Contact dermatitis is a common inflammatory skin disease caused by direct or indirect contact with harmful substances. It can be irritant contact dermatitis from irritants like soaps or allergic contact dermatitis from allergens that cause a delayed hypersensitivity reaction. Symptoms include erythema, vesicles, papules and scaling with itch. Diagnosis involves identifying the causative agent through patient history and patch testing. Treatment focuses on eliminating contact with the irritant or allergen and using topical corticosteroids.
Urticaria is a skin problem triggered by reaction to food, medicine or allergic to any other thing. Urticaria leads to red, itchy, and swollen skin. This disease is also known as Hives. Hives formed due to allergy, changes size rapidly and often move around, in different parts of the body.
Urticaria is a skin problem triggered by reaction to food, medicine or allergic to any other thing. Urticaria leads to red, itchy, and swollen skin. This disease is also known as Hives. Hives formed due to allergy, changes size rapidly and often move around, in different parts of the body.
Lecture notes for Nursing graduates on Occupational Dermatological issues . Students will able to understand knowledge and skill about Dermatitis .
All healthcare personal can read this for improving knowledge .
It has information and knowledge based .
It has very informative to all health care professionals .
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
3. Introduction
•Contact dermatitis is a common inflammatory, noninfectious skin disease
that occurs after direct or indirect contact with substances that are harmful
to the skin.
•Skin disease accounts for 30% of all occupational disease in industrialized
nations, of which 90% is due to contact dermatitis.
Middleton's Allergy: Principles and Practice, Ninth Edition
4. Introduction
•Contact dermatitis may be subdivided into
• Irritant contact dermatitis (ICD)
• Allergic contact dermatitis (ACD)
• Photocontact dermatitis
• Photoirritant contact dermatitis (PICD, phototoxic dermatitis)
• Photoallergic contact dermatitis (PACD, photoallergy)
• Protein contact dermatitis (PCD)
Nat Rev Dis Primers. 2021 May 27;7(1):38.
6. Epidemiology
•Prevalence
• The most common form of CD is ICD, accounting for 80% of cases
• Common irritants include soap, degreasing agents, cosmetics, dust, foods and
solvents.
Nat Rev Dis Primers. 2021 May 27;7(1):38.
7. • Prevalence of ACD
• North American Contact Dermatitis Group (NACDG)
• 5,597 patients referred for assessment of contact allergy
• 66.6% had at least one positive reaction to a patch test
• 50.2% had a final, primary diagnosis of ACD
• European countries
• 3,119 people from five European countries
• 27% of individuals had a positive patch test and therefore had contact allergy.
• Meta-analysis
• 22 studies from Europe, 4 from North America and 2 from Asia.
• The prevalence of contac allergy was consistently ~20%.
• The prevalence in children is not known, but rates of positive patch test results from children
referred with suspected ACD range from 27% to 95.6%.
Nat Rev Dis Primers. 2021 May 27;7(1):38.
Epidemiology
Middleton's Allergy: Principles and Practice, Ninth Edition
8. •Prevalence of photocontact dermatitis
• Vary from 5.7% in the United Kingdom to 49.5% in China
•Prevalence of protein contact dermatitis
• Unknown
• PCD constituted 11% of all cases of occupational skin disease between 2005
and 2011 in Finland.
Nat Rev Dis Primers. 2021 May 27;7(1):38.
Epidemiology
9. •Risk factor for ACD
• Acquired
• Underlying inflammatory skin diseases such as ICD and stasis dermatitis
• Occupation
• hairdressers, health-care workers, beauticians, construction workers, metal workers and those in
the foodservice industry
• Innate
• Genetic susceptibility, such as mutations in the gene encoding filaggrin
• Ethnicity
• Darker skin types have a lower risk of ACD than individuals with lighter skin types
Epidemiology
Nat Rev Dis Primers. 2021 May 27;7(1):38.
10. •Risk factor for ACD
• Women > men
• Occupation
• Starts at a younger age in women (20–29 years old) than in men (50–59 years old)
• Atopic dermatitis
• The results from different studies have been conflicting
• The association of ACD with atopic dermatitis is likely multifactorial, with impaired skin
barrier function and sensitization to products used in the treatment of atopic dermatitis
being relevant.
