Medication Summary
After the identification and removal of any potential causal agents, the use of ceramides creams or bland emollients and bland barrier creams such as those containing dimethicone are the mainstays of medical treatment for irritant contact dermatitis (ICD).
A number of agents commonly found in therapeutic products for the skin (eg, propylene glycol, lactic acid, urea, salicylic acid) may produce further skin inflammation and may need to be avoided in these individuals. Topical corticosteroids play a limited role in the treatment of irritant contact dermatitis. They do not address the process directly, but they may be helpful for superimposed eczematous features.
Corticosteroids, Topical
Class Summary
Corticosteroids are immunosuppressives with anti-inflammatory properties that modify the body's immune response to diverse stimuli. Other actions include vasoconstriction and antiproliferation. These agents have limited use in the treatment of irritant contact dermatitis.
Hydrocortisone topical (AlaCort, AlaScalpt, Aquanil)
Hydrocortisone is an adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. It has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity. Use 0.2% cream or ointment. A thin layer can be applied 1-2 times daily to affected areas on the face, groin, neck, and axilla for 1-2 weeks.
Triamcinolone topical (Kenalog Orabase, Kenalog topical, Pediaderm TA)
Triamcinolone is indicated for inflammatory dermatosis responsive to steroids; it decreases inflammation by suppressing migration of PMNs and reversing capillary permeability. A thin layer can be applied 1-2 times daily to affected areas on the extremities and trunk for 1-2 weeks.
Clobetasol (Clarelux, Clobex, Clobex Spray)
A class I superpotent topical steroid, clobetasol suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction. Use 0.05% cream or ointment. A thin layer can be applied 1-2 times daily to affected areas on the palms and soles for 1-2 weeks.
Calcineurin Inhibitors
Class Summary
Topical calcineurin inhibitors can be used as an alternative to topical corticosteroids.
Tacrolimus ointment (Protopic)
Tacrolimus reduces itching and inflammation by suppressing release of cytokines from T cells. It also inhibits transcription for genes that encode interleukin 3 (IL-3), IL-4, IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor–alpha (TNF-alpha), all of which are involved in the early stages of T-cell activation.
Additionally, tacrolimus may inhibit release of preformed mediators from skin mast cells and basophils and may down-regulate expression of high-affinity IgE receptor (FCeRI) on Langerhans cells.
Tacrolimus is approved for moderate-to-severe atopic dermatitis and can be used in patients as young as 2 years. It is more expensive than topical corticosteroids. This agent is available as ointment in concentrations of 0.03 and 0.1%.
Apply a thin layer to the affected area daily.
Pimecrolimus (Elidel)
Pimecrolimus is indicated for eczema and atopic dermatitis. It was the first nonsteroid cream approved in the United States for mild-to-moderate atopic dermatitis. Pimecrolimus is derived from ascomycin, a natural substance produced by fungus Streptomyces hygroscopicus var ascomyceticus.
This agent selectively inhibits production and release of inflammatory cytokines from activated T cells by binding to cytosolic immunophilin receptor macrophilin-12. The resulting complex inhibits phosphatase calcineurin, thus blocking T-cell activation and cytokine release. Cutaneous atrophy was not observed in clinical trials, a potential advantage over topical corticosteroids.
Apply a thin layer to the affected area daily.
Emollients
Petrolatum & mineral oil topical
Petrolatum and other emollients can be used liberally on the affected area.
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Chronic irritant contact dermatitis of the hands in an older worker; the condition resulted in early retirement.
