This handout is for contact dermatitis — allergic vs irritant (dermatology lens). Your care team identified this based on: subacute/chronic eczematous rash whose distribution maps to a contact exposure (geometric/linear margins, hands, face/eyelid, feet) (nosbaum eur j dermatol 2009 pmid 19447733).
Other reasons your team may use this plan: temporal/spatial link to an occupational or personal-product exposure (wet work, gloves, cosmetics, jewellery, topical medicaments) (karagounis curr allergy asthma rep 2023 pmid 36749448); itch-dominant + spread beyond contact site (favours acd) vs burning/stinging confined to contact site (favours icd) (fyhrquist-vanni dermatol clin 2007 pmid 17903620); eczema (incl. atopic) recalcitrant to adequate therapy or atypically distributed → suspect superimposed acd, patch-test entry (nacdg 2021-2022 pmid 40274377).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| allergen_irritant_identification_and_strict_avoidance | — | — | — | Nosbaum Eur J Dermatol 2009 (PMID 19447733) / ACDS 2020 (PMID 32947457) — identification (patch test for ACD; exposure history for ICD) + strict avoidance of the allergen, cross-reactors, and concomitant irritants is the only definitive cure; supply a named safe-product / Contact Allergen Management Program list. |
| barrier_protection_gloves_and_substitution | — | — | — | Karagounis Curr Allergy Asthma Rep 2023 (PMID 36749448) — gloves (allergen-appropriate; cotton liners), reduced wet-work, workplace substitution/ergonomics; glove rubber-accelerator allergy itself can perpetuate hand dermatitis. |
| emollient_barrier_repair | — | — | — | Karagounis 2023 (PMID 36749448) — liberal emollients restore the barrier and are the mainstay of ICD; reduce irritant penetration and accelerate resolution once exposure is removed. |
Plan: Contact dermatitis — trigger-elimination-first + stepwise anti-inflammatory ladder (ACD/ICD)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: written allergen/irritant avoidance plan with named allergens + cross-reactors + safe-product list (Contact Allergen Management Program / safe-list), barrier-protection + emollient habit, occupational return-to-work + workplace-substitution plan and workers-comp documentation where applicable, education on delayed re-exposure flares and id reactions, and re-patch-test criteria if a new pattern emerges. Dermatology continuity for any systemic agent; reassess for superimposed ACD if a sibling-engine dermatosis remains recalcitrant.
Guideline: ACDS Core Allergen Series 2020 Update (Schalock et al, Dermatitis; PMID 32947457, with 2017 PMID 28169850 + original PMID 23340393) + NACDG Patch Test Results 2021-2022 (Houle/DeKoven et al, Dermatitis; PMID 40274377 — current North American allergen-prevalence + relevance reference) + Occupational Hand Dermatitis review (Karagounis & Cohen, Curr Allergy Asthma Rep 2023; PMID 36749448) + ICD-vs-ACD pathophysiology (Nosbaum et al, Eur J Dermatol 2009 PMID 19447733; Fyhrquist-Vanni et al, Dermatol Clin 2007 PMID 17903620) + poison-ivy systemic-steroid duration RCT (Curtis & Lewis, J Clin Med Res 2014 PMID 25247016) + dupilumab for refractory/occupational ACD (Slodownik et al, Dermatology 2022 PMID 35462358; Goldminz & Scheinman, Dermatol Ther 2018 PMID 30246906)