Contact dermatitis is treated with some combination of topical steroids, oral steroids, topical antibiotics, oral antibiotics and emollients. A program of sensitive skin care and avoidance of irritants and allergens is explained to the patient.
Topical steroids of the appropriate strength and base our first line treatment. Weaker group 5 or 6 topical steroids are usually not strong enough to control inflammation. The most potent and topical steroid, clobetasol, can be used for thick resistant areas but this medication may not be necessary for first line treatment.
Desoximetasone 0.25 or topical steroids of a similar strength such as fluocinonide are excellent first-line medications. They’re strong enough to control most cases and are safer than clobetasol. The cream base is appropriate for medications because it is pleasant and enhances compliance. Patients with thicker areas or those in which there are many possible allergens may do better with the ointment based steroid. Apply the medication for a limited period, 7-30 days, then stop. Attempt to maintain clearance with the use of emollients.
Consider a short course of prednisone for areas that are extensive and highly inflamed. Inflammation can be rapidly controlled and then the patient can transition to topical steroids. Prednisone 20 mg twice a day for 7-10 days followed by prednisone 20 mg in the morning for 3 days is a possible short course schedule.
Mupirocin cream or ointment may be used 2 or 3 times a day for a few days prior to the application of topical steroids when there are signs of infection. Avoid triple antibiotic products that contain neomycin or bacitracin. These antibiotics are potential sensitizers and can cause contact dermatitis.
Cephalexin 500 mg 4 times a day or cefadroxil 500 mg twice a day can be used if the patient shows signs of widespread infection. A 5 to seven-day course should be adequate. Began oral antibiotics and then introduce topical steroids 2 or 3 days later. There are many other effective oral antibiotics.
Emollient creams and lotions are the cornerstone of maintenance therapy. They have many functions. They form a protective barrier. Some patients will respond just with the use of emollients alone. Thicker emollients such as Aquaphor are very effective but greasy. They can be applied in the evening while watching television. Slowly work this product into the skin.
Light lotions and creams can be used in the morning and throughout the day. They’re not messy and are well-tolerated. Apply these products after hand washing. There are numerous products and all are effective. Bar soaps such as Dove for sensitive skin are well-tolerated and not irritating.
Cloth soaked in cold water and then applied to the skin surface of an area of acute eczema is a highly effective technique for controlling acute inflammation. The compress is applied and left on for 20-30 minutes. It can be repeated several times a day until the acute process is brought under control. Which compresses I then discontinued. Continued use of wet compresses will cause excessive drying and aggravate the eczema.
Topical steroids or not available before the 1950s. Tar was the mainstay of treatment. Most preparations had an ointment base and were messy and had an unpleasant odor. There were sometimes quite effective at controlling inflammation. These products are still available today and are available over-the-counter. They can be used as the primary medication in patients who feel uncomfortable using topical steroids. Consider their use as maintenance therapy after topical steroids are discontinued. Balnetar is a tar bath oil that may also be applied directly to inflamed skin lesions.
Tacrolimus and pimecrolimus
These nonsteroidal anti-inflammatory topical medications are moderately effective for contact dermatitis. They are not in most cases first-line drugs. Their use has been curtailed because of concern that they will cause immunosuppression and possibly cancer.
Sedating antihistamines such asDiphenhydramine (Benadryl) and nonsedating antihistamines such as Cetirizine (Zyrtec) are sometimes useful during the acute phase of inflammation. There are however only marginally effective at controlling itching.
Patient’s with hand eczema should use gloves for protection. Visit http://www.allerderm.com. The combination of the seamless cotton gloves worn under the heavy duty vinyl glove is an The excellent combination.