Treating Contact Dermatitis

Contact dermatitis is a large group of skin rashes that result from contact with external agents. It can occur on any part of the body, and its appearance is highly variable. It can present as red, weaping or blistering skin lesions or as dry, scaly, and cracked skin.

Contact dermatitis occurs through one of two mechanisms, either allergy (unique to an individual's immune system and not present in all people) or irritation (where most people's skin would respond in the same way to an insult). Examples of allergic contact dermatitis include poison ivy, which is usually acute and obvious following poison ivy exposure, and allergies to perfumes or other cosmetic agents, which can be more chronic and less obvious. Examples of irritant contact dermatitis include chemical burns, which are usually acute and obvious, and the chronic changes that occur from excessive water and soap exposure. Allergic and irritant contact dermatitis can sometimes coexist and often occur in people with other skin conditions, such as eczema and psoriasis.

Elucidating the cause of contact dermatitis is not always easy. A rash's location is often helpful but can be deceptive (for example, when mascara allergy only affects one eye). A history of exposures is often revealing (for example, when topical antibiotic to a wound precedes the rash) but sometimes not. If the cause of dermatitis is not obvious, typical treatments are not working, and/or a hypoallergenic skin regimen is failing to clear a rash, special testing called patch testing can be used to help identify relevant contact allergens.

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What are the treatments for contact dermatitis?

Most contact dermatitis is treated with appropriately chosen topical steroids for the body site. Severe cases of dermatitis may be treated with short courses of oral steroids (prednisone) or longer courses of immunosuppressive agents, such as methotrexate, cyclosporine, mycophenolate mofetil, or azathioprine.

No matter the cause of dermatitis, after the skin is inflamed it is imperative that gentle skin cares be started along with aggressive skin moisturization to restore the natural skin barrier. Regular emollients (moisturizers) should be applied to the skin. Over-exposure to water and soap should be minimized. When appropriate, gloves should be worn to protect against chemicals and friction.

Individual results may vary.

Medical Dermatology