Epidemiology
Nat Rev Dis Primers. 2021 May 27;7(1):38.
Middleton's Allergy: Principles and Practice, Ninth Edition
12. Common Contact Allergens
in the United States
Allergen Common Source of Exposure Positive Result Rate
in Patch Test
Nickel sulfate Jewelry, metal items, coins 20.1
Fragrance mix I Fragrance 11.9
Methylisothiazolinone Preservative 10.9
Neomycin Topical antibiotic 8.4
Bacitracin Topical antibiotic 7.4
Cobalt chloride Metal 7.4
Myroxylon pereirae (balsam of Peru) Fragrances, spices 7.2
p-Phenylenediamine Permanent hair dye 7.0
Formaldehyde Preservative 7.0
Methylchloroisothiazolinone /
Methylisothiazolinone
Preservative 6.4
Fragrance mix II Fragrance 5.7
Formaldehyde Preservative 5.6
Lanolin alcohol Cosmetics 5.4
Carba mix Rubber accelerators 4.8
Quaternium 15 Preservative 4.8 Middleton's Allergy: Principles and Practice, Ninth Edition
13. •The most common allergens in the pediatric population are
• nickel, cobalt, neomycin, Myroxylon pereirae (MP; balsam of Peru), lanolin,
fragrance, bacitracin, carmine, p-phenylenediamine, quaternium 15, propolis,
and formaldehyde
Epidemiology
Middleton's Allergy: Principles and Practice, Ninth Edition
14. • Fragrance mix I
• is used to screen for fragrance allergy and contains the following eight different
fragrance ingredients (International Nomenclature of Cosmetic Ingredients name):
cinnamyl alcohol, cinnamal, amyl cinnamal, geraniol, hydroxycitronellal, eugenol,
isoeugenol, and oakmoss absolute (Evernia prunastri)
• Fragrance mix II
• has increased the detection of fragrance allergy.
• This contains HICC (hydroxyisohexyl-3-cyclohexene carboxaldehyde, also known as
lyral), citral, citronellol, coumarin, farnesol, α-hexyl-cinnamal, and Myroxylon pereirae
resin
Epidemiology
Middleton's Allergy: Principles and Practice, Ninth Edition
16. Irritant Contact Dermatitis (ICD)
• Irritant
• soaps, detergents, shampoos, solvents, oils, cleaning agents, disinfectants, acids,
alkalis, dusts, fiberglass, plants, and a number of miscellaneous chemicals.
• Wet work
• Skin is exposed to liquid or occlusive glove use for prolonged periods.
• exposed longer than 2 hours per day, or use occlusive gloves longer than 2 hours per day, or clean their
hands very often (e.g., 20 times per day, or less often if the cleaning procedure is aggressive).
• Is common among healthcare workers and hairdressers.
• The role of physical and environmental irritants has been highlighted, such as heat;
sweating under occlusion; friction, such as from handling paper; manual handling;
and low humidity.
Middleton's Allergy: Principles and Practice, Ninth Edition
17. Irritant Contact Dermatitis (ICD)
•Irritant will cause direct injury to the skin in any person, if applied in a
sufficient concentration for a sufficient amount of time, without prior
sensitization or immunologic memory.
•The spectrum of ICD ranges from acute disease, caused by a single
exposure to a severe irritant, to chronic disease caused by repeated
exposure to a mild irritant.
•The concentration of the irritant and duration of exposure determine the
severity of disease with acute exposures.
Middleton's Allergy: Principles and Practice, Ninth Edition
19. Photoirritant contact dermatitis (PICD)
• is a specific type of irritant or toxic reaction that is mediated by exposure to
ultraviolet radiation.
• Common causes include
• Systemic agents
• Diuretics, NSAIDs, tetracyclines, and phenothiazines
• Topical agents
• Plants containing furocoumarins
• A classic example of this is skin exposure to lime juice in a tropical environment, causing a
characteristic angulated, streaky erythema on the areas of exposure, which is followed by
marked hyperpigmentation.
