How Should Contact Dermatitis Be Treated?

Treatment of irritant contact dermatitis usually involves the cessation of the aggravating activity, initiation of intensive therapy with moisturizers, and if necessary, a short course of topical steroids. Long-term prevention of the rash may be difficult, especially in individuals who repeatedly wash their hands during work, such as nurses and physicians. In these people, use of a moisturizer multiple times throughout the day is extremely important.

In people who are in constant contact with irritating chemicals, use of protective gloves is usually needed. Initial treatment of acute allergic contact dermatitis, such as poison ivy, includes thorough washing with lots of water to remove any trace of the substance that may remain on the skin. If the rash is mild, topical steroids may reduce inflammation and lessen the itching. More severe cases, with pain and blistering over large portions of the body, usually require oral or injected corticosteroids to reduce inflammation.

Prednisone is usually given in doses up to 60–80 mg per day, and tapered gradually over 10 to 14 days to prevent recurrence of the rash. Wet dressings, soothing anti-itch or drying lotions (e.g., calamine), and oatmeal baths (e.g., Aveeno-bath) may also provide comfort, particularly when large areas of the skin are involved. With appropriate treatment, acute allergic contact dermatitis usually clears up without complications within 1 to 2 weeks, but it may return if the substance or material that caused it cannot be identified or avoided. It is critical that contact allergens be avoided, and occasionally a change of occupation or alteration of work habits (e.g., use of protective gloves) may be necessary if the rash is caused by occupational exposure.

Treatment of chronic allergic contact dermatitis may be more difficult, as the skin is often hardened and thickened and active inflammation has become less intense. In these patients, complete avoidance of the allergen and aggressive moisturization therapy may be the two most important aspects of the therapeutic program.

Ellen’s comment: I am a nurse in a doctor’s office and bring back about 20 to 25 patients per day to be seen by the doctor.

Between each patient, I wash my hands with an antibacterial soap and dry them with a paper towel. After working there for about 5 years, I started to notice that my hands were extremely dry and chapped, and occasionally I had cracking between my fingers. I did use latex gloves a couple of times per day to help with procedures, but I never noticed any redness or itching while wearing the gloves or after taking them off.

A dermatologist diagnosed me as having irritant contact dermatitis and recommended that I wash only when necessary, use Cetaphil soap while washing, use Nivea cream on my hands while at work, and use Aquaphor ointment in the morning and in the evening. I have been doing this for the past 2 weeks and have seen a marked improvement in my skin.