TCA #6

Skin disorders and Skin Infections

IMPETIGO
• Impetigo is a superficial infection of the skin caused by:
o Staphylococci – most common cause
o Beta-hemolytic streptococci
o Other bacteria
• Incubation period: 4-10 days
• AFFECTED AREAS: Face, Neck, Hands, Extremities, Body

CLINICAL MANIFESTATIONS
• Small - Red macule
• Thin walled vesicles that rupture easily
• Lesion becomes pustular
• Honey colored crustation
• Red, moist surfaces

MANAGEMENT
• Systemic Antibiotics
o If no response to topical
 Penicillin
 Cloxacillin
 Dicloxacillin
• Topical antibiotics
• Soaking lesions in normal saline
• Washing lesions with soap and water
• Cleaning skin with betadine or hibiclens
• Teaching to avoid spread of infection

HOME CONSIDERATIONS
• Good hygienic practices
o Avoid being around others with impetigo

FOLLICULITIS
• Infection of the hair follicle
FURNCLE
• Infection of hair follicle that spreads to subcutaneous tissue
CARBUNCLE
• Abscess of the skin and subcutaneous tissue – Boils or Risins

CAUSATIVE ORGANISM • Redness

• Staphylococcus • Lesion filled with purulent material
• 9 out of 10 • Lesions vary in size

SIGNS AND SYMPTOMS TREATMENT

• Acute localized inflammation • Antibiotics
• Pain o Topical or Systemic
• Tenderness • Incision and Drainage
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• Antibacterial Soap • Social isolation r/t changes in

• Avoid rupturing the lesion
• Warm moist heat
• Dressing with drainage
NURSING DIAGNOSIS
• Impaired skin integrity
inflammatory process, exude
• Body image disturbance r/t lesions
appearance
• Powerlessness r/t disease
NURSING MEASURES (for viral and
bacterial)
r/t • Meticulous hand washing
• Avoid picking or squeezing lesion
• Instruct on proper use of antibiotics
and antipyretics
• Dressing changes if draining

VIRAL INFECTIONS

SHINGLES (HERPES ZOSTER)

• Inflammatory viral condition caused by the same virus that causes chicken pox
• Signs and Symptoms
o Vesicle eruptions that follow a nerve tract
o Very painful
o Outbreaks occur with stress
o Virus dominant state  Active State
• Treatment
o Symptomatic, pain control: Tylox, IV narcotics
o Corticosteroids: Dry lesions
o Antiviral Meds: Acyclovir – Oral, IV
o Possible isolation
o AVOID soap because drying of skin

HERPES SIMPLEX - TYPE I AND TYPE II

• Inflammatory viral condition usually involving the mucus membranes (oral, genital)
• Type I
o Mouth – Inflammation of mucous membrane
o Altered Nutrition; liquid diet – Juice ½ and ½ and no carbonated beverages
• Type II
o Genital area
o Can be symptom free to a draining lesion; erosion then the vesicle ruptures
• Signs and Symptoms
o Vesicles
o Burning, Itching, Redness
o Exudates, Crust
• Treatment
o Antiviral Meds: Zovirax, Acyclovir
o May clear untreated in 1-2 weeks if not severe case

VARICELLA – CHICKEN POX

• Signs and Symptoms
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o 1st 24 hours – Slight fever (99-100.2o), malaise, anorexia then rash that begins as
a macule and progresses to papule and then vesicle with crusts forming.
o All three stages are present at the same time and are scattered about on the body
o Communicable for 1 day prior to eruption to 6 days when crusts have formed
o Incubation period 13-17 days
• Treatment
o Strict isolation in the hospital
o Isolate child in the home until vesicles are dried (about 1 week)
o Keep cool, calamine lotion, if child
o AVOID use of aspirin, Use Tylenol
• Benadryl or other OTC for itching
• Cool baths and baking soda decrease itching

