How is contact dermatitis managed?

If the patient has ACD, the allergen should be detected by patch testing, and subsequently it should be thoroughly avoided. Sources of the allergen as well as cross-reacting agents should be explained to the patient. An acceptable nonsensitizing substitute should be offered. For ICD, avoidance of as many irritants as possible is crucial. Frequent water exposure, which desiccates and chaps the skin, should be kept to a minimum. Frequent moisturization and hand protection with gloves, if indicated, are important. With contact dermatitis, systemic steroids should be used only in acute situations. Compresses may be helpful if vesicles are present. When the condition is chronic, topical steroids of appropriate strength and moisturizers are the mainstay of therapy. Recently, the newer nonsteroidal macrolide immunosuppressive agents, tacrolimus and pimecrolimus, have been used increasingly with good results. Lastly, phototherapy and Grenz ray therapy has also been used in difficult cases.

Rietschel RL, Fowler JF: Treatment of contact dermatitis. In Rietschel RL, Fowler JF, editors: Fisher’s contact dermatitis, ed 6, Hamilton, Ontario, BC Decker, 2008, pp 722–729.