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SOURCE

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Source: Law RM, Law DTS. Dermatologic drug reactions and common skin conditions. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146079670. Accessed May 10, 2017.

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DEFINITION

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  • Inflammation of skin following contact by irritants or allergic sensitizers.

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ETIOLOGY

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  • Skin contact with irritant or allergenic substance.

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PATHOPHYSIOLOGY

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  • In allergic contact dermatitis (ACD), antigenic substance triggers immunologic response, sometimes several days later.

  • In irritant contact dermatitis (ICD), organic substance causes reaction within a few hours of exposure.

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EPIDEMIOLOGY

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  • Accounts for 5.7 million physician visits each year in the United States.

  • Affects all age groups.

  • Prevalence of ACD similar in children and adults.

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PREVENTION AND SCREENING

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  • Prevention by avoiding skin exposure to known irritants or sensitizing agents.

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CLINICAL PRESENTATION

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SIGNS AND SYMPTOMS
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  • Acute phase: eczematous inflammation with erythema, vesicles, papules, crusting, fissuring, or scaling.

  • Resolving or chronic phase: scaling, erythema, and perhaps thickened skin; itching, burning, and stinging may be severe.

  • Lesions on exposed areas include erythematous macules, papules, and vesicles.

  • Affected area may be warm and swollen, with exudates and crusting.

  • Lesion location may suggest cause.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • Patient history, signs, and symptoms.

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LABORATORY TESTS
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  • Gram stain and culture of lesions can exclude impetigo or secondary infection.

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DIFFERENTIAL DIAGNOSIS
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  • Atopic dermatitis

  • Drug-induced photosensitivity.

  • Seborrheic dermatitis.

  • Tinea infections.

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DESIRED OUTCOMES

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  • Identify, withdraw, and avoid the offending agent.

  • Relieve symptoms and decrease skin lesions.

  • Remove precipitating factors.

  • Prevent recurrences.

  • Provide patient and caregiver information and support, helping them to develop coping strategies for contact dermatitis.

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TREATMENT: GENERAL APPROACH

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  • First intervention: identify, remove, and avoid the offending agent.

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TREATMENT: NONPHARMACOLOGIC THERAPY

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  • Cold compresses soothe and cleanse skin; apply to wet or oozing lesions, remove, remoisten, and reapply every few minutes for 20–30 min.

  • If affected areas are dry or hardened, use wet dressings as soaks without removal for up to 20–30 min to soften and hydrate skin; avoid soaks on exudating lesions.

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TREATMENT: PHARMACOLOGIC THERAPY

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  • Topical corticosteroids are primary treatment. Use higher-potency products initially, switching to medium or lower potency as condition improves (see Dermatitis, Atopic for topical corticosteroid potencies).

  • Oatmeal baths or oral first-generation antihistamines may provide relief for excessive itching.

  • Calamine lotion or Burow solution (aluminum acetate) may also be soothing.

  • May use moisturizers to prevent dryness and skin fissuring.

  • Secondary prevention involves the ...

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