug Label

If irritation develops, clobetasol propionate should be discontinued and appropriate therapy instituted Allergic contact dermatitis with corticosteroids is usually diagnosed by observing failure to heal rather than noting a clinical exacerbation as with most topical products not containing corticosteroids.

The treatment of acute allergic contact dermatitis with clobetasol propionate involves discontinuing the drug if irritation develops and instituting appropriate therapy. Allergic contact dermatitis should be diagnosed by observing failure to heal. 2

From the Research

Treatment of Acute Allergic Contact Dermatitis

• The treatment of acute allergic contact dermatitis involves avoiding the causative substance and using topical or systemic steroids to reduce inflammation and relieve symptoms 3, 4, 5.
• Localized acute allergic contact dermatitis lesions can be successfully treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05% 3.
• If the 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 3.
• In patients with severe rhus dermatitis, oral prednisone should be tapered over two to three weeks because rapid discontinuation of steroids can cause rebound dermatitis 3.
• Antihistamines and physical measures such as cold water compresses can also be used to relieve symptoms 4.
• Emollients, topical corticosteroids, and antihistamines can be used to restore the skin barrier and reduce skin inflammation 5.

Importance of Avoiding Causative Substances

• Avoiding the suspected irritants or allergens is crucial in the treatment of acute allergic contact dermatitis 5, 6.
• Patient education is critical to the proper treatment and management of the patient, and detailed education is imperative 6.
• Identifying the causative allergens through patch testing or other diagnostic tests can help guide treatment and prevent further exposure 3, 4, 5, 6.

Considerations for Corticosteroid Use

• Corticosteroids can be used to treat acute allergic contact dermatitis, but patients may exhibit cross-reactivity to other corticoids 7.
• Oral corticosteroids can elicit allergic contact dermatitis in some patients, and patch testing or oral provocation tests can be used to identify the causative corticosteroid 7.