Allergic/ irritant dermatitis

Recommendation: Require medical referral

Rational: 

Swelling of the body or extremities: This can indicate a more widespread reaction than just localized dermatitis. It could be a sign of an allergic reaction, a systemic infection, or another underlying medical condition. For example, stasis dermatitis, which occurs due to poor circulation, can cause swelling in the lower legs.

Rational: 

Swollen eyes or eyelids swollen shut: Significant swelling, especially around the eyes, can be a sign of allergic contact dermatitis or a more severe allergic reaction like anaphylaxis, which needs immediate medical care.

Rational: 

Angioedema: This is swelling that occurs deep under the skin and is often a sign of a severe allergic reaction. It can affect the face, lips, tongue, throat, and extremities and can be life-threatening if it affects breathing.

Recommendation: Require medical referral

Rational: 

Possible bacterial infection

Recommendation: Require medical referral

Rational: 

Possible viral or secondary infection

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Diagnosis: Irritant contact dermatitis (ICD) possible cause.   To know about irritant contact dermatitis and it's difference with allergic contact dermatitis and atopic dermatitis, Click here   Contact dermatitis: characterized by inflammation, erythema, itching, burning, and stinging that is limited to the area exposed to the irritant or allergen. Frequency of exposure and concentration of irritant increases the severity of dermatitis.   Goal of treatment: Prevent future exposure, prevent development into chronic dermatitis, relieve inflammation and irritation, educate patient.   Non-pharmacotherapy  

• Wash the exposed area immediately and adequately. Advise patient to identify & eliminate possible causative agent.
• Colloidal oatmeal is treatment of choice. 
  • Bathing in it relieves itching and cleanses the affected area
  • Application: 1 pack or 1 cup of milled oatmeal mixed thoroughly in warm bath water. Soaking for 15-20 minutes twice a day followed by gently patting the skin dry helps releive symptoms
• Use protective clothing and gloves while working with irritants
• Immediately wash the exposed area
• Cold or lukewarm showers with cleansers may relieve itching. Avoid hot showers as they further injure the skin
• keep fingernails short as they may trap irritants and bacteria.

  Pharmacotherapy  

• Topical hydrocortisone in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlussive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

 

Referral: Counsel for medical referral if not resolved in 2-3 days

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Diagnosis: Allergic contact dermatitis (ACD) possible cause.   To know about allergic contact dermatitis and it's difference with irritant contact dermatitis and atopic dermatitis, Click here   Contact dermatitis: characterized by inflammation, erythema, itching, burning, and stinging that is limited to the area exposed to the irritant or allergen. Frequency of exposure and concentration of irritant increases the severity of dermatitis   Goal of treatment: Treat inflammation, relieve itching, prevent excessive scratching, relieve debris accumulation, and prevent secondary skin infection.   Non-pharmacotherapy  

• Wash the exposed area immediately and adequately. Advise patient to identify & eliminate possible causative agent.
• Use protective clothing and gloves while working with irritants.
• Cold or lukewarm showers with cleansers may relieve itching. Avoid hot showers as they further injure the skin
• keep fingernails short as they may trap irritants and bacteria

  Pharmacotherapy  

• Topical hydrocortisone is the drug of choice in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlusive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

 

Referral: Counsel for medical referral if not resolved in 2-3 days

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Diagnosis: Atopic dermatitis (atopic eczema) possible cause.   To know about atopic dermatitis and the difference between allergic contact dermatitis and irritant contact dermatitis, Click here   Atopic dermatitis (syn- atopic eczema, itch that rashes) is characterized by episodic flares and remission. Dry skin is accompanying symptom that contribute to reduced comfort. Onset is first year of life (2-3 months), remission at 2 years of age and continue into adulthood   Goal of treatment: There is no cure; goal is to stop itch-scratch cycle, maintain skin hydration and barrier function, avoid triggers, and prevent secondary infections.   Non-pharmacotherapy  

