With treatment, the symptoms of contact dermatitis can be effectively managed. Some people find their symptoms clear up entirely, whereas others find their symptoms improve. Up to 80% of people will experience at least a partial improvement in their symptoms following treatment.
There are a number of different ways to treat contact dermatitis. These treatments are outlined below.
Avoiding trigger factors
Identifying and avoiding exposure to potential allergens or irritants is one of the most important parts of your treatment for contact dermatitis.
If you can successfully avoid trigger factors, then you should not experience any symptoms. However, it is not always easy to avoid trigger factors, but your GP will help you to find ways of minimising your contact with them (see 'prevention' section).
If you are exposed to irritants as part of your job, make sure you wear adequate protective clothing to help minimise any contact with potential irritants. Make sure you tell your employer about your condition so that they can help you avoid any trigger factors as effectively as possible.
Emollients
Emollients are substances that help to soften and soothe your skin in order 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 in order to prevent it from becoming further irritated.
The type of emollient you are prescribed will depend on:
- how dry your skin is,
- which area of skin the emollient is going to be used on,
- your individual preference (such as how convenient it is to use and whether you find it effective).
You may have to try a number of different emollients before you find one which is effective. If the first emollient that is prescribed is not suitable, your GP will prescribe a different one.
You may also need a number of different emollients for long-term use. For example, you may need a more intensive emollient for when your symptoms are severe and a milder one at other times. You may also need different emollients for different areas of skin. For example, you may need a different emollient for your hands and one for your face.
How should I use emollients?
Emollients should be applied by smoothing them into the skin in the same direction that the hair grows. However, you should avoid rubbing emollients in because doing so can irritate the skin.
After washing, make sure that you gently pat the skin dry. Apply the emollient as soon as the skin is dry. Do not share emollients with other people.
Creams and lotions tend to be more suitable for red, inflamed areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.
When should I use emollients?
Emollients should be used frequently, even when the skin appears to be clear. If the skin is very dry, emollients should be applied every 2-3 hours.
To ensure that you apply emollients frequently, you may wish to consider keeping separate supplies of emollients at work, or at nursery or school if your child has the condition.
Creams and lotions tend to be more convenient and easier to use during the day, whereas ointments are best used at night as they can be greasy.
If you are exposed to irritants at work which trigger your irritant contact dermatitis, make sure you apply emollients regularly during and after work to help prevent your symptoms being triggered.
Can emollients cause any side effects?
The most common side effect of using emollients is a rash. If you have contact dermatitis, your skin will be sensitive, and can sometimes react to certain ingredients within the emollient. If your skin reacts to the emollient, you should speak to your GP, who will be able to prescribe an alternative product.
If you are using an emollient for the first time, you may want to try applying a small amount of the emollient first, before applying it to a widespread area. This will allow you to check whether your skin will react to it or not.
It is important to be aware that some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, they should not be left near a naked flame. You should also avoid applying emollients while you are smoking.
Emollients which are added to your bath or shower can also be easy to slip on. As long as you are aware of these hazards, you can use emollients safely.
Topical corticosteroids
If your skin is very red, sore and inflamed, your GP may prescribe you a topical corticosteroid. This type of medicine works by quickly reducing inflammation. It is applied directly to your skin.
You may be concerned about using medication which contains steroids. However, corticosteroids are not the same as anabolic steroids (which are sometimes used by bodybuilders and athletes to build muscle and improve performance). When used correctly, corticosteroids are a safe and effective treatment for contact dermatitis.
The strength of the topical corticosteroid your GP prescribes you will depend on the severity and location of your symptoms. For example, if your dermatitis is affecting your eyelids or face, you will require a very mild corticosteroid, because the skin is thin and delicate.
Children will always be started with a very mild corticosteroid, to reduce the risk of side effects.
Applying topical corticosteroids
When using topical corticosteroids, you should follow the information that comes with your particular product.
However, as a general guide, you should always apply your emollient first and then wait several minutes before you apply your topical corticosteroid. This will give the emollient a chance to be fully absorbed into your skin.
You should apply a thin layer of corticosteroid to all of your affected skin, but you should not make more than two applications a day. For most people, applying the corticosteroid once a day will be sufficient.
The corticosteroid should then be applied for 48 hours after your symptoms have cleared. If you have not noticed an improvement after two weeks, you should see your GP.
Alitretinoin
Alitretinoin (sold under the brand name Toctino) is a medication for severe, chronic hand eczema that has failed to respond to other treatments, such as topical corticosteroids.
Treatment with alitretinoin must be supervised by a dermatologist (a specialist in treating skin conditions).
Alitretinoin is a type of medication called retinoids. Retinoids help reduce the levels of irritation and itchiness associated with eczema.
Alitretinoin comes in tablet form and most people are recommended to take one tablet a day during a meal for 12-24 weeks.
Alitretinoin should never be taken during pregnancy because it can cause severe birth defects. You should 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 condoms, or a cap, plus spermicide, even if you are not currently sexually active,
- you agree to have pregnancy tests before and during treatment, and
- you sign a confirmation form stating that you are aware of the risks and what precautions you need to take.
Common side effects of alitretinoin include:
- headaches,
- inflammation of the eyes,
- muscle and joint pain,
- flushed (warm and red) skin,
- dry skin.
Uncommon side effects of alitretinoin include:
- hair loss.
- nose bleeds, and
- sight problems, such as blurred, or distorted, vision.
If you experience vision problems, you should stop treatment immediately and contact your dermatologist.
