Fast Five Quiz: Dermatitis

William James, MD


November 04, 2020

TCSs are the mainstay of treatment for allergic contact dermatitis. Various symptomatic treatments can provide short-term relief of pruritus. However, the definitive treatment of allergic contact dermatitis is the identification and removal of any potential causal agents; otherwise, the patient is at increased risk for chronic or recurrent dermatitis. Online resources allow the physician to create a list of products free of allergens to which the patient is allergic.

TCSs are the mainstay of treatment, with the strength of the TCSs appropriate to the body site. For severe allergic contact dermatitis of the hands, 3-week courses of class I TCSs are required, whereas class VI or class VII TCSs typically are used for allergic contact dermatitis of intertriginous areas or the face.

Individuals with chronic allergic contact dermatitis that is not controlled well by TCSs may benefit from PUVA treatments. Psoralen is a photosensitizer that is ingested before light exposure. Narrow-band UVB phototherapy may be as effective. Light at 308 nm can also be delivered to limited chronic areas of dermatitis.

Definitive treatment of irritant contact dermatitis is the identification and removal of any potential causal agents. An inflammatory reaction from irritant contact dermatitis to an agent, such as benzalkonium chloride (eg, Zephiran), rarely needs treatment and usually resolves with cessation of exposure. Further symptomatic therapy depends on the degree of involvement and the presence or absence of secondary infection. TCSs and TIMs are of unproven use in treating irritant contact dermatitis.

Advise patients with irritant contact dermatitis to use creams that contain ceramides or bland emollients after washing hands with soap and before sleep. Recommend mild skin cleansers (eg, Aquanil, Cetaphil, Oilatum AD, Neutrogena) in place of soap on affected areas. Instruct individuals to refrain from use of inappropriate solvents (eg, gasoline) or abrasives (eg, pumice stone) to cleanse hands; these directly defat or traumatize the skin.

Read more about the treatment of allergic contact dermatitis.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Atopic Dermatitis, Allergic Contact Dermatitis, and Irritant Contact Dermatitis.

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