• Advise patient to identify & eliminate possible causative agent.
• If skin is dry & fissured, recommend mild cleansers, emollients (cream or ointment) & good bathing practice (avoidance of hot-water bathing)
• Symptoms may be aggravated by high temperature and low humidity
• Exposure to irritants (e.g., fragrances, bleach, smoke) and allergens (e.g., pollen, and pets) may worsen symptoms.. Avoidance can decrease occurrence
• In presence of clear discharge, drying the lesions prior to initiating topical therapy will improve drug absorption. Cleanse with mild non-soap cleansers and water and cover to limit exposure to bacteria and viruses.
• Utilize un-scented or chemical-free laundry detergents
• Apply moisturizer immediately after bathing to maximize skin hydration
• keep fingernails short as they may trap irritants and bacteria

  Pharmacotherapy  

• Topical hydrocortisone is the drug of choice in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlusive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo)

 

Referral: Counsel for medical referral if not resolved in 2-3 days

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Non-pharmacotherapy  

• Wash the exposed area immediately and adequately. Advise patient to identify & eliminate possible causative agent.
• Use protective clothing and gloves while working with irritants
• Cold or lukewarm showers with cleansers may relieve itching. Avoid hot showers as they further injure the skin
• keep fingernails short as they may trap irritants and bacteria

  Pharmacotherapy  

• Topical hydrocortisone is the drug of choice in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlusive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

Referral: Counsel for medical referral if not resolved in 2-3 days.

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Diagnosis: Irritant contact dermatitis (ICD) possible cause.   To know about irritant contact dermatitis and it's difference with allergic contact dermatitis and atopic dermatitis, Click here.   Contact dermatitis: characterized by inflammation, erythema, itching, burning, and stinging that is limited to the area exposed to the irritant or allergen. Frequency of exposure and concentration of irritant increases the severity of dermatitis.   Goal of treatment: Prevent future exposure, prevent development into chronic dermatitis, relieve inflammation and irritation, educate patient.   Recommendation for treatment: First dry the lesion and then follow non-pharmacological and pharmacological recommendation.   Drying the lesion  

• Recommend cool water compresses or
• Aluminum acetate soaks as needed to the lesions
• Colloidal oatmeal bath may be helpful
• Home prepared astringents
  • Preparations
    • Isotonic saline solution: Mix 1 teaspoon salt in 2 cups of water
    • Diluted white vinegar: Half cup vinegar in 1 pint of eater
    • Baking soda mixed with water
  • Application
    • A compressed soak in astringent to the affected area for 20 to 30 minutes, 4-6 times a day help soften crusted lesions for removal and can relieve itching.
    • Use should be limited to areas with cesicles, bullae, and weeping lesions.

  Non-pharmacotherapy

• Wash the exposed area immediately and adequately. Advise patient to identify & eliminate possible causative agent.
• Colloidal oatmeal is treatment of choice. 
  • Bathing in it relieves itching and cleanses the affected area
  • Application: 1 pack or 1 cup of milled oatmeal mixed thoroughly in warm bath water. Soaking for 15-20 minutes twice a day followed by gently patting the skin dry helps releive symptoms
• Use protective clothing and gloves while working with irritants
• Immediately wash the exposed area
• Cold or lukewarm showers with cleansers may relieve itching. Avoid hot showers as they further injure the skin
• keep fingernails short as they may trap irritants and bacteria

Pharmacotherapy

• Topical hydrocortisone in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlussive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

 

Referral: Counsel for medical referral if not resolved in 2-3 days.

