Contact dermatitis treatment

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

The initial treatment goal of contact dermatitis is identifying the causative substance and eliminating its exposure. The second treatment goal is symptom relief. 

In many cases contact dermatitis may not require medical treatment at all. Non-drug therapy for contact dermatitis is... 

With adequate treatment, most cases of contact dermatitis should improve within 7 days. Complete resolution of symptoms may take up to 3 weeks.12 If a patient experiences severe symptoms associated with fever or difficulty breathing, they should be instructed to seek medical attention immediately. Furthermore, patients should return to their health care provider if any of the following occur ... 

Erythema, inflammation, pain, and itching caused by contact dermatitis can be effectively treated with topically applied corticosteroids. With such a wide range of products and potencies available, an appropriate steroid selection is based on severity and location of the lesions. Table 62-6 shows a list of topical steroids and their potencies. Higher-potency preparations are used in areas where penetration is poor, such as on the elbows and knees. Lower-potency products should be reserved for areas of higher penetration, such as on the face, axillae, and groin. Low-potency steroids are also recommended for the treatment of infants and children.32,33... 

Given the information presented, develop a treatment regimen for a patient with contact dermatitis. 

Develop a treatment plan appropriate for contact dermatitis. 

Provide patient education on contact dermatitis and treatment ... 

The goals of treatment for contact dermatitis are to relieve the patient s symptoms, identify the underlying cause, identify and remove offending agents, and avoid future exposure to likely offending agents. 

A contact dermatitis occurs infrequently. Because feverfew also inhibits human blood platelet aggregation, interactions are possible with antithrombotic medications such as aspirin or warfarin (Groenewegen and Heptinstall 1990). Abrupt discontinuation of feverfew by people taking it chronically for treatment of migraine can produce rebound withdrawal symptoms. These consist of migraines, anxiety, poor sleep patterns, and stiffness of the muscles and joints. 

Trautmann A, Akdis M, Schmid-Grendelmeier P, Disch R, Brocket EB, Blaser K, et al Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. 1 Allergy Clin Immunol 2001 108 839-846. 

Q21 What is the most appropriate treatment that could be dispensed over-the-counter for irritation caused by contact dermatitis ... 

Hj antihistamines are clinically used in the treatment of histamine-mediated allergic conditions. Specifically, these indications may include allergic rhinitis, allergic conjunctivitis, allergic dermatological conditions (contact dermatitis), pruritus (atopic dermatitis, insect... 

After treatment, use topical corticosteroids to decrease contact dermatitis, antihistamines for pruritus pruritus may continue for 4-6 wk... 

Before commencing the sessions the patients were assessed by physical examination and full medical history including age, sex, occupation, residence, special habits of medical importance with particular emphasis on the history of the underlying disease including duration of ulcer, mode of onset, ulcer pain, history of deep vein thrombosis or varicose veins, trauma, lump, varicosities, contact dermatitis and symptoms suggestive of ischaemia. Photographic reference of ulcer and ulcer area measurements were carried out at the commencement of treatment and during the follow up laser therapy, which continued for 6 months. 

Plasma levels of doxepin similar to those achieved during oral therapy may be obtained with topical application the usual drug interactions associated with tricyclic antidepressants may occur. Therefore, monoamine oxidase inhibitors must be discontinued at least 2 weeks prior to the initiation of doxepin cream. Topical application of the cream should be performed four times daily for up to 8 days of therapy. The safety and efficacy of chronic dosing has not been established. Adverse local effects include marked burning and stinging of the treatment site which may necessitate discontinuation of the cream in some patients. Allergic contact dermatitis appears to be frequent, and patients should be monitored for symptoms of hypersensitivity. 

Kucharekova, M., Van De Kerkhof, P.C.M., and Van Der Valk, P.G.M., A randomized comparison of an emollient containing skin-related hpids with a petrolatum-based emolhent as adjunct in the treatment of chronic hand dermatitis, Contact Dermatitis, 48, 293, 2003. 

Draelos, Z.D., Sensitive skin Perception, evaluation, and treatment, Am. J. Contact Dermatitis, 8, 67, 1997. 

Piperidinyl derivatives, (II), (HI), and (IV), prepared by Brough (2), Baxter (3), and Thom (4), respectively, were effective in modulating immunologically mediated disorders and used in the treatment of psoriasis, atopical dermatitis, contact dermatitis, and other eczmatous dermatitides. 

The major adverse reactions to the penicillins are hypersensitivity responses. Manifestations of hypersensitivity inclnde nrticaria, angioedema, and anaphylaxis (type 1 reaction) hemolytic anemia (type 11 reaction) interstitial nephritis, vascnlitis, and serum sickness (type 111 reaction) and contact dermatitis or Stevens-Johnson syndrome (type IV reaction). A maculopapular rash occnrs late in the treatment course of 2% to 3% of patients receiving a penicillin drug. Once a patient has had a hypersensitivity response to a penicillin, it is probable, bnt not certain, that a reaction will occur with exposure to the same penicillin or to any other penicillin. Intradermal skin tests can predict whether a patient is at risk for developing a hypersensitivity reaction to the penicillins. If the resnlts are positive, penicillins should generally be avoided. 

Allergic contact dermatitis may occur in the presence of treatment with topical corticosteroids. 

Contact dermatitis may resolve without treatment within days but may take up to 3 weeks in allergic cases. In contrast, in toxic cases resolution may take 3 to 6 weeks. Avoidance of the offending agent is the first step in the treatment of contact dermatitis, with emphasis given to decreasing rubbing and scratching. Snpportive therapy includes cool compresses. In addition, application of topical steroid ointment or cream preceded by cool compresses temporarily relieves symptoms. Steroid use should be limited to 5 to 10 days due to the risk of tachyphylaxis, atrophy of the skin, and increased risk of infection. 

Well-controlled studies on aminocaproic acid in a limited number of patients showed no serious adverse effects. Minor unwanted effects have been reported in 10-20% of patients and include headache, nasal congestion, conjunctival suffusion, nausea, vomiting, diarrhea, and transient hjrpotension (32). Skin rashes have also been associated with aminocaproic acid, including maculopapular and morbilliform eruptions. Rarer dermatological reactions reported include purpuric rashes (33), bullous eruptions (34), and contact dermatitis with positive patch tests (35-37). Treatment with a high dose (the maximum daily dose is 36 g/day) can result in an osmotic diuresis (38). 

Propolis can cause allergic contact dermatitis (4), and have been reported in HIV-infected patients (5-7). It has been associated with allergy after its use in cosmetics and in the self-treatment of various diseases. Although most cases involve allergic contact dermatitis arising from topical application, a few reports have described an allergic reaction after oral ingestion. Adulteration of propolis capsules with excessive amounts of lead has been reported from New Zealand (8). 

Although antihistamines are often used in the treatment of allergic conditions, topical use often produces skin sensitization and subsequent contact dermatitis (90,91). This effect occurs more often with the use of ethylenedia-mines and phenothiazines the latter also produce photo-allergic cutaneous reactions (92). A photoallergic contact dermatitis followed by a persistent light reaction was attributed to topical dioxopromethazine hydrochloride incorporated into a gel in a woman with periocular... 

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