Middleton's Allergy: Principles and Practice, Ninth Edition
20. Allergic Contact Dermatitis
•ACD is caused by a type IV delayed hypersensitivity reaction in the skin
and is initiated by an low molecular weight chemicals and metal allergens
penetrating the skin and combining with major histocompatibility complex
(MHC) class II molecules on epidermal dendritic cells or Langerhans cells.
•The disease pathology is comprised of two distinct phases
• the initial sensitization phase
• the elicitation phase
Middleton's Allergy: Principles and Practice, Ninth Edition
Yale J Biol Med. 2020 Dec; 93(5): 699–709.
29. Photoallergic contact dermatitis (PACD)
•is rare and occurs where UVA exposure causes certain chemicals to
undergo transformation to become allergenic.
•The most common photoallergens are fragrances, topical nonsteroidal
antiinflammatory drugs, and sunscreen agents, such as benzophenones.
Middleton's Allergy: Principles and Practice, Ninth Edition
31. Clinical features
•Contact dermatitis is characterized by signs of erythema, vesicles,
papules, scaling, fissures, hyperkeratosis, and symptoms of marked itch
and sometimes pain.
•Typically, contact dermatitis is induced by exogenous factors and often
has its origins in direct or indirect contact with irritant or allergic factors.
Middleton's Allergy: Principles and Practice, Ninth Edition
32. Irritant Contact Dermatitis
• The first signs of ICD are dry and slightly scaly skin, with increasing redness and
lichenification after prolonged or repeated irritant exposure.
• This may be followed by formation of fissures, also known as rhagades.
• Itching is generally not as severe as in ACD.
• On the hands
• the predominant areas involved include the web spaces initially, the dorsal aspects of the
hands and fingers, as well as exposed portions of the forearms.
• Over the course of disease, the palms may also be involved.
• The eczematous lesions generally remain limited to exposure sites, and secondary
spread to other areas typically does not occur.
Middleton's Allergy: Principles and Practice, Ninth Edition
35. Allergic Contact Dermatitis
• The clinical presentation in ACD varies greatly, making allergic and irritant contact
dermatitis difficult to distinguish clinically and histologically.
• ACD generally is more acute, however, with marked itching, possibly vesiculation
or frank blistering, and swelling.
• Skin changes include redness, scaling, blistering, formation of papules or
pustules, exudation, and excoriation.
• In chronic disease, findings may include fissures, lichenification, and
hyperkeratosis.
• Unlike in ICD, the borders of the lesions are poorly defined.
Middleton's Allergy: Principles and Practice, Ninth Edition
37. •Distribution often relates to the site of allergen exposure.
•Additional lesions can appear on other parts of the body that have not
come into contact with the allergen (a phenomenon known as secondary
spread).
Middleton's Allergy: Principles and Practice, Ninth Edition
Allergic Contact Dermatitis
38. Allergic Contact Dermatitis
•An airborne pattern of ACD may be seen in persons exposed to an
airborne allergen, often plants, from the Compositae group.
• Differentiated from photoallergy and other photosensitive eruptions
• no sparing of shaded areas, such as behind the ears, on the eyelids, and under the
chin.
Middleton's Allergy: Principles and Practice, Ninth Edition
39. Systemic contact dermatitis
•Systemic exposure to an allergen in a sensitized patient with the
subsequent development of a cutaneous delayed hypersensitivity reaction
•The clinical presentation of SCD can be complex with a high degree of
variability.
• The simplest presentation seen is a localized recall reaction where the dermatitis
occurs at the site of prior topical sensitization.
• The other end of the spectrum would be erythrodermic SCD.
Fitzpatrick's Dermatology, Ninth Edition
40. Systemic contact dermatitis
•Baboon syndrome
• erythema of the buttocks and upper inner thighs was seen resembling the red
rump of baboons
• Mercury, nickel, and ampicillin were the first described causative agents
Fitzpatrick's Dermatology, Ninth Edition
41. Systemic contact dermatitis
•Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE)
• more precise term which by definition denotes a specific cutaneous adverse
drug reaction in which previous cutaneous sensitization is not a necessary
condition
• Diagnostic Criteria for SDRIFE
1. Exposure to a systemically administered drug either at the first or repeated dose.
2. Sharply demarcated erythema of the gluteal/perianal area and/or V-shaped erythema of the
inguinal/perigenital area.
