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Treatment of these
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The image shows a study page on Contact Dermatitis - both Irritant and Allergic types. The allergic type involves Type IV (delayed) hypersensitivity, with common allergens listed (Nickel, Chromium, PTBP, PPD, Neomycin, MBEH). The handwritten note mentions "Topical Corticosteroids" as treatment.
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Here is a complete treatment overview for Contact Dermatitis (both Irritant and Allergic types), as shown in your study image:
Treatment of Contact Dermatitis
1. Irritant Contact Dermatitis (ICD)
Mechanism: Non-immunological skin barrier damage from direct chemical/physical irritants (soaps, detergents, water, solvents).
Primary Treatment
- Avoidance of the irritant - this is the single most important step
- Barrier protection: Petrolatum-based ointments or emollients applied regularly
- Protective equipment: Gloves (e.g., nitrile for healthcare workers), protective clothing
- Substitution of soap with bland emollient for washing
Pharmacological
- Topical corticosteroids for inflammation and pruritus
- Low-to-mid potency TCS for maintenance; potent TCS for acute flares
- Bland emollients between applications
2. Allergic Contact Dermatitis (ACD)
Mechanism: Type IV (delayed-type) hypersensitivity - T-cell mediated reaction. Requires prior sensitization.
First Line - Avoidance
- Identify and completely avoid the allergen (patch testing helps identify the exact allergen)
- Nickel: avoid artificial/costume jewellery
- Chromium: avoid cement exposure, use barrier gloves
- PPD: avoid hair dyes
- Neomycin: avoid topical ointments containing it
- PTBP: avoid bindi/adhesive-containing products
- MBEH: avoid rubber products containing monobenzyl ether of hydroquinone
Topical Treatment
| Severity | Treatment |
|---|---|
| Mild-Moderate | Topical corticosteroids (mid-to-high potency) twice daily x 1-2 weeks |
| Small area, moderate | Superpotent TCS - clobetasol propionate or betamethasone dipropionate BD x 1-2 weeks |
| Maintenance/sensitive areas | Topical immunomodulators - tacrolimus (Protopic) or pimecrolimus (Elidel) |
Adjuncts (topical)
- Cool wet compresses/soaks for 10-15 minutes - soothing in acute phase
- Wash skin/clothes with soap and water ASAP after allergen exposure (especially plant allergens like poison ivy)
- Bland emollients for skin barrier repair
Systemic Treatment
| Indication | Drug |
|---|---|
| Severe/widespread ACD | Oral corticosteroids - prednisone (tapering course over minimum 2 weeks to prevent rebound) |
| Pruritus control | Antihistamines - hydroxyzine, diphenhydramine (sedating); loratadine, cetirizine, fexofenadine (non-sedating) |
Important: Systemic steroids should be continued for at least 2 weeks - stopping earlier risks rebound dermatitis.
Patch Testing
- Refer to dermatologist for patch testing to confirm the specific allergen
- Can be customized to occupation or hobbies
- Once allergen identified, strict avoidance is the definitive management
Summary Table
| Feature | ICD | ACD |
|---|---|---|
| Mechanism | Direct toxicity | Type IV hypersensitivity |
| Treatment cornerstone | Avoidance + barrier | Avoidance + TCS |
| Topical steroids | Yes | Yes (1st line) |
| Systemic steroids | Rarely | For severe cases |
| Patch testing | Not needed | Yes - to identify allergen |
| Immunomodulators | Occasionally | Yes (tacrolimus/pimecrolimus) |
Key exam point from your notes: Topical corticosteroids are the mainstay pharmacological treatment for both types, with allergen avoidance being the definitive cure for ACD. - Textbook of Family Medicine 9e, p. 932-933; Dermatology 2-Volume Set 5e
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