CONTACT DERMATITIS SYMPTOMS & DIAGNOSIS

Topical Steroids

Topical steroids are anti-inflammatory medications. They help to get the rash under control more quickly and are usually applied 1-2 times a day. Topical steroids come in different formulations and strengths. Milder topical steroids such as hydrocortisone can be purchased over the counter. If the rash is not improving after 7 days or getting worse, you should consult your physician. A more potent topical steroid may be required but should be used sparingly in sensitive areas such as the face, underarms, and groin as they can thin the skin and cause stretch marks.

Antihistamines

Antihistamines may be given for the relief of the itch associated with CD but topical steroids are likely to be more effective in rash resolution. Sedating oral antihistamines promote sleep but may have side-effects including dryness, difficulty urinating, dizziness, and impaired coordination. Sedating antihistamines should be used cautiously in elderly patients for all the above reasons and due to a potential association with dementia. These medications should be used in conjunction with consultation with your allergist/immunologist.

Topical Immunomodulators

Topical calcineurin inhibitors (pimecrolimus, tacrolimus) are anti-inflammatory agents that may provide another option in patients with ACD or ICD. However, they are not FDA approved for CD. They do not cause skin thinning, which is beneficial for the treatment of patients with facial dermatitis and dermatitis in other sensitive areas (bending areas, genitals). The most common adverse effects encountered are burning and itch at the application site.

Topical Antibiotics

These creams or ointments are sometimes used if there are open fissures and evidence of a secondary bacterial infection. However over-the-counter topical antibiotics are frequent causes of CD and should be used under the recommendation of your allergist/immunologist.

Systemic Steroids

These medications can be given by mouth or injection and may be needed if the rash is severe, associated with swelling, or if the rash covers much of your body. They will lead to rapid improvement and are usually considered safe when prescribed for short periods of time. However, systemic steroids can have significant side effects requiring close monitoring by your physician and are not recommended for long term therapy of CD. Some of these side effects can include weight gain, bone thinning, cataracts, glaucoma, easy bruising and sleep disturbances. It is also important to take these medications exactly as directed to avoid a flare in your dermatitis with rapid discontinuation as well as other side effects. Other oral medications that can be tried in difficult to treat cases include cyclosporine, methotrexate, azathioprine, and mycophenolate mofetil.

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