• Advise the person to avoid contact with the stimulus.
• Apply an emollient first-line to cool the skin and restore the skin barrier.
• Treat localized acute dermatitis with a topical corticosteroid.
• Prescribe a potency appropriate to the severity and location of the dermatitis.
• Consider a systemic corticosteroid if there is significant impairment of function, such as in eczema on the hands.
• Consider treating extensive acute dermatitis (greater than 20% of total skin surface involved) with a systemic corticosteroid.
• Recommend frequent, liberal use of an emollient to maintain skin hydration and improve barrier repair.
• CKS does not recommend the use of antihistamines for relieving pruritus associated with acute contact dermatitis.

• Further information on preventing work-related skin problems can be found on the Health and Safety Executive website at www.hse.gov.uk/skin/employ/prevention.htm.

Irritant/allergen avoidance

• Identifying and eliminating exposure to potential stimuli is the most important step in the treatment of contact dermatitis. This recommendation is supported by expert opinion from one UK guideline [Bourke et al, 2001], one US guideline [Beltrani et al, 2006], and the current literature [Beck and Wilkinson, 2004; Wilkinson and Beck, 2004; Mark and Slavin, 2006].

Cold compresses

• The use of cool, moist compresses or wet dressings is recommended by several experts in the current medical literature [Beck and Wilkinson, 2004; Beltrani et al, 2006; Jacob and Castanedo-Tardan, 2007].
• CKS expert reviewers advised against the use of cold compresses because soaking the skin can make dermatitis worse.
• CKS found no good-quality evidence to support or refute the use of cool, moist compresses.

Topical corticosteroids

• Topical corticosteroids are recommended by experts for the management of both allergic and irritant contact dermatitis [Beck and Wilkinson, 2004; Wilkinson and Beck, 2004; Beltrani et al, 2006].
• Good evidence from several small studies indicates that very potent or moderately potent topical corticosteroids are effective at improving acute allergic contact dermatitis.
• The efficacy of topical corticosteroids in irritant contact dermatitis has been questioned in recent studies. However, because it is often difficult to distinguish clinically between allergic and contact dermatitis, topical corticosteroids are recommended for the treatment of irritant contact dermatitis.

Systemic corticosteroids

• Systemic corticosteroid treatment is recommended by experts for widespread contact dermatitis (usually allergic) [Beltrani et al, 2006; Jacob and Castanedo-Tardan, 2007].

Emollients

• The recommendation for the use of emollients in treating contact dermatitis is based on evidence from several small studies [Saary et al, 2005] and is supported by expert opinion [Jacob and Castanedo-Tardan, 2007].

Antihistamines

• Antihistamines are generally considered ineffective for the management of pruritus associated with contact dermatitis [Beltrani et al, 2006].