Alopecia Bullous Skin Disease Vitiligo Dermatitis (Contact or Allergic) Uritcaria / Angiodema Anaphylaxis
Urticaria
Atopic Dermatitis - Predisposed for skin Infection
- Increased risk of lymphoma associated with disease itself and not medications
- Dilute bleach bath may work (on an individual basis; strong evidence; only one study)
- Have predisposed skin condition including
- Barrier abnormality: Hence, fluticasone cream (2/ week) unto 12 month has better outcome
- Immune abnormality
- Identification and Elimination of Triggers
- Wet dressing (protect skin from persistent scratch, promotes rapid healing)
- Now, idea is to be more proactive than reactive..eg. is such a use of barrier treatment
- COPY AND PASTE THE FLOW CHART OF PRACTICE PARAMETER FOR AD
Contact Dermatitis (HAS NOT BEEN DOWNLOADED YET) - Dermatitis with Scattered generalized dermatitis
- Even though most likely it can be due to Atopic Dermatitis, can also be Contact Dermatitis
- Allergic Contact Dermatitis with Diffuse Contact
- Irritant CD
- Allergic CD
- Note: Moisture releases textile dyes.
- Systemic Contact Dermatitis
- Baboon Syndrome (most recognizable form of SCD
- Upper inner thigh, and axilla may be involved
- Nickel, and Balsam of Peru are common cause
- Various foods, and utensils are rich has nickel and balsam of Peru
- Hand Dermatitis
- Both Irritant and Allergic Contact Dermatitis
- Allergic:
- Has more vesicles; dorsum of hand, finger tips, Nails of hand
- Less commonly involves palm
- Eyelid Dermatitis
- 72 % allergic CD
- I5 % Irritant CD
- Atopic Dermatitis is < 5 %
- Face and Neck
- Periphery Face involvement
- Sampoo etc that drips down in the neck
- Central Face Involvement
- Lip Dermatitis
- Irrtant 36 %
- Allergic CD 25 %
- AD 19 %
- When doing Patch Test for Eyelid, Face and Neck or Lip Dermatitis, personal home products should be used. Often dissolved with Normal Saline
- Shoe Induced Dermatitis
- Neomycin somehow in the shoe, can cause persistent contact Dermatitis. Changing shoes can fix it.
- PATCH TESTING RECOMMENDATION
- Steroid use can cause false negative test
- Topical Calcineurion inhibitor and topical steroids : stope 5-7 days before.
- Routine Patch Test does not include roughly total of 40 % of materials that may cause contact dermatitis
- If you read only one reading at 48 hr , 1/3 rd of patch test positive will be missed
- Dealyed patch test reactnatns > 5 days: Gold, Metal, Abx (neomycin, bacitracin)
- Can send the photo of the back
- Likewise, some allergen will be absent after 5 days. eg. Fragrance Mix, and Basalam of Peru
- 0.5 - 5 % of patient can have allergy to topical steroids
- Topical Steroids
- Group 1 - 7.
- Low potency steroids have highest incidence
- Dexamenthasone has the least incidence of steroids allergy . Hence, this is perhaps the best way to go
- Rim test, while is negative for other allergens may be positive for steroids as high steroid dose in central may inhibit the high concentration area
- True test for patch tests also includes steroids
- Budesonide,
- Hydrocortisone
- Tixocortocl Pivalate
Food For thoughts: Patch testing in a patient with eiosinophilic esophagitis and other food allergies
- Autoimmune Blistering Disease
- pemphigus vulgaris
- bullous pemphigoid
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