3. Involvement of at least one other intertriginous/flexural localization.
4. Symmetry of affected areas.
5. Absence of systemic signs or symptoms.
Fitzpatrick's Dermatology, Ninth Edition
42. An. Bras. Dermatol. 92 (4). Jul-Aug 2017
JAAD Case Rep. 2018 Dec 14;5(1):89-90.
43. Systemic Drugs That Can Cause Systemic Reactivation of
Allergic Contact Dermatitis
RELATED DRUG WITH POTENTIAL TO CAUSE
SYSTEMIC REACTIVATION OF ALLERGIC CONTACT
DERMATITIS
ONTACT ALLERGENa
Aminophylline
Piperazine antihistamines: hydroxyzine, cetirizine,
levocetirizine and meclizine
Ethylenediamine dihydrochloride (stabilizer
infrequently found in skin care products)
Tetraethyl thiuram disulfide (generic name: disulfiram) Thiuram (rubber antioxidant)
Piroxicam Thimerosal (mercury-derived preservative)
Fitzpatrick's Dermatology, Ninth Edition
44. Noneczematous Variants of Allergic
Contact Dermatitis
Sites/appearance Common causes
Erythema multiforme-like allergic
contact dermatitis (ACD)
Occur at periphery of allergen
application;
systemic symptoms of erythema
multiforme are absent.
Exotic woods,
medicaments
Purpuric ACD Lower legs Rubber, textile dyes
Lichenoid ACD Commonly oral mucosa Color developers, metallic dyes in
tattoos; dental amalgams (oral
lichenoid ACD)
Pigmented ACD Clothed portions of body, face may
be involved (Riehl melanosis)
Textile dyes, cosmetics, and
fragrances
Lymphomatoid ACD Histologic criteria only Metals, para-phenylenediamine,
dimethylfumarate, para-tert-
butylphenol resin
Fitzpatrick's Dermatology, Ninth Edition
48. Contact urticaria
• is a transient wheal and flare reaction from direct contact with a chemical
or protein agent.
•Lesions appear within minutes to an hour and resolve within hours after
exposure.
•Type
• Nonimmunologic contact urticaria (NICU)
• Immunologic contact urticaria (ICU)
• Contact urticaria of uncertain mechanism
Fitzpatrick's Dermatology, Ninth Edition
49. Nonimmunologic contact urticaria (NICU)
•Most common type of contact urticaria
•Remains localized, and is less severe than immunologic contact urticaria
(ICU) reactions
•NOT inhibited by H-1 antihistamines
•oral or topical nonsteroidal anti-inflammatory medications are effective
Fitzpatrick's Dermatology, Ninth Edition
51. Immunologic contact urticaria (ICU)
• is a type I hypersensitivity reaction mediated by allergen-specific immunoglobulin
E (IgE) and seen in individuals previously exposed to the specific agent.
• Atopic individuals are particularly at risk.
• Contact urticaria from latex gloves is the prototypical example of ICU.
• Foods is the second most common cause of ICU.
• potato, carrot, apple, tomato, shellfish, seafood, and meats are well documented, and
wheat allergens
• Additional causes
• preservatives, fragrances, disinfectants, antibiotics, topical medicaments, epoxy resin
hardeners, formaldehyde in clothing, several woods, and birch pollen
Fitzpatrick's Dermatology, Ninth Edition
54. Contact urticaria of uncertain mechanism
•This type of reaction may occur with substances that produce a CU and a
generalized histamine-type reaction but lacks a direct or immunologic
basis for the reaction.
•It is most commonly caused by ammonium persulfate in bleaching hair
boosters
•Typically has a sudden onset characterized by erythema, edema, severe
pruritus, urticaria, and occasionally syncope with wheezing and dyspnea.
