Allergic Contact Dermatitis (ACD)

Question 1

Risk factors for ACD

Answer 1

occupation: health professions, chemists, beauticians, hairdressers, construction workers
age: contact sensitization begins in early childhood
hx of atopy

Question 2

Signs and sx ACD

Answer 2

erythematous, indurated, scaly patches
edema may be present in certain areas of the skin
repeated exposures–> dry scaly thick skin
itching burning stinging pain

Question 3

ACD Dx

Answer 3

clinical features
hx expossure to Ag during activites
patch testing results
lab tests

Question 4

ACD Management

Answer 4

identify and avoid offending agent
tx skin inflammation
restore natural barrier
protect skin

Question 5

ACD tx options

Answer 5

1st line- topical steroids

Question 6

chronic, localized ACD or ACD involving face or intertriginous areas tx options

Answer 6

topical calcineurin inhibitors

Question 7

ACD >20% of BSA or for acute ACD face, hands feet or genitalia

Answer 7

systemic corticosteroids

Question 8

weeping vesicles tx

Answer 8

drying agents, aluminum acetate soaks

Question 9

soothing agents

Answer 9

oatmeal baths, calamine lotion

Question 10

Toxicodendron dermatitis

definition
s/sx
prevention
tx

Answer 10

poison ivy, oak, sumac, cross reactivity w/ mango, cashew nuts
intense pruritus and erythema, papules or plaques, vesicles, 4-96h after exposure, peak btwn 1-14 d, usually resolves in 1-3wks

tx: soothing measures
for dry weeping lesions: aluminum acetate (Burow’s solution), aluminum sulfate calcium acetate (Domeboro)

topical steroids - high potency helpful early on, x<1wk
systemic steroids - for severe, facial, genital
Medrol Dosepak NOT LONG ENOUGH
Give prednisone taper over 2-3 weeks
po antihistamines - meh, zzzzz is better, itch isnt from histamine
topical calcineurin-i ineffective

Question 11

Latex allergy

4 strategies

Answer 11

1 = avoidance
2 = pharmacotherapy (steroids, carry EN 0.3-0.5mg SQ repeated prn q5-10min)
3 = immunitherapy (SCIT, SLIT)
4 = Anti-IgE tx (omalizumab [costly, duration?])