Recommendations for the dermatologist: Managing a patient with contact dermatitis
It is known that sometimes a patient with contact dermatitis may not initially receive or comply with optimal treatment advice, may not be referred for patch testing in a timely manner, or may have to wait on a lengthy waiting list for patch testing. When this happens a person’s skin condition may deteriorate. However, this can be minimised if the correct advice is given to the patient when first seen.
As mentioned, there often may be a wait before a patient can be seen at the occupational or general contact dermatitis clinic, this wait may vary from a week or two, to several months. If an urgent appointment is required, please let the clinic booking manager know, and the patient can be placed on the cancellation list.
Some recommended actions a dermatologist should consider for a person with suspected contact dermatitis may include:
1/ Provision of adequate amounts of an appropriate topical corticosteroid
Ensure sufficient quantities are prescribed, think about the package size of cortisone cream/ointment, for example is it enough to cover feet and legs for extended period of time? Also consider the cost of the recommended treatment for the patient.
2/ Recommend a good moisturiser
Recommend frequent use of a fragrance free cream or ointment (in a tub or tube).
If occlusion of hands is required, suggest cotton gloves rather than vinyl or latex (these can cause sweating)
3/ Recommend mild skin care cleansers
Recommend a fragrance free, mild hand cleanser or soap substitute to be used at home and work (if possible).
4/ Encourage patient to reduce the amount of wet work performed where possible.
Can someone else bath the children or do the dishes?
Can an alcohol based hand rub be used?
5/ Ensure patient is not using products that contain the preservative methylisothiazolinone (MI)
Is the patient using baby wipes? – check for MI.
Check their moisturiser, deodorant, sunscreen, hand washes and body washes, as MI is commonly contained in many household products
For more information about avoiding MI download information sheet below:
6/ Ensure patient is not using products containing fragrance. Currently we are finding that different types of fragrances make up the five most common causes of allergic contact dermatitis in our clinic.
For more information about avoiding fragrances download information sheet below:
7/ If the patient uses latex gloves at work or at home – consider a Blood Serum test checking for latex allergy. If latex allergy is diagnosed, the patient can stop using them before their patch testing appointment, which may help the skin to improve if this is the problem.