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Dermatitis - contact - Management
How should I manage persistent symptoms?

  • If measures to avoid the stimulus do not resolve the dermatitis:
    • Reassess the diagnosis.
    • Reassess the identity of possible allergens and irritants.
    • Refer to a recognized centre for patch testing if not already done.
    • Exclude ongoing exposure to irritants or allergens:
      • Check compliance with avoidance measures.
      • If compliance is good, step up avoidance measures where possible.
  • Consider using a more potent topical corticosteroid if response to initial treatment is poor.
  • Consider a contact allergy from topical medication (including allergy to topical corticosteroids) if dermatitis fails to respond or deteriorates with use:
    • Confirm the suspicion by applying the product on skin that is unaffected by dermatitis and observing for a reaction.
    • If allergy from a topical medication is suspected, refer for patch testing to try and identify which topical medication(s) the person is sensitized to.
  • Refer to a dermatologist if:
    • The person has chronic, recurring, or unrelenting eczematous or lichenified dermatitis despite avoidance measures and appropriate-strength topical corticosteroid treatment.
    • There is a suspicion of contact dermatitis but no clear history of relevant exposure.
    • Recalcitrant or chronic contact dermatitis does not respond to first-line corticosteroid therapy.
Clarification / Additional information
  • Second-line treatment in secondary care might include phototherapy, such as psoralen and ultraviolet A or B, or steroid-sparing immunosuppressant therapy.

[Jacob and Castanedo-Tardan, 2007]

Basis for recommendation
  • CKS found no guidelines regarding the management of persistent contact dermatitis. These recommendations are pragmatic measures to confirm correct identification of the irritant or allergen and to ensure that the irritant or allergen is being avoided.
  • The recommendation for testing for allergy to topical corticosteroids is based on expert opinion [English, 2000].
  • The recommendation for referral criteria is based on a UK guideline [Bourke et al, 2001] and expert opinion [Beltrani and Beltrani, 1997; Mark and Slavin, 2006]:
    • People with chronic, recurring, or unrelenting eczematous or lichenified dermatitis may benefit from second-line treatment.
    • If contact dermatitis is suspected but there is no obvious exposure, patch testing may be indicated.
  • Expert opinion indicates that desensitization protocols (allergy vaccination) have no role in managing allergic contact dermatitis [Beltrani and Beltrani, 1997].

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