Allergic Contact Dermatitis (ACD)

Question 1

What chemical causes the rash for poison ivy, poison sumac, poison oak, and mangos

Answer 1

Urushiol

Question 2

ACD allergens

Answer 2

• Latex
• Netaks
• Topical abx (neomycin)
• Topical steroids
• Topical anesthetics
• Propylene glycol
• Fragrances

Question 3

ACD presentation

Answer 3

-Erythematous, indurated, scaly plaques

Question 4

ACD management

Answer 4

• Identify and avoid offending agent
• treat skin inflammation
• restore skins natural barrier
• protect the skin

Question 5

ACD therapeutic options

Answer 5

• Topical corticosteroids (first line)
• high potency on thick skin or non face/flexural areas
• medium potency on face or flexures (no longer than 2 wks)
• Topical CI (for chronic, localized ACD or ACD involving face or intertriginous areas
  
  • slower onset than steroids
• Systemic steroids (patients with ACD >20% of BSA or for acute ACD of face, hands, feet or genitalia)
• Drying agents for weeping vesicles - aluminum acetate soaks, etc
• Soothing agents - oatmeal baths, calamine lotion

Question 6

Toxicodendron dermatitis

Answer 6

• Poison ivy, oak, sumac
• redness, itching, swelling, blisters
• cross reactivity is common (mango rind, cashew nutshell, ginkgo tree)
• Wear protective clothing
• Washing clothes and pets after exposure
• Antihistamines do not help itch
• TCI are not effective
• Topical steroids, high potency helpful after early exposure
• Systemic steroids (for severe, facial, genital exposures)
  
  • Medrol dose pak not long enough (rebound dermatitis)
  • prednisone taper over 2-3 weeks

Question 7

Latex allergy

Answer 7

• Pharmacotherapy (steroids, epinephrine for acute rxns)
• Immunotherapy (SCIT or SLIT)
• Anti-IgE therapy (omalizumab): monoclonal antibody investigational