Contact Dermatitis : Treatment, Preventing Skin Inflammation

by Food and Drug Administration (FDA)

(Page 3 of 3)

Treatment

For self-treatment of mild contact dermatitis, a .5 percent hydrocortisone topical preparation (ointment, cream or lotion) can be applied to the skin to relieve the itchiness, redness, scaling, and swelling. Because these formerly prescription-only medications had a good safety record, FDA approved them for over-the-counter sale in 1979 on the recommendation of the Advisory Review Panel on OTC Topical Analgesic, Antirheumatic, Otic, Burn and Sunburn Prevention Treatment Drug Products. A petition to make 1 percent topical hydrocortisone drug products available for over-the-counter sale is currently being evaluated by the agency.

The labeling of the OTC products states that if symptoms worsen or persist longer than seven days, a doctor should be consulted. (Occasionally, bacterial or fungal infections superimpose themselves on the dermatitis.) The labeling also cautions against internal use and use on children under 2 years. Lubricating creams or lotions, preferably preservative- and lanolin-free, can be used to prevent cracking and dryness, especially of the hands, and the irritating factor or allergen should be avoided whenever possible.

Severe cases should be seen by a doctor. Stronger concentrations of topical corticosteroid preparations or oral corticosteroids, such as prednisone, may be prescribed. If there's a secondary infection, an oral antibiotic may be necessary.

When inflammation has gone on for a long time, an extended period of convalescence is often necessary. "I tell my patients it's like skin that's been burned after sitting on a hot stove," comments dermatologist Shelley. "You've got to allow time for the skin to heal itself."

Preventing Skin Inflammation

Sensitive-skinned people — and even those with tougher hides — would do well to follow a number of measures to prevent contact dermatitis:

Read the labels on cosmetics. FDA requires that all ingredients in cosmetics be listed on the label in descending order of predominance. If a cosmetic causes a problem, note the ingredients — fragrances and preservatives are the most likely suspects — and avoid similar cosmetic formulations in the future. (Specific fragrance components are not listed, so a switch to fragrance-free products should be tried if dermatitis persists.)

Wash new clothing and bed linens several times before using. Contact dermatitis caused by clothing is usually due to formaldehyde released by chemicals in the finishing of fabrics, and sometimes to the dyes. Avoid polyester blends and cottons that are labeled "permanent press" and "wrinkle-resistant," and stick to natural fibers, such as cotton, linen and silk. (Though wool is a natural fiber, it can be irritating.)

Use soaps or detergents specifically formulated for babies' wash if laundry products are under suspicion. Avoid fabric softeners and antistatic products, and double-rinse the wash.

Wear heavy-duty vinyl gloves with cotton liners, if possible, when hands are in contact with harsh cleansers at home or chemical irritants at work. Avoid abrasive soaps for removing grease and oil. Remove rings when using soaps and detergents, because these materials can become trapped under rings and cause irritation. Keep the hands well-moisturized with a bland cream or lotion.

Learn to recognize the leaves of poison ivy and poison oak, each three-leaved, and poison sumac with its oval leaves and white berries. If exposed to them, wash hands and skin thoroughly after exposure, using any kind of soap. Before applying over-the-counter poison ivy preparations, read the labels and use with caution medications containing zirconium, benzocaine, and diphenhydramine hydrochloride. Although most people have no problem with these, sometimes they may sensitize and produce a dermatitis on top of the poison ivy rash. Dermatitis can result from handling other plants, including vegetables such as parsnips, garlic, onions, tomatoes, carrots, and ginger.

Don't self-treat too long. If the dermatitis is not better after a week or 10 days, see the doctor. The topical medications may be the problem, or the itching and rash may be the symptoms of something quite different. An intolerable itch may be a sign of Hodgkin's disease, or of scabies, transmitted by the itch mite, a parasite. Red, itchy rashes can also be caused by superficial fungal infections, such as candidiasis, or impetigo and other bacterial infections.

Common Sensitizers

Among common sensitizers, poison ivy leads the pack. Estimates of Americans with poison ivy allergy range from 50 to 70 percent. Most of the rest of the population would develop poison ivy dermatitis on further exposures, though some people will never get it. Cross-sensitization to other members of the poison ivy family occurs, so that allergy can develop to poison oak, poison sumac, the oil in cashew nutshells, mango fruit peel and leaves, and the fruit of gingko trees. A severe airborne dermatitis can result from contact with the smoke from burning plants on exposed skin.

In mild cases, topical corticosteroids are used to relieve the itching, while severe cases are treated with oral or injected corticosteroids. In severe cases, hospitalization is sometimes necessary. Unfortunately, shots or medicines for desensitization to poison ivy have not been very effective and, in fact, can make poison ivy dermatitis worse.

Some common house and garden plants are not completely innocuous, either. Primroses and philodendrons cause allergic dermatitis in some people. Handling tulip bulbs may result in a sensitivity known as "tulip fingers." Asters, chrysanthemums, English ivy, castor beans, oleanders, geraniums, poinsettias, magnolias, lilacs, narcissus, and other bulb plants can be sensitizers, as can ragweed, some pollens, such as birch pollen (which can cross-sensitize to apples, carrots and celery), and the timber and sawdust of some trees.

Some vegetables may also cause a problem. Dermatitis can result from handling parsnips, garlic, onions, tomatoes, carrots, and ginger.

Nickel, the most common metallic sensitizer, produces more allergic dermatitis than all other metals combined. Other common sensitizers are permanent hair dyes containing the chemical paraphenylenediamine, rubber compounds, and the chemical ethylenediamine, found in dyes, insecticides, synthetic waxes, and used as a preservative in some medicines.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.