Homework Answers
#. Contact Dermatitis
Definition: Rash due to direct skin exposure to a substance
-Classified as allergic contact dermatitis or irritant contact dermatitis
-distance from systemic effects due to drug or allergen sensitivities
#. Pathophysiology of Contact Dermatitis
-type IV hypersensitivity reaction involving T cells
-First exposure: immune system sensitized to antigen that is presented to APC in epidermis and carried to naive T cells. Takes 10-14 days
-Re-exposure: Antigen presented to sensitized lymphocytes and it releases cytokines that activate inflammation, destroying cells along with antigen. Takes 12-48 hrs
#. Common Triggers of Contact Dermatitis (Antigens)
-Plant oleoresin (ex poison ivy, oak, and sumac (sometimes mango)
-nickel in jewerly
-formaldehyde (clothing, nail polish)
-tape adhesives
-fragrances, preservatives
-antibiotic ointment (Neomycin in Neosporin)
-Latex (less common now than in 80s)
#. Acute Presentation Allergic Contact Dermatitis
-Acute exposure: one exposure and a few days later get a rash
-Usually able to identify a triggering exposure
ex. pulled weeds at house
-Intensely pruritic or burning rash with vesciles, wet, crusty, weepy
#..Chronic Presentation Allergic Contact Dermatitis
-Chronic exposure: exposed on a daily basis, and evolves more slowly
-belly ring or belt buckle for example
-More difficult to elicit trigger from history with chronic because most often an ongoing exposure
-Still intensely pruritic but scalin, red, and thickened (lichenified)
#. Diagnostic Tests for Contact Dermatitis
-Diagnosed on basis of history and physical (what it looks like &distribution). Another clinical diagnosis
-If you think it is contact dermatitis, treat it as such and hope it gets better
-Usually rash gets better so more testing is not usually necessary
-If rash does not get better, can do more testing if needed:
-Epicutaneous patch testing- take a bunch of common antigens & put on skin see if get a rash
-daily diary to track possible exposures
#. Complications :-
Infection
Cellulitis
Neurodermatitis
Decreased quality of life
#. Health promotion and prevention methods / client education :-
- avoid irritants and substances that cause allergies
- use of proper clothes , gloves etc
- avoid moisture buildup
- compliance to medications
- maintaining hygiene
#. Medications :-
Topical and oral corticosteroid
Antihistamines
Analgesics
#. Nursing care :-
- Teach patient how to maintain hygiene
- Teach patient the importance of compliance to medications and how to have the medications
- Advise patient to avoid irritants and substances that cause allergies
- Assisst in diagnostic procedure
- Provide psychological and emotional to the patient
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