Exam 5 - Contact Dermatitis Flashcards
Define contact dermatitis
Condition characterized by the following on dermal areas exposed to irritant or antigenic agents:
- inflammation
- redness
- itching
- burning
- stinging
- vesicle/pustule formation
What is irritant contact dermatitis (ICD)?
Inflammatory reaction of the skin caused by exposure to an irritant
Causes of irritant contact dermatitis (ICD)
Frequent handwashing
Oils
Strong acids/bases
Fiberglass
Wood dust
Urine
Fecec
Causes of allergic contact dermatitis (ACD)
Nickel
Cobalt
Cosmetics
Latex
Poison ivy/oak/sumac
What is allergic contact dermatitis? (ACD)
Immunologic reaction of the skin caused by exposure to antigen
Clinical presentation of ICD
Skin is:
- inflamed
- swollen
- erythematous
- painful
- itchy
- stinging/burning
Skin may be dry or macerated
Most commonly seen on hands, forearms, face
What irritants require multiple exposures to cause ICD?
Mild irritants:
- soaps
- solvents
- detergents
What affects response severity of irritant contact dermatitis (ICD)?
Quantity and concentration of substance exposure
What irritants are likely to cause immediate/severe response of ICD?
Chemical irritants like acids/bases
When should a patient with ICD be referred?
Younger than 2
> 10% of skin surface
Rash has not decreased in 7 days
Chronic dermatitis symptoms present
Involvement of:
- eyes
- eyelids
- mouth
- face
- neck
- genitals
Where is ICD most commonly seen?
Hands
Forearms
Face
Treatment goals of ICD
- Remove irritant & prevent further exposure
- Relieve inflammation & irritation
- Educate patient on self-treatment & prevention
OTC pharmacologic treatment for ICD
Burow’s solution (aluminum acetate 5%)
Emollients & moisturizers
Barrier creams/ointments
What is the gold standard emollient/moisturizer for ICD
Petrolatum
Non-pharmacological treatment for ICD
Avoid the irritant
Wash w/ tepid water and mil/hypoallergenic soap or saline soak
Change clothes, diapers, and gloves more frequently
Wear protective clothing/gloves
Burow’s solution preparation and use
1:40 aluminum acetate - tap water solution
Soak affected area for 15-30 min 3-4x daily
OR use compress for 20-30 min 4-6x daily
OTC pharmacologic treatments for itching
Topical corticosteroids
Colloidal oatmeal bath
What causes allergic contact dermatitis?
3000 chemicals
Common:
- poison ivy/oak/sumac
- nickel
- latex
- fragrances
- cosmetics
What products should be AVOIDED for itching?
Topical “-caine” anesthetics
Patient education for ICD
Rash should resolve once irritant is removed
Emphasize prevention and protection
Nonpharmacologic factors are key
Counsel on proper use of pharmacologic options
Refer if rash/itching worsens or does not heal in 7 days
Clinical presentation of allergic contact dermatitis (ACD) (acute vs late)
Acute:
- papules
- small vesicles
- large bullae
- inflamed
- swollen
Late:
- oozing
- drying crust lasting 14-21 days
What should NOT be done with urushiol containing plants
DO NOT burn them
Smoke can affect lungs and other unprotected areas
What is urushiol
Oily allergen in toxicodendron plants (poison plants)
Oil remains active for 5 years and can seem to “spread”
What do the symptoms of urushiol ACD depend on?
Amount of urushiol exposure
Area/length of exposure
Age
Genetics/sensitivity
Immune tolerance
Treatment goals for ACD
- Remove irritant, prevent future exposure
- Treat inflammation/irritation
- Relieve itching & excessive scratching
- Relieve debris from oozing, crusting, scaling
- Prevent secondary infections
Exclusions for self-treatment of ACD
Younger than 2 years
Involvement of the eyes, eyelids, mouth, or genitals
If urushiol: BSA >20%
If anything else: BSA >10%
Prevention of ACD
ID and avoid plant
Never burn the plant
Avoid the antigen
Clip/clean nails
Wear protective clothes (launder separately)
Mechanically remove or apply herbicide
(I Need A Cig With Mia)
OTC prevention options for ACD
Barrier products: IvyBlock, Hydropel
Removal of antigen at time of exposure: wash with mild soap and water ASAP
Symptomatic relief of ACD
Weeping: astringents
Non-weeping: calamine
Itching: colloidal oatmeal, oral antihistamines
Inflammation & itching: hydrocortisone 0.25-1%
ACD treatment for pregnant patients
Topicals generally safe if limited use
ACD treatment for elderly patients
Increased absorption risk
Fall hazard w/ ointments
What is xerosis
Dry skin
Barrier dysfunction due to decreased lipid components, NOT a lack of natural oils
Clinical presentation of xerosis
Roughness
Fissures
Loss of flexibility
Inflammation
Pruritus
Scaling
(R-FLIPS)
Treatment goals for xerosis
- Hydrate the skin
- Restore skin barrier function
- Educate about prevention/treatment
Key aspects of xerosis care
- Proper moisturization w/ emollients
- Modification of bathing practices
How do emollients work?
Filling cracks and forming occlusive barrierr
Examples of emollients
Petrolatum
Oils
Dimethicone
Silicone
(PODS)
What else may moisturizers contain?
Fragrances
Colors
Plant oils
Emulsifiers (polysorbates)
Humectants (glycerin, urea)
Preservatives
(Fucking Crazy People Eat Hot Pasta)
Xerosis: neonates
Higher drug absorption
Xerosis: pregnancy
Topicals generally safe w/ limited use
Xerosis: elderly
Increased absorption risk
Fall hazard w/ ointments
