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 ACD
  • 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

Others

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

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

• ACD: 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, esp 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 ACD