Contact Dermatitis: Educating Patients

Pharmacists are likely to encounter patients seeking guidance on OTC products for treating contact dermatitis.

Contact dermatitis is characterized as acute inflammation of the skin due to exposure to or direct contact with irritants or allergens.^1,2 The severity and symptoms of contact dermatitis vary from patient to patient and depend on the cause and the extent of exposure to the allergen or irritant.^2-5 Upon exposure to an irritant or allergen, the skin may appear red and swollen. The symptoms associated with contact dermatitis commonly include pruritus, erythema, inflammation, and the formation of vesicles and pustules.^2-5

Contact dermatitis may be classified as irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD; Online Table 1).^2-5 Sometimes differentiating ACD from ICD may present a challenge, especially if the cause of the skin irritation is unknown; ACD is typically confined to the contact area, while ICD may appear more widespread on the skin.^2-5 Moreover, a red rash occurs immediately in ICD, while sometimes in ACD, a rash may not appear for 24 to 48 hours after exposure to an allergen.^2-5

Table 1: Types of Contact Dermatitis

Irritant Contact Dermatitis

Allergic Contact Dermatitis

· ICD is the most prevalent form of contact dermatitis, accounting for an estimated 30% to 90% of all cases.

· It is caused by an inflammatory reaction of the skin due to exposure to an irritant such as a chemical, soap, detergent, or household cleaning product.

· The reaction typically resembles a burn.

· ICD is usually associated with a patient’s occupation; possible causes include frequent use of hand hygiene products, exposure to chemicals, and glove use.

· Most cases involve exposed or unprotected areas of the skin, such as the face, hands, and arms.

· An estimated 30% of ICD cases involve the hands; 10% of cases involve the face.

· The most common symptoms include inflammation, edema, erythema, and crusting and formation of pustules or vesicles.

· ACD is less prevalent than ICD and is characterized by an inflammatory skin reaction due to exposure to an allergen, such as poison ivy, poison oak, or poison sumac.

· Metal allergies, especially to nickel salts found in jewelry, clothing, and cell phones, are a prevalent cause of ACD.

· Cosmetics, fragrances, and some skin care products (due to additives or dyes) can cause ACD.

· The signs and symptoms of ACD may include localized pruritus, rash, pain, and blistering. The skin may appear swollen and red.

ACD = allergic contact dermatitis; ICD = irritant contact dermatitis.

Adapted from references 2-5.

Nonprescription Topical Products

A host of topical products is marketed for symptomatic relief of contact dermatitis. Dosage forms include creams, ointments, gels, lotions, and sprays. Hydrocortisone is considered to be the most effective topical therapy for treating (1) symptoms of mild to moderate dermatitis that does not involve edema and/or extensive areas of the skin and (2) atopic dermatitis.^1,3,5 Non-prescription strength hydrocortisone is available in 0.5% or 1% strength and should not be used in patients younger than 2 years. Typically, it should not be used for more than 7 days, unless directed by a physician, and should not be applied to broken or cracked skin.^1,3,5

If experiencing itching, patients with contact dermatitis may elect to use topical antihistamine products; however, the use of topical antihistamines is not advised in individuals with atopic dermatitis.^1,3 Because topical antihistamines may cause sensitivity reactions, they should not be applied to broken, blistered, or oozing skin and should not be used for more than 7 days unless otherwise directed.³ Moreover, they should not be used concurrently with other antihistamine-containing products, including oral dosage forms, because the serum concentration may increase and these agents should not be applied to large areas of the skin.³

Other agents that may provide antipruritic and anesthetic relief include external analgesics such as phenol, menthol, and camphor, which are available in various dermatologic products.³ External analgesics should not be used on open lesions and inflamed skin because of potential irritation and burning.³

If appropriate, patients with contact dermatitis may also use astringent products (eg, aluminum acetate, zinc oxide, zinc acetate) to promote drying of moist, wet, oozing lesions and to serve as a protective covering for inflamed skin.³ Colloidal oatmeal baths and products containing calamine may also provide symptomatic relief from itching.³

Pharmacists should ascertain the appropriateness of self-treatment and advise patients to seek further medical evaluation when warranted, especially if patients exhibit any signs of skin infection. During counseling, patients should be reminded that cases of ICD and ACD typically resolve in 7 to 21 days, with or without therapy.³

Patients with a history of allergies to skin care products and cosmetics should be advised to use hypoallergenic products. Patients should be reminded to immediately contact their primary health care provider if there are no signs of improvement after self-treatment, if there are signs of infection, or if symptoms worsen. Exclusions for self-treatment of contact dermatitis can be found in Table 2, and affected patients should always be referred to their primary health care provider for treatment.³

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References:

• Contact dermatitis. Merck Manual for Healthcare Professionals Online Edition website. www.merckmanuals.com/professional/dermatologic_disorders/dermatitis/contact_dermatitis.html. Accessed February 27, 2014.
• Contact dermatitis and latex allergy. Centers for Disease Control and Prevention website. www.cdc.gov/oralhealth/infectioncontrol/faq/latex.htm. Accessed February 27, 2014.
• Plake K, Darbishire P. Contact dermatitis. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Contact dermatitis. Medline Plus website. www.nlm.nih.gov/medlineplus/ency/article/000369.htm. Accessed February 27, 2014.
• Contact dermatitis. Cleveland Clinic Health Information website. http://my.clevelandclinic.org/disorders/Dermatitis_Contact/hic_Contact_Dermatitis.aspx. Accessed February 27, 2014.