Identification of the substance and its subsequent avoidance are the mainstay of treatment (1):
- prevention techniques are useful to reduce the risk
- use appropriate protective clothing, for the hands, occlusive vinyl gloves - not rubber - with a thin pair of cotton gloves underneath to absorb perspiration, is ideal
- any irritant chemicals should be washed off as soon as possible and emollients such as emulsifying ointment BP should be applied regularly to hydrate the skin.
- barrier creams are less effective than gloves.
Acute care
- affected area should be soaked in cool or lukewarm water, saline (1 teaspoon/pint) or Burrow’s solution (13 % aluminium acetate dissolved in water at a 1:40 concentration)
- antibacterial as well as an anti-inflammatory properties and cooling effect of Burrow’s solution will decrease pruritus and prevent infection
Topical treatments for the condition include:
- barrier creams
- useful against low-grade irritants and specially for workers who constantly use water, soap and detergents
- help to accelerate the rate of healing in damaged skin by increasing skin hydration and modifying endogenous epidermal lipids
- commonly used products include:
- petrolatum - combination of paraffin wax, microcrystalline wax, and white mineral oil,
- dimethicone
- is a man-made polymer of the naturally occurring element silica or silicon
- used as an emollient to soften and moisturize the skin, facilitate epidermal exfoliation, and provide a protective barrier from irritant
- sensitization and inflammatory reactions to silicon polymers has limited its use
- lipid based moisturizers
- topical corticosteroids (1):
- efficacy of topical corticosteroids in irritant contact dermatitis is less clear
- used in a limited scope to treat acute eczematous ICD as they can help decrease inflammation and itch.
Using a soap substitute may be helpful in some people (2).
Antibiotics should be given for any secondary infection. Flucloxacillin or clarithromycin (if the person is allergic to penicillin) is recommended first-line treatment (2).
References:
- Fonacier L, Bernstein DI, Pacheco K, et al; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma & Immunology; Joint Council of Allergy, Asthma & Immunology. Contact dermatitis: a practice parameter - update 2015. J Allergy Clin Immunol Pract. 2015 May-Jun;3(3 Suppl):S1-39.
- Bourke J et al. Guidelines for the management of contact dermatitis: an update. BJD 2009; 160:946-954.