Contact Dermatitis Treatment Guidelines

First-Line Treatments

The British Association of Dermatologists recommends topical corticosteroids as the primary treatment for established contact dermatitis due to their anti-inflammatory, antipruritic, and vasoconstrictive actions 1, 2
The potency of topical corticosteroids should be selected based on severity and location, with lower potency steroids recommended for face, neck, and skin folds to avoid skin atrophy 3
Long-term intermittent use of mometasone furoate has shown efficacy in chronic hand eczema (Quality of evidence I) 1
Replacement of soaps and detergents with emollients is beneficial even if they are not the direct cause of dermatitis, and helps restore the skin barrier and prevent further irritation 1, 2, 4
After-work creams provide some protection against developing irritant contact dermatitis (Quality of evidence I) 1, 5

Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are useful steroid-sparing agents, particularly for sensitive areas 2, 3
For steroid-resistant chronic hand dermatitis, second-line treatments include phototherapy (PUVA) 1, 2, systemic immunomodulators: azathioprine, ciclosporin, methotrexate, mycophenolate mofetil 2, 4, and alitretinoin 2, 4

The most important step for successful treatment is to identify and avoid the causative allergen/irritant 6
For mild to moderate cases, apply mid-potency topical corticosteroids to affected areas twice daily and use emollients and soap substitutes regularly 1, 2
For severe or extensive cases, consider short-term systemic corticosteroids and patch testing to identify specific allergens 1, 7
For chronic or recurrent cases, consider proactive therapy with twice-weekly application of topical corticosteroids or calcineurin inhibitors to previously affected areas 3

Barrier creams alone have questionable value in protecting against contact with irritants and may give a false sense of security (Quality of evidence I) 1, 5
Long-term application of topical antibiotics is not recommended due to increased risk of resistance and skin sensitization 3
Topical antihistamines have limited evidence supporting their efficacy and may increase the risk of contact dermatitis themselves 3
The prognosis for occupational contact dermatitis is often poor, with only 25% of patients completely healing over a 10-year period 2, 4
If the causative agent can be completely avoided, milder cases of contact dermatitis have a better prognosis 1, 4