Fitzpatrick's Dermatology, Ninth Edition
55. Protein contact dermatitis
•is a chronic eczema because of immediate hypersensitivity to protein and
not related to haptens.
•Repeated episodes of contact urticaria can lead to protein contact
dermatitis.
Curr Opin Allergy Clin Immunol. 2020 Apr;20(2):117-121.
Middleton's Allergy: Principles and Practice, Ninth Edition
60. Diagnosis
•Any patient who presents with an eczematous dermatitis should be
regarded as possibly having ACD.
•Careful medical and environmental exposure history
• A history of skin disease, atopy
• The usage of personal care products (soap, shampoo, conditioner, deodorant,
lotions, creams, medications, hair styling products, etc.)
• The patient’s avocations or hobbies
• Occupations
Fitzpatrick's Dermatology, Ninth Edition
65. Patch test
•is the standard and most important diagnostic procedure for identifying
delayed type hypersensitivity as the cause of ACD.
•reproduces exposure to an allergen, creating a localized area of ACD.
•must be performed in accordance with international guidelines: It is
important that substances be tested appropriately, which often involves
diluting them as prescribed by published data, to avoid both inadvertent
sensitization and irritation.
Middleton's Allergy: Principles and Practice, Ninth Edition
66. Path test
• Test in
• patients with AD suspected to have ACD, especially those who do not respond to
treatment, initially improve and then exacerbate, or present with a change of pattern of
dermatitis.
• Not test in
• acute generalized dermatitis or with extensive eczema on the back
• on immunosuppressant medications
• prednisone (less than 20 mg/day) and cyclosporine may still yield clinically relevant results
• Topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), or ultraviolet radiation
• Topical potent TCS or TCI should not be applied on the test site for 5 to 7 days before testing
• not to have a suntan or use a sunbed 2-4 weeks before the PT
J Allergy Clin Immunol Pract. Sep-Oct 2015;3(5):669-75.
67. Side effect
• Skin reddening and itching at the application site
• this usually disappears after a few days
• Persistent reaction
• some positive test reactions, for example, to gold, may persist for up to a month.
• Flare of eczema
• a positive PT may be accompanied by a flare of existing or previous eczema.
• Pigment change
• an increase or decrease in pigment may be seen at the site of patch tests; this may last for months or rarely (1 in
1000) is permanent.
• Infection
• this is rare and would need antibiotic treatment.
• Scarring
• very rare (1 in 10,000)
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68. Methodology
• Test site
• The upper back is the preferred site, as the concentration of standard allergens has
been determined for the skin of the back only.
• Loading the chambers
• acrylates, fragrances, and allergens in aqueous vehicle
• should be loaded in the chambers and placed on the patient right away
• place a filter paper disk (if needed) and apply a drop of liquid, just sufficient to soak the disk
• allergens on petrolatum base
• may be prepared 24-48 hours before application
• apply a 5 mm ribbon of petrolatum-based antigen to each disk
J Allergy Clin Immunol Pract. Sep-Oct 2015;3(5):669-75.
69. Methodology
•Application of the PT
• Clean the back with water and pat dry.
• Do not use alcohol as this could be irritating.
• Applied to the upper or mid-back areas (2.5 cm lateral to a midspinal reference
point, as patches applied to the mid-spinal area frequently become detached),
which must be free of dermatitis and hair.
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70.
71. Timing of the patch test reading
• 1st
• 20-30 minutes after application, if contact urticaria is considered
• 48 hours after their application
• The tests are read 20-30 minutes after removal of the patches to allow erythema from
the occluding pressure or stripping of the tape and/or the chamber to resolve.
• 2nd
• between 3 and 7 days after application.
• 30% of relevant allergens that were negative at the 48-hour reading became positive at a
96-hour.
