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Allergic Contact Dermatitis (Skin Allergies)

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Medication continued...

Drug Category: Corticosteroids -- Have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Drug Name
 
Clobetasol (Temovate) -- Class I superpotent topical steroid; suppresses mitosis and increases synthesis of proteins that decrease inflammation and cause vasoconstriction.
Use 0.05% cream or ointment.
Adult DoseApply bid for up to 2 wk; not to exceed 50 g/wk
Pediatric DoseNot established
ContraindicationsDocumented hypersensitivity; viral or fungal skin infections
InteractionsNone reported
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsMay suppress adrenal function in widespread or prolonged therapy; superpotent topical steroid and, in general, should not be applied to face or intertriginous areas except under care and close supervision of experienced dermatologist; skin atrophy, striae, or other problems may result from inappropriate use
Drug Name
 
Hydrocortisone (Valerate, Westcort) -- Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.
Use 0.2% cream or ointment.
Adult DoseApply sparingly to affected areas bid
Pediatric DoseApply as in adults
ContraindicationsDocumented hypersensitivity; viral, fungal, and bacterial skin infections
InteractionsNone reported
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsProlonged use, applying over large surface areas, application of potent steroids, and occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria; ointment is more potent than cream and, in general, more caution should be exercised; should not be applied to face or intertriginous areas except under care and close supervision of experienced dermatologist; skin atrophy, striae, or other problems may result from inappropriate use
Drug Name
 
Prednisone (Deltasone, Meticorten, Orasone) -- Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production.
Adult Dose40-60 mg/d PO qd or divided bid/qid; taper over 2-3 wk, as symptoms resolve; 0.5-2 mg/kg/d; taper as condition improves; single morning dose is safer for long-term use, but divided doses have more anti-inflammatory effect
Pediatric Dose4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2-3 wk, as symptoms resolve
ContraindicationsDocumented hypersensitivity; viral infection, peptic ulcer disease; hepatic dysfunction; connective tissue infections; fungal or tubercular skin infections
InteractionsCoadministration with estrogens may decrease prednisone clearance; when used with digoxin, digitalis toxicity secondary to hypokalemia may increase; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
PregnancyB - Usually safe but benefits must outweigh the risks.
PrecautionsHyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use; abrupt discontinuation may cause adrenal crisis
Drug Name
 
Triamcinolone (Aristocort, Amcort, Aristospan Intra-articular) -- For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Intramuscular injection may be used for widespread skin disorder or intralesional injections may be used for localized skin disorder.
Adult Dose40-60 mg IM, may repeat in 4-6 wk
3-10 mg/mL intralesional
Pediatric Dose<6 years: Not established
6-12 years: 0.03-0.2 mg/kg IM
>12 years: Administer as in adults
ContraindicationsDocumented hypersensitivity; fungal, viral, and bacterial skin infections
InteractionsCoadministration with barbiturates, phenytoin, and rifampin decreases effects of triamcinolone
PregnancyC - Safety for use during pregnancy has not been established.
PrecautionsMultiple complications (eg, severe infections, hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression) may occur; abrupt discontinuation of glucocorticoids may cause adrenal crisis; SC injection may cause skin atrophy that may be slow to recover

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