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ICD vs ACD
- ICD: inflammatory rxn of the skin caused by exposure to an irritant
- ACD: immunologic rxn of the skin caused by exposure to an antigen
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primary treatment advice for ICD
avoidance of further irritant exposure
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why should -caine anesthetics be avoided for tx of ICD?
it can cause ACD
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why is hydrocortisone OINTMENT recommended for use in tx of ICD?
creates barrier to protect skin & keep moisture in
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MOA of emollients in tx of ICD
- helps restore moisture to stratum corneum
- serves as protectant from further exposure to effects of a wet working enviroment
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how long does a cell-mediated/Ag-sensitized T cell immune rxn take?
24 hrs - 21 days
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in previously sensitized patients, how long does it take for ACD sx to appear?
2-48 hours
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plants know to have cross-sensitivity w/ urushiol (4)
- 1) cashew nut shell
- 2) mango peel
- 3) Japanese lacquer tree lacquer
- 4) gingko fruit
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presentation of ICD vs ACD
- ICD: dry, cracked, inflamed skin
- ACD: papules, small vesicles, & sometimes large bullae over inflamed, swollen skin
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visual presentation suggesting poison ivy/oak exposure
- streaks of vesicles that correspond with points of urushiol contact from the damaged plant
- specks of black oxidized urushiol on skin/clothing
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how long does dermatitis take to resolve naturally?
10-21 days
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exclusions to self-tx of ACD
- <2yo
- >20% of BSA
- swelling of extremities
- signs of infection
- failure to self-tx after 7 days
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primary non-pharm action for relief of ACD-induced itching
take cold/tepid showers
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for up to ____(time), washing may remove unreacted oleoresin
30min
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why is alcohol NOT recommended for removal of Ag?
can dissolve & transport surface oleoresin to clean skin surfaces
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FDA-approved barrier product used to protect against exposure to oleoresin
IvyBlock Lotion
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how to use IvyBlock
- apply topically at least 15min before exposure to Toxicodendron
- reapply q4h or prn
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youngest age to use IvyBlock
<6yo
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pharm tx for ACD-induced itching (2)
- 1) oral antihistamines
- 2) topical corticosteroid cream
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name 3 oral antihistamines used in the tx of ACD-induced itching
- cetirizine
- diphenhydramine
- chlorpheniramine
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MOA of hydrocortisone cream in the tx of ACD-induced itching
treats immune-mediated inflammation that causes itching
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MOA of astringents in the treatment of ACD (3)
- 1) cool/dry skin through evaporation
- 2) cause vasoconstriction & reduce blood flow in inflamed tissue
- 3) cleanse skin of exudates, crust, & debris
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why should ointments NOT be applied in ACD cases?
- removal from skin is more difficult
- may trap bacteria beneath
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most effection form of topical agent for tx of mild-mod ACD (that doesn't involve edema & extensive areas of the skin)
hydrocortisone cream
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MOA of colloidal oatmeal in the tx of ACD-induced inflammation
- emollient
- soothes area
- decreases itching
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margin presentation: ICD vs ACD
- ICD: no clear margins
- ACD: clear margins based on contact of offending substances
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