Allergic Contact Dermatitis

Corticosteroids (Topical/Oral)

• Anti-inflammatory & immunosuppressing effects by decreasing the production of cytokines & stopping lymphocyte production
• Topical corticosteroids
  
  • Usually effective for most cases of allergic contact dermatitis
  • 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 allergic contact dermatitis

Antihistamines (Oral)

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

Others

• 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 w/ chronic, localized allergic contact dermatitis, localized allergic contact dermatitis resistant to topical corticosteroids, allergic contact dermatitis that involves the face or intertriginous areas or allergic contact dermatitis caused by topical corticosteroids

Irritant Contact Dermatitis

Corticosteroids (Topical)

• 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

Others

• Antibiotics¹ (Topical/Oral)
• May be needed in cases of secondary infection

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

Identify & Eliminate Trigger Factors

• Allergic contact dermatitis: Patient should avoid allergens & all cross-reactants completely
  
  • Counsel patient regarding cross-reactants (eg patient w/ 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 w/ known allergy

Skin Care

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

Acute Dermatitis

Wet Dressings

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

Chronic Dermatitis

Emollients

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

Severe Chronic Allergic Contact Dermatitis

Phototherapy

• Narrow-band UVB or PUVA may be used in patients w/ severe chronic allergic contact dermatitis unresponsive to topical or oral corticosteroids