Upgrade to remove ads
Only $2.99/month

Contact Dermatitis

Terms in this set (54)

Irritant CD
Itching occurs later
Stinging and burning is common and occurs early
Rare vesicles, bullae or papules
Rash occurs minutes to hours after exposure
Concentration dependent
Caused by direct tissue damage
Usually on hands, wrist, forearms or diaper area
No clear margins
Allergic CD
Itching occurs early
Stinging and burning are rare but can occur later
Vesicles, bullae and papules are common
Rash is delayed
Non concentration dependent
Immunologic reaction
Occurs anywhere on body that contacts the antigen
Clear margins based on contact with antigen
Irritant contact dermatitis is ____
Inflammatory reaction of the skin caused by exposure to an irritant
Not a sensitization, but a direct toxicity to the skin (directly damage the epidermal cells by direct absorption through the cell membrane)
Irritant dermatitis can be effected by
Presence of existing skin diseases/conditions
Quantity and concentration of chemical exposure (occupational hazards)
Occlusive clothing or diapers
Environmental factors (humidity/temperature)
Common irritant contact dermatitis (ICD) substances
Strong acids or alkalis (cleaning products, salon products)
Detergents, soaps and sanitizers
Flour
Oils
Solvents
Urine/feces
Water
Wood & dust particles
ICD presentation
erythema, burning and stinging
Severe cases may develop vesicles, papule,ulcers, crusts or necrosis
Once irritant is removed, generally resolves quickly
Chronic exposure can lead to severe symptoms (fissures, scaled, lichenification, thickening of skin or hyper/hypopigmentation)
ICD prevention
Try to avoid causative substances
Use protective clothing, gloves or other equipment to limit exposure
Emollient such as dimethicone offers better protection (repair the epidermal barrier)
ICD initial treatment
Remove offending agent
Wash area with tepid water and mild cleanser
ICD symptom treatment
Protect/Hydrate Skin:
Emollients applied liberally
Restore moisture to the stratum corneum
Protect from wet working environments
Itching then use colloidal oatmeal
Avoid __(2)__ in ICD treatment
Topical corticosteroids and topical anesthetics
Allergic contact dermatitis is occurs in 2 steps
exposure 1: ____
exposure 2: ____
Induction phase: initial exposure and sensitization to allergen and there is usually no reaction
subsequent exposure: type IV delayed hypersensitivity that occurs 24 hours to 21 days after sub exposure (typically 24 to 48 hours) which is a cell mediated allergic reaction via antigen sensitized T cell
Most common ACD antigens
Urshiol-Induced (Toxicodendron: Poison ivy, poison sumac, poison oak)
Medications (benzocaine, neomycin)
Metals (nickel, chromium salts, cobalt salts)
Cosmetics (fragrances, lanolin, thimerosal)
Latex
ACD presentation
Can occur anywhere on the body
Limited to the area of antigen contact
Urushiol-induced ACD can be linear
If plants are burned, oil can be inhaled and cause serious lung problems
ACD skin presentation
Intense pruritus and edema
Erythema
Papules
Small vesicles evolving to crusts
Sometimes large bullae
- vesicles and bullae occur more freuqnetly is urushiol-induced ACD
Severity of Urushiol induced ACD (oil from plants): mild and moderate
Mild: linear streaks so itching may be minimal - distinct patched of dermatitis in unprotected skin
Moderate: erythema, edema, pruritus, papules, vesicles and or bullae
Severity of Urushiol induced ACD (oil from plants): severe
Extensive involvement and edema of the extremities
Involvement of the face : swelling of the eyelids due to rubbing with urushiol-contaminated fingers
Extreme itching
Numerous vesicles and bullae
Limitations of daily activities
Involvement of >20% of BSA
Involvement of genitals
- can lead to infection
ACD prevention
Avoidance by patient education (plant identification)
Eradicate of toxicodendron plants near resident
Bentoquatam use for ACD prevention
apply to exposed areas before potential exposure and repeat application every 4 hours - wash thoroughly with water after potential exposure has ended
Ivyblock (bentoquatam) - not currently being manufactures MOA
physically block urushiol from being absorbed into skin
- shake well before use
Ivyblock (bentoquatam) risks
flammable
generally well tolerated
not used in ages < 6
ACD protection -toxicodendron
Wear protective clothing
Cover nose and mouth when eradicating plants
Remove clothing immediately and wash separately from other clothes
Wash exposed areas as soon as possible
Shower preferred (oil can stay in tub after a bath)
Clip fingernails and clean meticulously under nails to avoid transfer of urushiol
Clean the fur of pets suspected of being exposed
Urushiol post-exposure to remove antigen
Wash with soap and water within 10 minutes of exposure
Washing even up to 30 minutes after exposure can minimize the reaction
May use hypoallergenic face soap (no harsh soaps or vigorous scrubbing)
- Avoid home remedies, harsh soaps, bleach,
Urshiol post-exposure: Zanfel
Use 1 ½ inches of cream and add to water to form a paste and rubbed into the affected area until itching stops (up to 3 minutes)
Can be used anytime after exposure
Urshiol post-exposure: Tecnu Outdoor skin cleanser
Originally developed to wash away radioactive material
Used up to 8 hours after exposure
Cleans for up to 2 minutes
Product can be wiped away (no water needed)
Contact dermatitis exclusions to self-care