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Diagnosis: Allergic contact dermatitis (ACD) possible cause.   To know about allergic contact dermatitis and it's difference with irritant contact dermatitis and atopic dermatitis, Click here.   Contact dermatitis: characterized by inflammation, erythema, itching, burning, and stinging that is limited to the area exposed to the irritant or allergen. Frequency of exposure and concentration of irritant increases the severity of dermatitis.   Goal of treatment: Treat inflammation, relieve itching, prevent excessive scratching, relieve debris accumulation, and prevent secondary skin infection.   Recommendation for treatment: First dry the lesion and then follow non-pharmacological and pharmacological recommendation.   Drying the lesion

• Recommend cool water compresses or
• Aluminum acetate soaks as needed to the lesions
• Colloidal oatmeal bath may be helpful
• Home prepared astringents
  • Preparations
    • Isotonic saline solution: Mix 1 teaspoon salt in 2 cups of water
    • Diluted white vinegar: Half cup vinegar in 1 pint of eater
    • Baking soda mixed with water
  • Application
    • A compressed soak in astringent to the affected area for 20 to 30 minutes, 4-6 times a day help soften crusted lesions for removal and can relieve itching.
    • Use should be limited to areas with cesicles, bullae, and weeping lesions.

  Non-pharmacotherapy  

• Wash the exposed area immediately and adequately. Advise patient to identify & eliminate possible causative agent.
• Use protective clothing and gloves while working with irritants.
• Cold or lukewarm showers with cleansers may relieve itching. Avoid hot showers as they further injure the skin
• keep fingernails short as they may trap irritants and bacteria.

  Pharmacotherapy  

• Topical hydrocortisone is the drug of choice in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlusive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

 

Referral: Counsel for medical referral if not resolved in 2-3 days

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Diagnosis: Atopic dermatitis (atopic eczema) possible cause.   To know about atopic dermatitis and the difference between allergic contact dermatitis and irritant contact dermatitis, Click here.   Atopic dermatitis (syn- atopic eczema, itch that rashes) is characterized by episodic flares and remission. Dry skin is accompanying symptom that contribute to reduced comfort. Onset is first year of life (2-3 months), remission at 2 years of age and continue into adulthood.   Goal of treatment: There is no cure; goal is to stop itch-scratch cycle, maintain skin hydration and barrier function, avoid triggers, and prevent secondary infections.   Recommendation for treatment: First dry the lesion and then follow non-pharmacological and pharmacological recommendation.   Drying the lesion

• Recommend cool water compresses or
• Aluminum acetate soaks as needed to the lesions
• Colloidal oatmeal bath may be helpful
• Home prepared astringents
  • Preparations
    • Isotonic saline solution: Mix 1 teaspoon salt in 2 cups of water
    • Diluted white vinegar: Half cup vinegar in 1 pint of eater
    • Baking soda mixed with water
  • Application
    • A compressed soak in astringent to the affected area for 20 to 30 minutes, 4-6 times a day help soften crusted lesions for removal and can relieve itching.
    • Use should be limited to areas with cesicles, bullae, and weeping lesions.

  Non-pharmacotherapy  

• Advise patient to identify & eliminate possible causative agent.
• If skin is dry & fissured, recommend mild cleansers, emollients (cream or ointment) & good bathing practice (avoidance of hot-water bathing)
• Symptoms may be aggravated by high temperature and low humidity
• Exposure to irritants (e.g., fragrances, bleach, smoke) and allergens (e.g., pollen, and pets) may worsen symptoms.. Avoidance can decrease occurrence
• In presence of clear discharge, drying the lesions prior to initiating topical therapy will improve drug absorption. Cleanse with mild non-soap cleansers and water and cover to limit exposure to bacteria and viruses.
• Utilize un-scented or chemical-free laundry detergents
• Apply moisturizer immediately after bathing to maximize skin hydration
• keep fingernails short as they may trap irritants and bacteria

  Pharmacotherapy  

• Topical hydrocortisone is the drug of choice in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlusive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

 

Referral: Counsel for medical referral if not resolved in 2-3 days

Recommendation: Pharmacotherapy and non-pharmacotherapy

  Recommendation for treatment: First dry the lesion and then follow non-pharmacological and pharmacological recommendation.   Drying the lesion  