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72. Timing of the patch test reading
• 3rd
• a late reading 7-10 days after PT application if there is a negative early reaction
• Contactants such as metals (nickel sulfate, gold sodium thiosulfate, palladium chloride,
potassium dichromate, cobalt chloride), some antibiotics (neomycin), TCS (tixocortol-21-
pivalate, budesonide), and dyes (para-phenylenediamine)
• Decrescendo effect
• irritant reactions that appear within the first 48 hours tend to disappear
• Crescendo effect
• allergic reactions tend to increase
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75. False-positive reactions
•An “angry back” or “excited skin” syndrome
• False-positive reactions adjacent to large true
positive reactions that induce contiguous skin
inflammation and irritability.
• The underlying mechanisms are not fully
understood.
• More likely to develop in patients with a
longer duration of the primary dermatitis.
J Allergy Clin Immunol Pract. Sep-Oct 2015;3(5):669-75.
huidziekten.nl
76. False-positive reactions
•An “angry back” or “excited skin” syndrome
• Should be suspected in patients with more than 5 reactions in close proximity to
each other
• If suspected, repeat the PT with greater separation of allergens or sequentially if
the initial reactions are not clinically relevant, because false-positive reactions
are not reproducible when the triggering allergens are removed.
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77. False-positive reactions
•A pustular patch reaction
• is an irritant reaction and is common in atopic
individuals especially in response to metals
such as nickel, copper, arsenic, and
mercuric chloride.
T.R.U.E. test
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78. False-negative reactions
•Occur in up to 30% of patch-tested patients
•Possible causes are due to the antigen, skin reactivity, or methodology.
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79. Photo patch test
•Duplicate samples of photoallergens are used; after 48 hours, one set is
exposed to 5 joules of UVA light.
•Test results are read as usual, at approximately day 4 to 7.
Middleton's Allergy: Principles and Practice, Ninth Edition
80. Repeated open application test (ROAT)
•The repeated application of a suspected allergen to the antecubital fossa
twice daily for up to 7 days and observing for the development of dermatitis
up to 3 weeks.
•To replicate the reactivity of eyelid skin, the ROAT can also be performed
on the back of the ear.
•Although the threshold concentration for a positive reaction for the ROAT
per application was significantly lower than the threshold concentration for
a positive PT, the accumulated ROAT dose was very similar to the PT.
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81. Histopathology
•Similar to that observed in eczematous reactions
• Spongiotic dermatitis
• Typical epidermal changes of spongiosis
• The presence of a dense lymphocytic infiltrate in the upper dermis, with epidermal
exocytosis of lymphocytes
• A greater number of eosinophils may be observed in ACD compared with ICD
Middleton's Allergy: Principles and Practice, Ninth Edition
83. Treatment
• Avoidance of identified allergens and irritants
•Consistent use of an emollient or moisturizing agent
•Topical corticosteroids
Middleton's Allergy: Principles and Practice, Ninth Edition
84. Treatment
• Avoidance of identified allergens and irritants
• The core of the management of contact dermatitis
• Avoiding wet work and mechanical irritation
• Consistent use of an emollient or moisturizing agent
• Preparations ideally should be free of preservatives or fragrances, although oil-based
ointments are often greasy, which may hinder compliance.
• In acute disease
• Dressings, lotions, or creams are used.
• In subacute and chronic stages
• Ointments should be used.
Middleton's Allergy: Principles and Practice, Ninth Edition
85. •Topical corticosteroids
• The choice of vehicle depends on the morphology, the eczema stage, and the
nature of the skin lesions
• The use of topical corticosteroids over longer periods of time should be avoided.
• It is preferable to use a stronger corticosteroid preparation to treat the disease
while the condition is acute, followed by relatively rapid tapering of the drug.
• ACD caused by topical corticosteroids is not uncommon and should be
considered when contact dermatitis does not respond to treatment.
Treatment
Middleton's Allergy: Principles and Practice, Ninth Edition
86. •Phototherapy
• proved effective in chronic contact dermatitis
•Systemic corticosteroids
• should be reserved for exceptional situations and restricted to short-term use.
•Alitretinoin
• An agonist of both vitamin A acid receptors
• is approved in Europe for the treatment of severe chronic hand eczema that
does not respond, or responds inadequately, to topical corticosteroids
Treatment
Middleton's Allergy: Principles and Practice, Ninth Edition