< 2 years of age or Dermatitis present > 2 weeks
Involvement of > 20 % body surface area
Presence of numerous bullae
Extreme itching, irritation or severe vesicle and bulla formation
Swelling of the body or extremities/Swollen eyes or eyelids swollen shut
Discomfort in genitalia from itching, redness, swelling or irritation
Involvement and/or itching of mucous membranes of the mouth, eyes, nose or anus/Signs of infection
Low tolerance for pain, itching or symptom discomfort that impair daily activities
ACD treatment
Oral antihistamines
Calamine
-Generally resolves in 10 to 21 days with or without treatment (first several days are the most uncomfortable)
ACD treatment: oral antihistamine
First Generation
- Help with itching and sedation at night
Second Generation(use if sedation is a concern)
ACD treatment: Calamine
Can be used on intact skin
Dries into a pink film (can be cosmetically unpleasant)
Products to avoid to treat allergic contact dermatitis
Topical anesthetics
Topical antihistamines
Topical antibiotics
ACD treatment for weeping rashes
Astringents :
Burrows solution
Isotonic saline
Diluted white vinegar
Astringent MOA
Cool and dry skin through evaporation
Cause vasoconstriction and reduce blood flow
Cleanse skin of debris and crust
Astringent use
Baths- soak affected area(s) for 15 to 30 minutes 2-4 times daily
Compresses- apply to affected area(s) for 20 to 30 minutes 4-6 times daily
- Use as long as symptoms are present
ACD Treatment: Hydrocortisone
Weeping: use cream formulations
Inflammation: use cream or ointment (if >20% BSA then systemic treatment may be needed)
Diaper Dermatitis
Occurs in around two-thirds of babies and adults that wear diapers (amount has decreased with use of disposable diapers)
Due to combination of moisture, bacteria, alkaline pH and mechanical disruption of the skin
Diaper Dermatitis Exclusions to self-care
Lesions present for >7 days
Lesions have not improved in 7 days with adequate care
Secondary infection
Diaper dermatitis outside of diaper region
Broken skin (blood, pus, weeping), vesicles or bullae
Concurrent UTI or genital disfigurement
Immunosuppressive conditions or therapy
Constitutional symptoms
Diaper Dermatitis Presentation
Red to bright red patches and lesions on the skin
Usually just on the area covered by the diaper, but can spread beyond
Result of skin irritation and breakdown
Can progress to secondary infections (candida infections are most common)
Non-pharmacologic therapy for diaper dematitis
Increase number of diaper changes to a minimum of six per day
Flush the skin with plain water and gently dry
Allow area to completely dry before re-diapering
Use baby wipes that are chemically bland
Switch to disposable diapers if using cloth diapers
If using cloth diapers, launder with a mild detergent and use extra rinse cycles if sanitizers are used
Diaper Dermatitis Treatment: skin protectants
Zinc oxide, petrolatum, and lanoline are the most common
- cannot contain antimicrobials, analgesics or antifungals
Skin protectant MOA
Creating a physical barrier between the skin and irritant
Lubricating to prevent friction
Absorbing moisture
Diaper dermatitis treatment: zinc oxide
Most common
Hydrophobic
Creates protective barrier
- Requires soap to remove
Diaper dermatitis treatment: Calamine
Absorptive, antiseptic, and antipruritic
Diaper dermatitis treatment: mineral oil
Must be washed off with each diaper change.
Can build up in pores
Diaper dermatitis treatment: petroleum and lanolin
bacteriostaic
Diaper dermatitis treatment: topical cornstarch/talc
Absorbent
Risk of inhalantion
Things to avoid in diaper dermatitis treatment
Topical OTC antifungals or antibiotics
(infection is an exclusion to self-care)
Topical OTC analgesics (can excoriate macerated skin)
Topical OTC hydrocortisone (increased risk of secondary infection and of systemic absorption)
- should improve in 24 hours/7 days
Prickly Heat Rash
Blocked or clogged sweat glands
Presents as pinpoint lesions in small numbers clustered together
Common sites: axilla, chest, upper back, back of neck, abdomen, and inguinal area
Prickly heat (Heat rash or miliaria)
Most common in infants but can occur in adults who work in hot working conditions
Results from blocked sweat glands (rupture leads to inflammation)
Prickly heat presentation
Stinging, burning, and itching
Pinpoint-size lesions: raised and red and erythematous papules
Lesions commonly occur in the axillae, chest upper back, back of neck, abdomen and inguinal area
Can evolve into infections, pustules and generalized dermatitis if not treated
Pickly heat exclusions to self care
Same as diaper dermatitis
Fever without sweating
Prickly heat non-pharmacologic therapy
Decrease sweating
Increase airflow to affected area
Wear loose clothing
DO NOT apply oily substances because they will clog pores
Prickly heat pharmacologic therapy
Antipruritic that are water washable or cream based (bland emollients and skin protectant that soothe skin)
Colloidal oatmeal
Prickly heat pharmacologic therapy: hydrocortisone
Can be used in adults if <10% BSA to relieve itching
Not approved in children <2 years of age
Prickly heat pharmacologic therapy: topical antihistamine and anesthetics
Risk of sensitization
Generally should be avoided but could be used as antipruritic
Prickly heat pharmacologic therapy: powders
Only as a preventative measure
- Overuse can clog pores and actually cause prickly heat
THIS SET IS OFTEN IN FOLDERS WITH...