Treatment of Contact Dermatitis

Diagnosis and Classification

• The American Academy of Dermatology recommends that patients with suspected allergic contact dermatitis should be referred for patch testing to identify specific allergens 4, 1
• The British Journal of Dermatology states that contact dermatitis can be classified as irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD), with irritant being more common but allergic carrying a worse prognosis unless the allergen is identified and avoided 2
• The pattern and morphology of dermatitis, particularly on the hands and face, is unreliable in predicting the cause or distinguishing between contact and atopic dermatitis, according to the British Journal of Dermatology 3

First-Line Treatment

• The American Academy of Dermatology recommends avoiding irritants such as frequent hand washing, use of dish detergents, very hot/cold water, and disinfectant wipes for hand dermatitis 4
• The primary treatment for contact dermatitis is identification and avoidance of the causative allergen or irritant, followed by topical corticosteroids as the first-line therapy for established dermatitis, as stated by Praxis Medical Insights 1

Skin Barrier Repair

• The Journal of the American Academy of Dermatology suggests replacing soaps and detergents with emollients to restore the skin barrier and applying moisturizer after washing hands and before wearing gloves 4
• Using two fingertip units of moisturizer for adequate hand coverage is recommended by the Journal of the American Academy of Dermatology 4

Important Considerations and Pitfalls

• The American Academy of Dermatology states that antibiotics are not indicated for uncomplicated contact dermatitis as it is not an infectious condition 4, 1
• Topical antibiotics (neomycin, bacitracin) are common allergens themselves and can cause allergic contact dermatitis, according to the Journal of the American Academy of Dermatology 4
• The prognosis for occupational contact dermatitis is often poor, with only 25% of patients completely healing over a 10-year period, as stated by Praxis Medical Insights 1

Special Situations

Hand Dermatitis

• The Journal of the American Academy of Dermatology recommends using rubber-free gloves (neoprene or nitrile) if latex allergy is suspected, considering cotton glove liners or loose plastic gloves, and avoiding washing hands with very hot water 4
• Avoiding applying gloves when hands are still wet from washing or sanitizing is also recommended by the Journal of the American Academy of Dermatology 4