• If measures to avoid the stimulus do not resolve 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 steroid therapy.

In depth