Dermatitis Flashcards
—- is an inflammation of the skin
Dermatitis
Facts about Dermatitis
Can be- ACUTE: a single exposure to an irritant CHRONIC: repeated exposure
Characterised by sore, red itching skin.
State the most common form of dermatitis in primary care
IRRITANT CONTACT DERMATITIS (ICD) & ALLERGIC CONTACT DERMATITIS (ACD) are most common
State the epidemiology of Dermatitis
ICD much more common than ACD
ICD accounts for 80% of occupational skin disorders
Dermatitis accounts for ~30% of skin consultations
Aetiology of ICD
ICD: agent must penetrate the outer layer of skin to invoke physiological response
state the common irritant of ICD
Nickel, leather, detergents and soaps, solvents, abrasives, oil, acids and alkalis.
State facts about Allergic contact dermatitis ACD
first requires sensitisation to occur. Once skin sensitised to allergen, re-exposure triggers memory T-Cells to initiate inflammatory response 24-48hours after exposure
Common irritants of ACD
nickel, topical corticosteroids, preservatives, cosmetics & rubber (incl. latex)
State the signs and symptoms of Contact Dermatitis
Both cases, rash develops at site of exposure
Acute phase: Lesions appear rapidly, within 6-12 hours of contactSkin appears red, itchy, inflamed & might show papules
Chronic Exposure: Skin becomes dry, scaly, and can crack/fissure
ICD rash tends to be well demarcated. ACD tends to be less well defined
State the signs and symptoms of Contact Dermatitis
Both cases, rash develops at site of exposure
Acute phase: Lesions appear rapidly, within 6-12 hours of contactSkin appears red, itchy, inflamed & might show papules
Chronic Exposure: Skin becomes dry, scaly, and can crack/fissure
ICD rash tends to be well demarcated. ACD tends to be less well defined
Questions to ask a patient suffering from Dermatitis
Location Personal history Exposure Occupation/work Known allergies/other ectopic conditions Family history
List the 3 steps in managing Contact Dermatitis
managing itch - avoiding irritants -maintain skin integrity
How to pharmacologically manage Contact Dermatitis
P’cological treatment of dermatitis should be managed with a combination of emollients and steroid-based products
How to treat Contact Dermatitis in Primary care/pharmacy
Emollients
Apply regularly & liberally.
a) Moisturisers e.g. Aveeno, Diprobase, Oilatum
b) Bath additives e.g. Balneum, Oilatum
c) Soap substitute e.g. Emulsifying Ointment, Aqueous cream, E45
d) Humectants e.g. Urea, lactic acid (Calmurid, Aquadrate, Humiderm
Treatment of Dermatitis contd
Topical steroids
OTC: Hydrocortisone 1% crm & Clobetason crm 0.05%
Anti-inflammatory.
side effect of using topical steroid to treat dermatitis
skin thining
see slide 23 for Steriod ladder and slide 24 for emolient ladder
Self advise for dermatitis
AVOID soap/bubble bath use soap substitute
Avoid contact with stimulus
Use during and after bathing/showering
State actions patient should take to reduce the likelihood of Dermatitis occuring
Patient should try to avoid contact with the stimulus causing the dermatitis. If they cannot completely avoid it, they should take the following actions to prevent/reduce the likelihood of it occurring:
Rinsing with water or washing with soap or, preferably, a soap substitute as soon as possible after contact (overuse of skin-cleaning agents can aggravate contact dermatitis).
Substituting products that contain identified allergens or irritants with other products that do not contain them.
Reducing the duration and frequency of contact with an irritant.
Using protective clothing. Most irritant contact dermatitis involves the hands, and protective gloves are the mainstay of protection.
Certain chemicals may demand more heavy-duty protective materials which are not subject to chemical degradation.
Gloves should be removed frequently, as sweating may aggravate existing dermatitis.
When to refer a patient with dermatitis
Children under 10 in need of corticosteroid
Lesions on the face unresponsive to emollients
OTC treatment failure
Widespread/severe dermatitis (signs of secondary infection
State the treatment options for dermatitis available in secondary care/dermatology
Treatment options in Secondary Care/dermatology:
Immunosuppressants
Adalimumab (black triangle biosimilar)
Self-Management with nurses
List the conditions to eliminate in Dermatitis
Psoriasis: Not precipitated to exposure to irritants/allergens
Fungal infections: Defined advancing edge w central clearing
Discoid dermatitis: Lesions oval/circular &clearly demarcated
Urticaria: can be due to food allergy, food additives & medicine. Itchy rash resembling nettle rash. Skin can be oedamatous & blanches when pressed. Respond to antihistamines.
