qr code excel B Laboratory Findings in Objective-C

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B Laboratory Findings
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Gram stain and culture confirm the diagnosis
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Clinical Findings
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A Symptoms and Signs
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In allergic contact dermatitis, the acute phase is characterized by tiny vesicles and weepy and crusted lesions, whereas resolving or chronic contact dermatitis presents with scaling, erythema, and possibly thickened skin Itching, burning, and stinging may be severe The lesions, distributed on exposed parts or in bizarre asymmetric patterns, consist of erythematous macules, papules, and vesicles The affected area is often hot and swollen, with exudation and crusting, simulating and at times complicated by infection The pattern of the eruption may be diagnostic (eg, typical linear streaked vesicles on the extremities in poison oak or ivy dermatitis) The location will often suggest the cause: Scalp involvement suggests hair tints, sprays, or tonics; face involvement, creams, cosmetics, soaps, shaving materials, nail polish; and neck involvement, jewelry, hair dyes, etc
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Differential Diagnosis
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The main differential diagnoses are acute allergic contact dermatitis and herpes simplex Contact dermatitis may be suggested by the history or by linear distribution of the lesions, and culture should be negative for staphylococci and streptococci Herpes simplex infection usually presents with grouped vesicles or discrete erosions and may be associated with a history of recurrences Viral cultures are positive
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Treatment
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In most cases, systemic antibiotics are indicated Cephalexin, 250 mg four times daily, is usually effective Doxycycline, 100 mg twice daily, is a reasonable alternative Communityacquired methicillin-resistant S aureus (CA-MRSA) may cause impetigo, and initial coverage for MRSA could include doxycycline, clindamycin, or trimethoprim-sulfamethoxazole About 50% of CA-MRSA are quinolone resistant Recurrent impetigo is associated with nasal carriage of S aureus, treated with rifampin, 600 mg daily, or intranasal mupirocin ointment twice daily for 5 days Crusts and weepy areas may be treated with compresses, and washcloths and towels must be segregated and washed separately
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Sladden MJ et al Common skin infections in children BMJ 2004 Jul 10;329(7457):95 9 [PMID: 15242915]
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B Laboratory Findings
Gram stain and culture will rule out impetigo or secondary infection (impetiginization) If itching is generalized, then scabies should be considered After the episode has cleared, the patch test may be useful if the triggering allergen is not known
Differential Diagnosis
Asymmetric distribution, blotchy erythema around the face, linear lesions, and a history of exposure help distinguish acute contact dermatitis from other skin lesions The most commonly mistaken diagnosis is impetigo Chronic allergic contact dermatitis must be differentiated from scabies, atopic dermatitis, pompholyx, and other eczemas
ALLERGIC CONTACT DERMATITIS
ESSENTIALS OF DIAGNOSIS
Erythema and edema, with pruritus, often followed by vesicles and bullae in an area of contact with a suspected agent (Plate 14)
Prevention
Prompt and thorough removal of allergens by washing with water or solvents or other chemical agents may be
CMDT 2008
as possible) to achieve a clinical effect and to taper slowly enough to avoid rebound A Medrol Dosepak (methylprednisolone) with 5 days of medication is inappropriate on both counts (See 26)
effective if done very shortly after exposure to poison oak or ivy Several over-the-counter barrier creams (eg, Stokogard, Ivy Shield) offer some protection to patients at high risk for poison oak and ivy dermatitis if applied before exposure Iodoquinol cream may benefit nickel allergic patients in a similar manner Ingestion of rhus antigen is of limited clinical value for the induction of tolerance The mainstay of prevention is identification of agents causing the dermatitis and avoidance of exposure or use of protective clothing and gloves In industry-related cases, prevention may be accomplished by moving or retraining the worker
Prognosis
Allergic contact dermatitis is self-limited if reexposure is prevented but often takes 2 3 weeks for full resolution
Craig K et al What is the best duration of steroid therapy for contact dermatitis (rhus) J Fam Pract 2006 Feb;55(2):166 7 [PMID: 16451787] Mark BJ et al Allergic contact dermatitis Med Clin North Am 2006 Jan;90(1):169 85 [PMID: 16310529]
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