• Recommend cool water compresses or
• Aluminum acetate soaks as needed to the lesions
• Colloidal oatmeal bath may be helpful
• Home prepared astringents
  • Preparations
    • Isotonic saline solution: Mix 1 teaspoon salt in 2 cups of water
    • Diluted white vinegar: Half cup vinegar in 1 pint of eater
    • Baking soda mixed with water
  • Application
    • A compressed soak in astringent to the affected area for 20 to 30 minutes, 4-6 times a day help soften crusted lesions for removal and can relieve itching.
    • Use should be limited to areas with cesicles, bullae, and weeping lesions.

  Non-pharmacotherapy  

• Wash the exposed area immediately and adequately. Advise patient to identify & eliminate possible causative agent.
• Use protective clothing and gloves while working with irritants
• Cold or lukewarm showers with cleansers may relieve itching. Avoid hot showers as they further injure the skin
• keep fingernails short as they may trap irritants and bacteria

  Pharmacotherapy  

• Topical hydrocortisone is the drug of choice in addition to emollient use and good bathing practices.
  • For acute flare-ups for 7 days
  • For age > 2 years
  • Avoid in mucus membranes
  • Apply 1-2 times in thin layer before moisturizers. For ACD apply 3-4 times a day as initial therapy.
  • Creams versus ointments
    • Ointments: effectively penetrate dermis and preferred specifically in lichenified, dry, scaly skin
    • Creams: to patients who do not desire the greasy feel of ointments or staining risk.
  • Continued use may reduce response to hydrocortisones. limit use only during flareups OR once or twice weekly dosing OR no use during remission phases
  • Application of topical steroids over a significant body surface is likely to increase systemic absorption
  • Stop existing topical therapies (may affect absorption of treatments of the AD or those may be the cause for AD)
  • Wash hands before and after application.
  • Symptom improvement should occur within 24-48 hrs of beginning the treatment.
  • Adverse effects:
    • uncommon because of minimal absorption; skin atrophy (rare, burning and irritation is self-limiting.
    • Chances of increased systemic absorption in geriatrics
    • If used for prolonged period, with occlusive dressing or the skin is open or cracked, the systemic absorption of hydrocortisone will be increased. In such case refer to the physician
    • Not safe for application over eyelids
  • Discontinue other topical medications on affected area till the symptoms are resolved with the pharmacotherapy. (Oil-based topical products or use of occlusive dressings over topical medication may increase systemic absorption and related A/E.
• Emollients
  • Use along with hydrocortisone during acute flare-ups
  • Can be used during all the phases of AD
  • Apply 2-4 times a day. More frequent application required to areas that ware cleansed multiple times a day
  • Dosage forms: oils may be preferred for hairy areas for better absorption; lotions preferred in warmer weather; lotions may have drying effects
  • Emollients with ceramides or pseudoceramides assist in preventing moisture loss and contribute to skin repair.
  • Adverse effect and precautions:
    • Potential stains on clothing, bed sheets, etc.
    • Avoid emollients with high water content as they may have drying effect
    • Avoid alcohol containing emollients (gels, foams, and mousses)- may cause drying and worsening of the symptoms.
    • Avoid emollients containing fragrances, dyes, and exotic oils to limit the potential contact irritation
    • Use non-medicated emollients in children
    • Frequent use of moisturizers required in geriatrics.
• For itching:
  • Calamine lotion may be used to relieve itching.
  • Topical anesthetics (e.g., benzocaine, lidocaine) not recommended
  • Topical antihistamines provides short-term relief but may cause sensitization
  • Oral antihistamines: not recommended. 1st generation may be considered if patient having sleeping disorder due to itching. Avoid in patients sensitive to anticholinergics ( BPH, glaucoma), and at risk for falls (e.g., elderly, presence of vertigo).

 

Referral: Counsel for medical referral if not resolved in 2-3 days.