Contact dermatitis - Treatment 

Treating contact dermatitis 

The symptoms of contact dermatitis can be effectively managed with treatment. Some people's symptoms improve, whereas others find their symptoms clear up entirely.

Up to 8 out of 10 people will experience at least a partial improvement in their symptoms after treatment.

There are several ways to treat contact dermatitis, including:

These treatments are explained below.

Avoiding the cause

One of the most important steps in treating contact dermatitis is identifying and avoiding the allergens or irritants that affect you. If you can successfully avoid the cause, you should not experience any symptoms.

It is not always easy to avoid irritants or allergens that affect you. Your GP or dermatologist (a specialist in treating skin conditions) can work with you to find ways to minimise your contact with them.

Read more information about preventing contact dermatitis.

If you are exposed to irritants as part of your job, wear adequate protective clothing to minimise any contact. Tell your employer about your condition so they can help you avoid the causes as effectively as possible.

Diet

The allergen nickel may rarely cause some cases of contact dermatitis. This is a trace element found in foods such as lentils, nuts and oats. There is limited evidence that people who are sensitive to nickel might benefit from following a diet low in nickel.

You should speak to your dermatologist before making any changes to your diet.

Emollients

Emollients are substances that help soften and smooth your skin to keep it supple and moist.

As contact dermatitis can cause your skin to be dry and cracked, it is important to keep it moisturised to prevent it from becoming further irritated. Emollients prevent water being lost from the outer layer of the skin and add water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.

Choice of emollient

Several different emollients are available. You may need to try a few to find one that works for you. You may also be prescribed a mix of emollients, such as:

  • an ointment for very dry skin
  • a cream or lotion for less dry skin
  • an emollient to use on your face and hands 
  • a different emollient to use on your body  
  • an emollient to use instead of soap 
  • an emollient to add to bath water or use in the shower

The difference between lotions, creams and ointments is the amount of oil they contain. Ointments contain the most oil so can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least oil so are not greasy but can be less effective. Creams are between the two.   

Some people find that some emollients can irritate their skin. If this happens, speak to your pharmacist or GP so that an alternative emollient can be prescribed instead.  

How to use emollients

Use your emollient frequently and in large amounts. Many people find it helpful to keep separate supplies of emollients at work or at school.

To apply the emollient:

  • use a large amount 
  • smooth the emollient into the skin in the same direction that the hair grows 
  • do not rub the emollient in
  • for very dry skin, apply the emollient every three to four hours 
  • after a bath or shower, gently dry the skin and then immediately apply the emollient while the skin is still moist 
  • do not share emollients with other people

Creams and lotions tend to be more suitable for red, weepy and wet areas of skin. Ointments are more effective for areas of dry skin. However, as they are greasier, you may dislike the way they affect your appearance.

If you are exposed to irritants at work that cause your contact dermatitis, make sure you apply emollients regularly during and after work.

Side effects

Occasionally, some emollients can irritate the skin. . If you have contact dermatitis, your skin will be sensitive and can sometimes react to certain ingredients such as perfume in over-the-counter emollients. If your skin reacts to the emollient, stop using it and speak to your GP, who will be able to recommend an alternative product.

Topical corticosteroids

If your skin is very red, sore and inflamed, your GP may prescribe a topical corticosteroid (one that is applied directly to your skin). Corticosteroids work by quickly reducing inflammation.

Corticosteroids are any type of medication that contains steroids, a type of hormone. Hormones are groups of powerful chemicals that have a wide range of effects on the body.

You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used (illegally) by bodybuilders and athletes. When used as instructed by your pharmacist or doctor, corticosteroids are one of the safest and most effective treatments for contact dermatitis.

Choice of topical corticosteroid

Different strengths of topical corticosteroids can be prescribed depending on the severity of your contact dermatitis and where the affected skin is. You may be prescribed:

  • a stronger topical corticosteroid for short-term use in severe contact dermatitis
  • a weaker topical corticosteroid if the eczema is mild
  • a weaker topical corticosteroid for use on your face, genitals or in the creases of your joints (such as your elbows), as your skin is thinner in these areas
  • a stronger topical corticosteroid to use on your palms and the soles of your feet, as the skin is thicker here

How to use topical corticosteroids

When using corticosteroids, apply the treatment in a thin layer to all the affected areas. Unless instructed otherwise by your dermatologist, follow the directions on the patient information leaflet that comes with the corticosteroid. This will give details of how much to apply.

