-Contact Dermatitis-
-delayed hypersensitivity reaction
-well demarcated plaques of erythema and edema
-may have some vesicles (acutely)
-Subacute/Chronic-may have some plaques of erythema, dry scales, or desquamation
-May have plaques of lichenification
-Treatment-to remove offending agent if able to isolate
-Topical steroids in mild cases
-Severe cases may require systemic corticosteroids for 2 weeks (tapered)
-Burrows solution on wet dressing may be helpful
-Atopic Dermatitis-
-Type I Hypersensitivity reaction
-Lesions may be present for months to years
-Poorly defined erythematous patches
-Chronically the lesions may have some lichenification with excoriation marks
-Fissured areas with painful areas are possible
-May have associated allergic rhinitis or asthma
-Topical anti itch lotions are helpful
-Patients may need low potency steroid ointment at times
-Wet dressings
-UVA and UVB light may be helpful for chronic and subacute
-Dyshidrosis-
-sweating does not play a role
-rash presents as vesicles in clusters in early phases
-later phases scaling and painful fissures and crusting
-80% on hands and feet
-Treatment involves high potency topical glucocorticoids for 1-2 weeks
-Burrow’s solution maybe helpful with wet dressings in early stages
-For severe cases systemic glucocorticoids is necessary over 1-2 weeks (tapered)
-Lichen Simplex Chronicus-
-Predilection of the skin that responds to trauma by epidermal hyperplasia
-Skin becomes hypersensitive and nerves and epidermis proliferate
-Itches
-Solid plaque of of lichenification from a confluence of small papules
-Scaling is minimal
-Skin feels thickened
-Areas of distribution scalp, ankles, lower thighs, exterior forearms, vulva, neck , scrotum and groin
-Occlusive dressings are helpful
-Can inject with triamcinolone
-Combination of crude tar in zinc oxide and topical glucocorticoids is helpful
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