General management of dermatitis

Management of most types of dermatitis involves improving the skin condition, avoiding known irritants and allergens, and using topical corticosteroids.

Dry skin can cause dermatitis and also aggravate certain types of pre-existing dermatitis—advise patients with dermatitis to improve the skin condition (eg with emollients).

Advise patients to avoid exposure to any known irritants and allergens, if possible.

Topical corticosteroids are the mainstay of therapy for dermatitis. Formulations and doses vary depending on the type of dermatitis; see individual topics for drug options and dose recommendations.

Instruct patients to apply topical corticosteroids liberally, not sparingly, to areas of inflamed skin. Reassure patients (and parents or carers) that the benefits of topical corticosteroids outweigh the harms, and that they should not be afraid to use them. Some types of dermatitis are chronic; repeated, intermittent use of topical corticosteroids is safe and appropriate. If topical corticosteroids are required continuously for longer than 8 weeks, specialist referral to optimise management is usually appropriate. For other considerations in topical corticosteroid use, see Considerations in the use of topical corticosteroids.

Antihistamines have limited therapeutic benefit for most types of dermatitis. However, if a patient has disturbed sleep from itching, a sedating antihistamine at bedtime may help (see here for doses of sedating antihistamines).

Even after successful treatment of dermatitis, the skin is usually still sensitive and prone to irritation and dryness—advise patients to continue to avoid exposure to irritants and allergens, and to use emollients to maintain the skin condition long term.