Pharmacological therapy
Allergic Contact Dermatitis (ACD)
Corticosteroids (Topical/Oral)
Corticosteroids have anti-inflammatory and immunosuppressing effects by decreasing the production of cytokines and stopping lymphocyte production.
Topical Corticosteroids
Contact Dermatitis_Management 1
Topical corticosteroids are usually effective for most cases of allergic contact dermatitis. Low-potency products are used in intertriginous skin areas and facial and anogenital regions. Moderate potency products are usually sufficient for ACD of the face and flexural areas. High-potency products may be required for persistent dermatitis or chronic dermatitis.
Oral Corticosteroids
Oral corticosteroids are 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. This provides rapid symptomatic relief of allergic contact dermatitis.
Antihistamines (Oral)
Oral antihistamines help relieve pruritus. If sedating antihistamine is used, it will help the patient to sleep through the night.
Other Agents
Antibiotics1 (Topical/Oral)
Antibiotics may be needed in cases of secondary infection.
Calcineurin Inhibitors (Topical)
Tacrolimus or Pimecrolimus can be an alternative to topical corticosteroids in patients with chronic, localized ACD; localized ACD resistant to topical corticosteroids; allergic contact dermatitis that involves the face or intertriginous areas; or ACD caused by topical corticosteroids. Exposure of skin to sunlight should be avoided during therapy due to potential photocarcinogenicity.
JAK inhibitor
Ruxolitinib, a selective JAK inhibitor used in atopic dermatitis, is undergoing clinical studies for its use in allergic contact dermatitis.
Immunosuppressants
Systemic immunosuppressive agents (eg Methotrexate, Azathioprine, Mycophenolate mofetil, Cyclosporine) may be considered in patients with allergic contact dermatitis.
Irritant Contact Dermatitis (ICD)
Corticosteroids (Topical)
Low-potency products are used in intertriginous skin areas and facial and anogenital regions. Moderate potency products are usually sufficient for acute dermatitis and may be considered for facial or flexural ICD. High-potency products may be required for non-facial persistent dermatitis or chronic dermatitis. Super high potency products for severe, acute ICD not involving the face or flexural areas should be considered.
Other Agents
Antibiotics1 (Topical/Oral)
Antibiotics may be needed in cases of secondary infection.
Antihistamines (Oral)
Oral antihistamines help relieve pruritus. If sedating antihistamine is used, it will help the patient to sleep through the night.
1Various products are available. Please see the latest MIMS for specific formulations and prescribing information.
Nonpharmacological
Identify and Eliminate Trigger Factors
In allergic contact dermatitis, patients should avoid allergens and all cross-reactants completely. Counsel the patient regarding cross-reactants (eg patients with Lidocaine allergy should avoid all local anesthetics of the amide type). If dermatitis is due to occupational exposure, personal protection (eg protective gloves, clothing, barrier creams, application of emollients) and workplace protection (eg use of equipment to handle substances, training programs on barrier repair, hazards, etc., regular examinations, facilities to manage severe disease) should be implemented. Advice on choice of career in person with a known allergy. Consider alternatives to offending products.
Skin Care
Bathing
Bathe affected areas using mild soap and lukewarm water. Oatmeal products added to baths may also relieve symptoms.
Moisturizers
Moisturizers should be applied frequently, especially after contact with water or irritants. These are used as an adjunct to topical corticosteroids. Moisturizers provide an occlusive layer over inflamed skin, reduce evaporation, and decrease fissuring. Examples of moisturizers are Ceramide, Dimethicone, flavonoids, Glycerin, Hyaluronic acid, Lanolin, lipids, liquid paraffin, mineral oil, petroleum jelly, polysaccharides, silicone, urea, and wax. Patient preference and treatment area will determine the formula used. Avoid products with high water content, preservatives, or fragrances.
Cold Compress
Cold compresses reduce inflammation and surface temperature.
Wet Dressings
Apply absorbent material dressings soaked in Aluminum acetate to affected areas several times daily. Wet dressings relieve symptoms and speed healing of weeping lesions with exudates by gentle debridement, debris removal, and evaporated cooling.
Phototherapy
Contact Dermatitis_Management 2Narrow-band ultraviolet-B (UVB) or psoralen plus ultraviolet-A radiation (PUVA) may be used in patients with severe chronic ACD unresponsive to topical or oral corticosteroids.