During an episode of severe contact dermatitis, do not apply the corticosteroid more than twice a day. Most people will only have to apply it once a day.

Side effects

Topical corticosteroids may cause a mild burning or stinging feeling as you apply them. Rarely, and if used for long periods of time, they may cause:

  • thinning of the skin, particularly in the crease of the elbow or knee joint
  • telangiectasia (visible blood vessels), particularly on the cheeks 
  • acne (spots)

Corticosteroid tablets

If you have a severe episode of contact dermatitis and it covers a large area of your skin, your dermatologist may prescribe corticosteroid tablets.

You may be prescribed prednisolone to take for five to seven days. Depending on how effective this is, your dose of prednisolone may gradually be reduced over three or four weeks. 

If corticosteroid tablets are taken often or for a long time, they can cause a number of side effects, such as:

For this reason, your GP is unlikely to prescribe repeat courses of corticosteroid tablets without referring you to a specialist (see referral, below).

Referral 

In some cases, your GP may refer you for assessment and treatment by a dermatologist. For example, your GP may refer you if:

  • it is not clear what is causing your contact dermatitis
  • the prescribed treatments are not successfully controlling your contact dermatitis 
  • you have long-term or recurring symptoms despite avoiding the causes and using the treatments prescribed

Further treatments

Treatments from a dermatologist could include:

  • phototherapy, where your contact dermatitis is exposed to ultraviolet (UV) light - this may be ultraviolet A or ultraviolet B, and may also involve a medicine containing psoralen, which makes your skin more sensitive to light
  • steroid-sparing immunosuppressant therapy - immunosuppressant medicines suppress your immune system (the body’s natural defence system)
  • alitretinoin (see below)

Alitretinoin

Alitretinoin (sold under the brand name Toctino) is a medication for severe, long-term hand eczema that has failed to respond to other treatments, such as topical corticosteroids. Treatment with alitretinoin must be supervised by a dermatologist and can only be used by people 18 years of age or over.

Alitretinoin is a type of medication called a retinoid. Retinoids reduce the levels of irritation and itchiness associated with eczema.

Alitretinoin comes as a capsule that most people take once a day for 12-24 weeks.

It should never be taken during pregnancy because it can cause severe birth defects. Also avoid taking alitretinoin when breastfeeding because the medication can enter your breast milk and harm your baby.

Due to the risk of birth defects, the use of alitretinoin is not recommended for women of child-bearing age. If you are a woman of child-bearing age, you will only be prescribed alitretinoin if you agree to the following strict rules:

  • You fully understand why you should not get pregnant and what you need to do to prevent it.
  • You agree to use one or preferably two methods of contraception, including a barrier form of contraception such as condoms.
  • You start using these contraception methods from one month before starting treatment until one month after finishing treatment. 
  • You agree to have pregnancy tests before, during and after treatment.
  • You confirm that you are aware of the risks and precautions you need to take, for example by signing a form stating this.

Some common side effects of alitretinoin include:

  • headaches
  • dry mouth 
  • anaemia (a reduced number of red blood cells)
  • flushed (warm and red) skin
  • increased levels of cholesterol and triglyceride (fatty substances) in the blood 
  • joint or muscle pain
  • dry eyes or eye irritation

Uncommon side effects of alitretinoin include nosebleeds and sight problems, such as blurred vision. If you have vision problems, stop treatment immediately and contact your dermatologist.

There have also been reports of people suddenly having thoughts of hurting or killing themselves while taking retinoids, which are related to alitretinoin. However, to date, this has never been reported with alitretinoin.

It may be helpful to tell a close friend or relative that you are taking alitretinoin and ask them to tell you if they notice changes in your behaviour or are worried about the way you are acting. If you have any concerns, let you dermatologist know.

For a full list of side effects, see the patient information leaflet that comes with your medicine or the alitretinoin medicines information.

Page last reviewed: 21/10/2014

Next review due: 21/10/2016

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Marvin Wells said on 30 March 2012

My cd is caused by working a dry cleaning facility due to the chemicals. I use a dermatitis treatment that has apricot kernel oil and neem oil mixed together with other oils that i bought online and it has helped my cd much better than all the other creams put together. My cd has faded and I dont scratch at it now.

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