Fast Five Quiz: Compare Your Knowledge of Contact Dermatitis

William James, MD

Disclosures

June 06, 2017

Acute severe allergic contact dermatitis, such as from poison ivy, often needs to be treated with a 2- to 3-week course of systemic corticosteroids. Most adults require an initial dose of 40-60 mg. The oral corticosteroid is tapered over a 2- to 3-week period, but a complicated tapering regimen is not necessary given the short duration of systemic corticosteroid use. The systemic corticosteroids must be administered for 2-3 weeks because shorter courses are notorious for allowing poison ivy dermatitis to relapse. Long-acting intramuscular triamcinolone acetonide (Kenalog) 40-60 mg may be used in place of oral prednisone.

Potential complications are associated with the use of steroids, particularly around the eye. The avoidance of long-term steroid use is essential, because such use may cause cataracts, glaucoma, corneal thinning/perforation, and loss of the eye, as well as other problems.

Bentoquatam creates a claylike barrier on the skin that protects against urushiol, the oily resin in poison ivy, oak, and sumac. Bentoquatam is not a replacement for accepted protective devices, such as gloves, boots, and clothing. When exposure cannot be avoided completely, barrier products may protect areas of exposed skin, such as the neck and face.

Individuals with severe dermatitis, particularly if it is a disabling vesicular dermatitis of the hands, may be treated with diets low in minerals and chemicals to which the individual is allergic. A low-nickel diet is the most common, but published diets are available that are low in chromate, cobalt, or balsam of Peru. These diets may be attempted for the occasional allergic patient with severe chronic vesicular dermatitis.

For more on the treatment of contact dermatitis, read here.

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