Exam 5 - Contact Dermatitis

Question 1

Define contact dermatitis

Answer 1

Condition characterized by the following on dermal areas exposed to irritant or antigenic agents:
- inflammation
- redness
- itching
- burning
- stinging
- vesicle/pustule formation

Question 2

What is irritant contact dermatitis (ICD)?

Answer 2

Inflammatory reaction of the skin caused by exposure to an irritant

Question 3

Causes of irritant contact dermatitis (ICD)

Answer 3

Frequent handwashing
Oils
Strong acids/bases
Fiberglass
Wood dust
Urine
Fecec

Question 4

Causes of allergic contact dermatitis (ACD)

Answer 4

Nickel
Cobalt
Cosmetics
Latex
Poison ivy/oak/sumac

Question 4

What is allergic contact dermatitis? (ACD)

Answer 4

Immunologic reaction of the skin caused by exposure to antigen

Question 5

Clinical presentation of ICD

Answer 5

Skin is:
- inflamed
- swollen
- erythematous
- painful
- itchy
- stinging/burning

Skin may be dry or macerated

Most commonly seen on hands, forearms, face

Question 5

What irritants require multiple exposures to cause ICD?

Answer 5

Mild irritants:
- soaps
- solvents
- detergents

Question 5

What affects response severity of irritant contact dermatitis (ICD)?

Answer 5

Quantity and concentration of substance exposure

Question 6

What irritants are likely to cause immediate/severe response of ICD?

Answer 6

Chemical irritants like acids/bases

Question 7

When should a patient with ICD be referred?

Answer 7

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

Question 7

Where is ICD most commonly seen?

Answer 7

Hands
Forearms
Face

Question 8

Treatment goals of ICD

Answer 8

1. Remove irritant & prevent further exposure
2. Relieve inflammation & irritation
3. Educate patient on self-treatment & prevention

Question 9

OTC pharmacologic treatment for ICD

Answer 9

Burow’s solution (aluminum acetate 5%)
Emollients & moisturizers
Barrier creams/ointments

Question 10

What is the gold standard emollient/moisturizer for ICD

Answer 10

Petrolatum

Question 11

Non-pharmacological treatment for ICD

Answer 11

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

Question 12

Burow’s solution preparation and use

Answer 12

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

Question 13

OTC pharmacologic treatments for itching

Answer 13

Topical corticosteroids
Colloidal oatmeal bath

Question 13

What causes allergic contact dermatitis?

Answer 13

3000 chemicals

Common:
- poison ivy/oak/sumac
- nickel
- latex
- fragrances
- cosmetics

Question 14

What products should be AVOIDED for itching?

Answer 14

Topical “-caine” anesthetics

Question 15

Patient education for ICD

Answer 15

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

Question 16

Clinical presentation of allergic contact dermatitis (ACD) (acute vs late)

Answer 16

Acute:
- papules
- small vesicles
- large bullae
- inflamed
- swollen

Late:
- oozing
- drying crust lasting 14-21 days

Question 17

What should NOT be done with urushiol containing plants

Answer 17

DO NOT burn them

Smoke can affect lungs and other unprotected areas

Question 18

What is urushiol

Answer 18

Oily allergen in toxicodendron plants (poison plants)

Oil remains active for 5 years and can seem to “spread”

Question 19

What do the symptoms of urushiol ACD depend on?

Answer 19

Amount of urushiol exposure
Area/length of exposure
Age
Genetics/sensitivity
Immune tolerance

Question 20

Treatment goals for ACD

Answer 20

1. Remove irritant, prevent future exposure 2. Treat inflammation/irritation 3. Relieve itching & excessive scratching 4. Relieve debris from oozing, crusting, scaling 5. Prevent secondary infections

Question 21

Exclusions for self-treatment of ACD

Answer 21

Younger than 2 years Involvement of the eyes, eyelids, mouth, or genitals If urushiol: BSA >20% If anything else: BSA >10%

Question 22

Prevention of ACD

Answer 22

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)

Question 23

OTC prevention options for ACD

Answer 23

Barrier products: IvyBlock, Hydropel Removal of antigen at time of exposure: wash with mild soap and water ASAP

Question 24

Symptomatic relief of ACD

Answer 24

Weeping: astringents Non-weeping: calamine Itching: colloidal oatmeal, oral antihistamines Inflammation & itching: hydrocortisone 0.25-1%

Question 25

ACD treatment for pregnant patients

Answer 25

Topicals generally safe if limited use

Question 25

ACD treatment for elderly patients

Answer 25

Increased absorption risk Fall hazard w/ ointments

Question 26

What is xerosis

Answer 26

Dry skin Barrier dysfunction due to decreased lipid components, NOT a lack of natural oils

Question 26

Clinical presentation of xerosis

Answer 26

Roughness Fissures Loss of flexibility Inflammation Pruritus Scaling (R-FLIPS)

Question 27

Treatment goals for xerosis

Answer 27

1. Hydrate the skin 2. Restore skin barrier function 3. Educate about prevention/treatment

Question 28

Key aspects of xerosis care

Answer 28

1. Proper moisturization w/ emollients 2. Modification of bathing practices

Question 29

How do emollients work?

Answer 29

Filling cracks and forming occlusive barrierr

Question 30

Examples of emollients

Answer 30

Petrolatum Oils Dimethicone Silicone (PODS)

Question 30

What else may moisturizers contain?

Answer 30

Fragrances Colors Plant oils Emulsifiers (polysorbates) Humectants (glycerin, urea) Preservatives (Fucking Crazy People Eat Hot Pasta)

Question 31

Xerosis: neonates

Answer 31

Higher drug absorption

Question 32

Xerosis: pregnancy

Answer 32

Topicals generally safe w/ limited use

Question 33

Xerosis: elderly

Answer 33

Increased absorption risk Fall hazard w/ ointments