Treatment - Contact dermatitis

If you identify and avoid the substance causing your contact dermatitis, your symptoms can improve.

There are treatments to ease your symptoms if you cannot avoid the substance.

A pharmacist can recommend treatments like emollients. Emollients are moisturising treatments that you put on your skin. Emollients can stop your skin from becoming dry.

Avoiding the cause

An important step in treating contact dermatitis is to identify the substance that causes your symptoms. If you can avoid or reduce your contact with the substance, your symptoms can improve.

It's not always easy to avoid the substance. Your pharmacist, GP or dermatologist can suggest ways to reduce your contact. A dermatologist is a doctor who specialises in skin conditions.

If you're in contact with irritants as part of your job, wear protective clothing. This reduces your contact with the irritant. Tell your employer about your condition so they can help you avoid the causes.

Emollients

Emollients are moisturising treatments that you put on the skin. They help to reduce water loss and cover your skin with a protective film. They're often used to ease dry or scaly skin conditions such as eczema.

Choice of emollient

Several different emollients are available. You may need to try a few to find one that works for you.

Your GP may recommend a mix of emollients, such as:

• an ointment for very dry skin
• a cream or lotion for less dry skin
• an emollient to use instead of soap
• an emollient to use on your face and hands, and a different one to use on your body

The difference between lotions, creams and ointments is the amount of oil in them.

Ointments contain the most oil so they can be quite greasy. But they are the most effective at keeping moisture in the skin. Lotions contain the least amount of oil so they are not greasy. But they can be less effective. Creams are somewhere between ointments and lotions.

Creams and lotions are more suitable for inflamed (swollen) areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.

Emollients may become less effective over time or may start to irritate your skin. If this is the case, your pharmacist can recommend another product.

How to use emollients

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

Do not rub the emollient into your skin. Smooth the emollient into your skin in the same direction the hair grows.

When you use the emollient after a bath or shower, gently dry your skin but leave it a bit damp. Then smooth the emollient into your skin while it's still damp.

For very dry skin, use the emollient 2 to 4 times a day or as prescribed by your GP.

If an irritant at work causes your contact dermatitis, use emollients often during and after work.

Do not share emollients with other people.

Side effects

Sometimes emollients can irritate your skin. If you have contact dermatitis, your skin can be sensitive. Sometimes your skin can react to ingredients such as perfume in over-the-counter emollients.

If your skin reacts to the emollient, stop using it and speak to your pharmacist. They may recommend a different product.

Some emollients contain paraffin and can be a fire hazard. Do not use them near a naked flame.

If you add emollients to bathwater, the bath can get very slippery. Take care getting in and out of the bath.

Topical corticosteroids

Contact dermatitis can cause lighter skin to become red. Darker skin can become dark brown, purple or grey.

If your skin is also sore and inflamed, your GP may prescribe a topical corticosteroid. Topical corticosteroids are creams or ointments that you apply to your skin. They can quickly reduce the inflammation.

Corticosteroids are a safe and effective treatment for contact dermatitis. You must follow the instructions given by your pharmacist or GP.

Choice of topical corticosteroid

Your GP can prescribe different strengths of topical corticosteroids. This depends on how serious your contact dermatitis and where the affected skin is.

Your GP may prescribe a:

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

How to use topical corticosteroids

Follow the instructions given by your GP. If they did not give instructions, follow the directions on the patient information leaflet that comes with your medicine. This gives details of how much to use.

Use your emollient first. Wait about 30 minutes before you put on the topical corticosteroid.

Put on the topical corticosteroid in a thin layer to all the affected areas.

If you have severe contact dermatitis, do not use the topical corticosteroid more than twice a day. Most people only have to use it once a day.

The treatment can start to have an effect within a few days. Speak to your GP if you are using a topical corticosteroid and your symptoms have not improved.

Side effects

Topical corticosteroids may cause a mild burning or stinging sensation for a short time when you put them on your skin.

In some cases, they may also cause:

• thinning of the skin
• changes in skin colour
• acne (spots)
• increased hair growth

Most of these side effects improve when the treatment stops.

If you use a strong topical corticosteroid or use a large amount of topical corticosteroid, your risk of side effects increases. Use the weakest and smallest amount possible to control your symptoms.

Steroid tablets

If you have severe contact dermatitis that covers a large area of your skin, your GP may prescribe corticosteroid tablets.

If you take steroid tablets often or for a long time, they can cause many side effects, such as:

• high blood pressure (hypertension)
• osteoporosis (brittle bones)
• diabetes

Your GP may not prescribe repeat courses of corticosteroid tablets. They will usually refer you to a specialist.

Further treatments

If the treatments prescribed by your GP do improve your symptoms, they may refer you to a dermatologist (skin specialist).

Treatments that may be available from a dermatologist include:

• phototherapy – the affected area of skin is exposed to ultraviolet (UV) light to help improve its appearance
• immunosuppressant therapy – medicines that reduce inflammation by suppressing your immune system
• alitretinoin – capsules for severe eczema affecting the hands