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Topic 30. Therapy of allergic skin diseases Allergic contact dermatitis is inflammation of the skin manifested by varying degrees of erythema, edema, and vesiculation. It is a delayed type of induced sensitivity (allergy) resulting from cutaneous contact with a specific allergen to which the patient has developed a specific sensitivity. Therapy: Identify the cause, if not the patient is at risk for chronic or recurrent dermatitis. Symptomatic treatment Acute vesicular dermatitis (poison ivy) cool compresses with saline / aluminum acetate solution Widespread vesicular dermatitis lukewarm oatmeal baths. Pruritus Sedating oral antihistamines Patients should avoid using topical antihistamines Itching - Antihistamines 1. Act by competitive inhibition of H1 receptor. 2. May control itching by blocking effects of endogenously released histamine. 3. Hydroxyzine - 10-25 mg PO 3xday; 25-100 mg PO 4xday Corticosteroids 1. Topical corticosteroids Severe allergic contact dermatitis of the hands 3-week courses of class I topical corticosteroids are required 2. Systemic corticosteroids Acute severe allergic contact dermatitis 2-week Most adults require an initial dose of 40-60 mg a. Clobetasol (Temovate) - Class I super-potent topical steroid; - Suppresses mitosis and synthesis of proteins inf. + vasoconstriction. - Use: Apply bid for up to 2 wk; not to exceed 50 g/wk b. Hydrocortisone (Valerate, Westcort) - Adreno-corticosteroid derivative applied on skin or external mucous membranes. - Has mineralocorticoid and glucocorticoid effects anti-inflammatory activity. - Use 0.2% cream or ointment. c. Prednisone (Deltasone, Meticorten, Orasone) - Immunosuppressant for autoimmune disorders - Inflammation by capillary permeability and suppressing PMN activity. - Stabilizes lysosomal membranes and suppresses ly-s and antibody production. - 1x40-60 mg/d PO or divided to 4xday; taper over 2-3 wk, as symptoms resolve

Efi. Gelerstein 2011

Topical Immunomodulators (TIMs) For atopic dermatitis, allergic contact dermatitis Pimecrolimus (Elidel cream) Tacrolimus (Protopic 0.1% ointment) for allergic contact dermatitis of the hands - Apply thin layer to affected skin areas and rub in gently and completely; - Continue treatment for 1 wk after clearing of signs and symptoms Disulfiram disulfiram chelates nickel, which excreted in the urine Individual who is highly allergic to nickel with severe vesicular hand dermatitis benefits from treatment with disulfiram (Antabuse). The chelating effect of disulfiram is helpful in reducing the body's nickel burden. - Initial: 1x500 mg PO - Maintenance: 1x125-500 mg PO PUVA Psoralen plus UV-A Immunosuppressive agents Azathioprine (Imuran) Cyclosporine (Neoral) Diet - treated with diets low in minerals and chemicals to which the individual is allergic.