Management of Contact Dermatitis

Introduction to Treatment

The British Journal of Dermatology recommends that the cornerstone of contact dermatitis management is complete avoidance of the causative irritant or allergen combined with emollients and topical corticosteroids for active inflammation 1, 2

The American Academy of Dermatology suggests replacing all soaps and detergents with emollient substitutes for hand washing and bathing 2
Common irritants to avoid include water itself, detergents, organic solvents, and in occupational settings: oils, coolants, alkalis, acids, and solvents 2, 3
For occupational cases, conduct a workplace visit to identify hidden irritants not apparent from history alone—this is critical as many exposures are missed without direct observation 2, 3

Apply emollients immediately after every hand wash using two fingertip units per application 2
Use tube packaging rather than jars to prevent bacterial contamination 2, 3
Use the "soak and smear" technique for severe hand involvement: soak hands in plain water for 20 minutes, then immediately apply moisturizer to still-damp skin every night for up to 2 weeks 2

For body and hands: Apply mid- to high-potency topical corticosteroid twice daily for acute flares 3
For facial lesions: Use only low-potency steroids to minimize risk of skin atrophy 3
Long-term intermittent use of mometasone furoate has Level I evidence for chronic hand eczema (Strength of recommendation B) 1
Topical tacrolimus has demonstrated effectiveness in nickel-induced allergic contact dermatitis 1

Patients with persistent eczematous eruptions should undergo patch testing (Quality of evidence II.ii, Strength of recommendation A) 1
Patch test to at least an extended standard series of allergens 1, 4
Trained personnel should perform day 2 and day 4 readings 1, 4

For steroid-resistant chronic hand dermatitis, second-line options include Psoralen plus UVA (PUVA), Azathioprine, and Ciclosporin 1, 3
These treatments have Level I evidence with Strength of recommendation A 1

Do not use topical corticosteroids for rosacea or perioral dermatitis—these conditions worsen with steroid application 1
If treatment fails after 7 days, re-evaluate the diagnosis and consider dermatology referral 3

The prognosis for occupational contact dermatitis is poor: only 25% of patients completely recover within 10 years 2, 3
50% have periodic symptoms and 25% have permanent symptoms 2
Changing jobs does not guarantee improvement—40% of those who changed occupations showed no improvement 2