Contact%20dermatitis Treatment

Allergic Contact Dermatitis (ACD)

Corticosteroids (Topical/Oral)

• Anti-inflammatory and immunosuppressing effects by decreasing the production of cytokines and stopping lymphocyte production
• Topical corticosteroids
  
  • Usually effective for most cases of ACD
  • Low potency products are used in intertriginous skin areas, facial and anogenital regions
  • Moderate potency products are usually sufficient for acute dermatitis
  • High potency products may be required for persistent dermatitis or chronic dermatitis

• Oral corticosteroids
  
  • Recommended in patients who have >10-25% of their body surface area (BSA) affected or if they have been exposed to allergens that cause symptoms to persist
  • Rapid symptomatic relief of ACD

Antihistamines (Oral)

• Help to relieve pruritus
  
  • If sedating antihistamine is used, it will help the patient to sleep through the night

Other Agents

• Antibiotics¹ (topical/oral)
  
  • May be needed in cases of secondary infection
• Calcineurin inhibitors (topical)
  • Tacrolimus or Pimecrolimus can be an alternative to topical corticosteroids in patients with chronic, localized ACD, localized ACD resistant to topical corticosteroids, ACD that involves the face or intertriginous areas or ACD caused by topical corticosteroids
  • Exposure of skin to sunlight should be avoided during therapy due to potential photocarcinogenicity

Irritant Contact Dermatitis (ICD)

Corticosteroids (Topical)

• Low potency products are used in intertriginous skin areas, facial and anogenital regions
• Moderate potency products are usually sufficient for acute dermatitis
• High potency products may be required for persistent dermatitis or chronic dermatitis

Antihistamines (Oral)

• Help to relieve pruritus
  
  • If sedating antihistamine is used, it will help the patient to sleep through the night

Other Agents

• Antibiotics¹ (topical/oral)
• May be needed in cases of secondary infection

¹Various products are available. Please see the latest MIMS for specific formulations and prescribing information.

Identify and Eliminate Trigger Factors

• ACD: Patient should avoid allergens and all cross-reactants completely
  
  • Counsel patient regarding cross-reactants (eg patient with Lidocaine allergy should avoid all local anesthetic of the amide type)

• If dermatitis is due to occupational exposure:
  
  • Personal protection eg protective gloves, clothing
  • Workplace protection
  • Advice on choice of career in person with known allergy

Skin Care

• Bathe affected areas using mild soap and lukewarm water
  
  • Oatmeal products added to bath may also relieve symptoms

Acute Dermatitis

Cold Compress

• Reduces inflammation and surface temperature

Wet Dressings

• Apply absorbent material dressings soaked in Al acetate to affected areas several times daily
• Relieves symptoms and speeds healing of weeping lesions with exudates by gentle debridement, debris removal and evaporated cooling

Chronic Dermatitis

Emollients

• Should be applied frequently, especially after contact with water or irritants
• Provide an occlusive layer over inflamed skin, reduce evaporation and decrease fissuring
• Patient preference and treatment area will determine formula used
  
  • Eg petrolatum, liquid paraffin, mineral oils, glycerine, etc
  • Avoid products with high water content, preservatives or fragrances

Severe Chronic ACD

Phototherapy

• Narrow-band UVB or PUVA may be used in patients with severe chronic ACD unresponsive to topical or oral corticosteroids