Assessment and initial management of contact dermatitis
The initial step in managing contact dermatitis is to take a thorough history to identify exposure to irritants and allergens at work, home and play. Review all topical products for irritant and allergic potential, including regularly or intermittently used products (eg prescription, over-the-counter, complementary and alternative medicines, cosmetics, personal care products).
‘Usage tests’ and patch testing can be used to identify the irritant or allergen.
Assess whether endogenous dermatitis (eg atopy) is contributing to the condition.
If contact dermatitis is suspected to be work-related1, contact the patient’s employer and obtain Safety Data Sheets (SDS) for any hazardous goods that the patient handles, to identify the causative irritant or allergen and obtain information on appropriate protective clothing (eg type of gloves required).
Advise the patient to avoid further contact with the allergen or irritant. If the patient cannot easily avoid the allergen or irritant, or fails to maintain the skin long term, the prognosis for contact dermatitis is poor. This applies particularly to patients with occupational hand dermatitis. Sometimes a change of occupation is needed.
Prescribe treatment based on the body part affected by contact dermatitis (eg hand, face, genitocrural area, feet). The patient may need a medical certificate for alternative duties until the contact dermatitis clears.
Skin may be more sensitive to irritation for weeks or months after visible healing of contact dermatitis—educate the patient about long-term preventive measures (eg using emollients, wearing gloves, reducing sweating), which should be continued even after the skin looks and feels normal.
If the contact dermatitis does not clear, refer for specialist advice for confirmation of diagnosis (eg with usage tests or patch testing). See also Lack of response to treatment of dermatitis.