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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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