++
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§ionid=146079670. Accessed May 10, 2017.
++
++
++
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.
++
+++
PREVENTION AND SCREENING
++
+++
CLINICAL PRESENTATION
++
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.
+++
MEANS OF CONFIRMATION AND DIAGNOSIS
++
++
+++
DIFFERENTIAL DIAGNOSIS
++
++
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.
+++
TREATMENT: GENERAL APPROACH
++
+++
TREATMENT: NONPHARMACOLOGIC THERAPY
++
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.
+++
TREATMENT: PHARMACOLOGIC THERAPY
++
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 ...