JT is a 42 yo white female, NKDA, who has had a tubal ligation (LNMP 2 weeks ago). She was a “work in” patient and complains of with a pruritic, raised and weeping rash on her hands, arms, and face (cheeks, mouth and eye lids). She is miserable. She reports doing yard work yesterday and had direct contact with Poison Ivy. She is disgusted with the fact that she was in the clinic only six days ago with a new diagnosis of plantar fasciitis, and now here she is “back again” for another problem. Normally, she only comes to the clinic once yearly for her general exam (including GYN and breast check) and thyroid labs. She also has another question – the Mobic prescribed for her plantar fasciitis was “bothering her stomach” so she bought some OTC Tums and has been taking them for the last few days and wonders if this is OK.
PMH:
SH: (medications) Synthroid 112 mcg daily (no change in dose for 2 years); Mobic 7.5 mg daily (for the plantar fasciitis) x 6 days
HINT: use Up To Date and search “contact dermatitis” and then read about management of allergic contact dermatitis.
Acute Contact Dermatitis (ACD) is a common skin condition that occurs when the skin comes into direct contact with an allergen or irritant. In this case, JT, a 42-year-old female, presents with a pruritic, raised, and weeping rash on her hands, arms, and face after coming into contact with Poison Ivy. This essay aims to discuss the treatment options for ACD based on evidence from Up To Date’s guidelines for managing allergic contact dermatitis.
Avoidance of the Trigger: The primary step in managing ACD is identifying and avoiding the offending allergen. In JT’s case, education regarding Poison Ivy’s characteristic three-leaf pattern and precautions to prevent direct contact during outdoor activities, such as yard work, is essential to prevent future episodes.
Topical Corticosteroids: Topical corticosteroids are the mainstay of treatment for ACD. High-potency corticosteroids, such as clobetasol propionate or betamethasone dipropionate, can be prescribed for severe cases involving extensive areas of the body. For JT’s presentation, a mid-potency topical corticosteroid like triamcinolone acetonide can be applied to the affected areas twice daily for up to two weeks.
Oral Antihistamines: To alleviate pruritus and discomfort, oral antihistamines like cetirizine or loratadine can be prescribed for JT. These medications can provide symptomatic relief and improve her overall comfort while the rash heals.
Cold Compresses: Applying cold compresses to the affected areas can help reduce inflammation and alleviate itching.
Emollients: Emollients or moisturizers are essential to restore the skin’s barrier function and prevent further irritation. Recommending a fragrance-free, hypoallergenic moisturizer for JT to apply frequently can support her skin’s healing process.
Systemic Steroids: In severe cases, where topical therapy is insufficient, a short course of systemic corticosteroids may be considered. However, this should be reserved for extensive rashes or when there is a risk of secondary infection.
Regarding JT’s query about the use of OTC Tums for the stomach discomfort caused by Mobic (meloxicam), it is generally safe to take antacids like calcium carbonate (Tums) with Mobic. However, it is crucial to advise JT to consult her healthcare provider about the stomach issues, as it may indicate gastritis or other gastrointestinal concerns that need further evaluation.
Managing Acute Contact Dermatitis requires a comprehensive approach, including avoidance of the triggering allergen, topical corticosteroids, oral antihistamines, cold compresses, and emollients. As a healthcare provider, it is essential to educate patients about allergen identification and preventive measures to minimize future occurrences. In JT’s case, the proper implementation of these treatment options will help alleviate her discomfort and support her skin’s healing process, ensuring a positive patient outcome.
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