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Allergic Contact Dermatitis template

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Description of Allergic Contact DermatitisAcute inflammation of the skin due to contact with an external substance or object
Etiology of Allergic Contact DermatitisChemical Irritants: Nickel, Turpintine, soaps, detergents. Usually produces immediate discomfort Plants: poison ivy or oak. Delayed hypersensitivity reaction produces discomfort within 4-12 hours
Risk Factors for Allergic Contact DermatitisFamily Hx Continued contact with an offending substance Topical drugs: Neomycin, thimerosal, paraben Occupation: gloves
Assessment Findings in Allergic Contact DermatitisRedness, itching, bullae, and/or surrounding erythema Lines of demarcation with sharp borders Papules and/or vesicles Scaling, crusting, oozing Initially, the dermatitis may be limited to the site of contact, but may later spread Palms and soles less likely to exhibit reaction Thin skin areas may be more sensitive
Nonpharmacologic Management of Allergic Contact DermatitisAvoid contact with offending substance If contact with substance occurs, wash skin immediately with soap and water Soaks with cool water may help burning and/or irritation Tepid bath may help with pruritus Emollients to prevent drying if chronic inflammation Monitor for secondary bacterial infection
Pharmacologic Management of Allergic Contact DermatitisCorticosteroids: topical, oral, and/or injectable 3 factors affect potency of topical cortocosteroid: Steroid, concentration, and vehicle (lotion, cream, etc) Absorption increases based on the vehicle:Lotion< cream< gel< ointment Calamine lotion for itching Moisture barrier: zinc oxide Antihistamine: topical and/or oral Topical or oral antibiotics if secondary infection
Topical Corticosteroids for Allergic Contact DermatitisExert anti-inflammatory effect nonspecifically thru mechanical, chemical, and immunologic means Use lowest potency cream that produces desired effect Skin atrophy is common with long-term steroid use Areas most susceptible are the face, groin, and axillae Topical steroids will worsen skin infections Systemic absorption is usually minimal, but broken skin will absorb significantly more steroid
Description of Atopic Dermatitis (Eczema)Chronic, pruritic skin eruption with acute exacerbations appearing in characteristic sites. Eczema is often used interchangeably with atopic dermatitis, but the word eczema describes acute symptoms associated with atopic dermatitis Commonly seen in pts with other atopic illnesses (asthma, allergic rhinitis)
Risk Factors for Atopic DermatitisFamily hx of atopic dermatitis Skin infections Stress Temperature extremes Contact with irritating substances
General Assessment Findings in EczemaPruritis Erythema Dry Skin Facial erythema Infraorbital folds (Dennie Morgan folds)
Assessment Findings in Infants with EczemaLesions on extensor surfaces of arms and legs, cheeks Lesions are erythematous and papular Vesicles may ooze, form crusts
Assessment Findings in Children with EczemaLesions common in wrists, ankles, and flexural surfaces PResence of scales and plaques; lichenification occurs from scratching
Assessment Findings in Adults with EczemaFlexural surfaces are common sites, dorsa of the hands and feet Often reappears in adulthood after absence since childhood Lichenification and scaling are typical
Nonpharmacologic Management of EczemaLimit bathing (Do not use hot water) to avoid further drying of skin Prevent skin trauma (sunburns, etc) Soak for 20 minutes in warm water before applying emollient Wet compresses (Burrows solution) if lesions are weeping or oozing Pt education
Pharmacologic Management of EczemaTopical corticosteroids are the mainstay therapy (Use lowest potency which controls symptoms) Topical immune modulators; Elidel, Protopic Antihistamines (oral and topical) for itching Emollients 2-3 times per day or as needed to correct dry skin Oral corticosteroids may be used for severe disease, this should be reserved and only used in short bursts Intralesional steroid injections
Topical Immune Modulators Used in Atopic Dermatitis (Eczema)Tacrolimus, Pimecrolimus Potent immune modulators which inhibit T-lymphocyte activation Do NOT use on infected skin Infection will significantly worsen eczema Potential for systemic absorption may increase formation of tumors
Consultation/ Referral for EczemaDermatologist for severe cases or those not responding to treatment

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