ERYTHEMA INFECTIOSUM – FIFTH DISEASE

• Caused by: Human Parvovirus, B19 (Transmission is unknown)
• Seen in Children Incubation: 4-14 days
• Signs and Symptoms
o Rash occurring in three stages
o Erythema on the face lasts about 1-4 days; 1 day after rash appears on face, then
upper extremities
o Rash subsides but reappears if skin is irritated by sunlight
• Complications
o Self limiting arthritis - after
• Treatment
o Symptomatic and supportive – Treat the symptoms - itching and fever
RUBEOLA - MEASLES
• Viral Infection, spread by direct contact
• Incubation Period: 10-20 days
• Communicability: 4 days before rash to 5 days after the rash appears
• Signs and Symptoms
o Prodormal Stage – Before the rash
 Fever Malaise Then cough begins
 Conjunctivitis Koplik Spots – Red spots inside buccal mucosa
o Rash Stage
 Once you see the rash ask what the child was like a week ago
 Appears 3-4 days after onset of prodromal stage
 Starts as a red rash on face and spreads
 After 3-4 days assumes a brownish color
• Complications
o Otitis Media Pneumonia Encephalitis
• Treatment
o Isolate till 5th-6th day of rash
o Respiratory precautions Rest Antipyretics Tepid baths

RUBELLA – GERMAN MEASLES

• Caused by the rubella virus. Transmission by direct contact and spread via infected
person.
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• Incubation Period: 14-21 days

• Communicable: from 7 days before to 5 days after appearance of rash
• Signs and Symptoms:
o Prodromal Stage Absent in children, present in adults and adolescents
 Low grade fever, H/A, Malaise
 Anorexia, Sore throat and cough, Conjunctivitis
 Lasts for 1-5 days subsides 1 day after appearance of rash
• Treatment:
o Treat fever, Discomfort
o Keep child away from pregnant woman – Causes Birth defects

ROSEOLA
• Caused by Human Herpes Virus Type 6; Usually seen in ages 6mos to 2 years
• Transmission, incubation, communicability is UNKNOWN
• Signs and Symptoms
o High fever 3-4 days in otherwise healthy appearing child - No medication stops the
fever
o Nonpuritic rash-rose; Pink maculopapules
• Treatment
o Control fever (104-105o) - Be alert for febrile seizures
 Use same precautions as with any seizure (Safety)

VURUCCAE (WARTS)
• Benign skin tumor caused by a virus
• Treatment
o Surgical removal if needed
o Cryotherapy to freeze them off

FUNGAL INFECTIONS
TINEA (RINGWORM)
- S/S
o Itching
o Scaling
o Redness
- Area of involvement
o Scalp
o Body
o Groin
o Feet
- Treatment
o Clean socks, cotton
o Wear different socks everyday
o Use clean washcloth everyday
o Don’t share personal items
o Antifungal meds

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CANDIDA
• Fungal infection usually found in areas that are warm and moist (Genitals and mouth)
• Signs and Symptoms
o Red, puritic rash in diaper area
o White adherent patches on the tongue, sides of mouth and palate
• Treatment
o Topical, oral, IV antifungal meds (not used 1st)
o Buttermilk, Yogurt, Swish and swallow
o Diflucan

PARASITIC SKIN DISEASES

Pediculosis
• Lice infestation on the outside of the host’s body
• Signs and Symptoms
o Itching
o Lymph nodes may enlarge
• Treatment
o OTC Shampoo
o Nit Removal
o Wash all linen in hot water
• Sent home X 3 time health department contacted
• Must be nit and lice free before return to school
• Check base of neck
• People and stuffed animals must be treated also

SCABIES
• An infestation of the skin by the itch mite
• Signs and Symptoms
o Itching
o Especially at night
• Treatment
o OTC shampoo
o Treat all family members
o Wash linen in hot water
o 1% lindane
o 3-5% sulfur orit (use 1 week)
o 20-33% benzyl benzoale
o Eurax

PSORIASIS
• Psoriasis is a chronic, recurrent disease characterized by dry, silvery, scaling papules
and plaques
• Deep based lesions
• A genetically determined, chronic, proliferative disease that is not infectious, contagious,
or caused by a nervous disorder.
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PRECIPITATING FACTORS
• Climate Stressors
• Trauma Infections
• Drugs

SIGNS AND SYMPTOMS

• Raised, erythematous papules that are covered with overlapping shiny, silvery scales
• Lesion has a deep red base, covered with a thin membrane that bleeds easily

MANAGEMENT
• Corticosteroids – Topical or intralesion
• Coal tar preparations - Topical
• Ultraviolet light treatments
• Antibiotics

NURSIG DIAGNOSIS
• Impaired skin integrity r/t pathological process and mechanical forces
• Social isolation r/t alterations in appearance
• Powerlessness r/t disease process

ACNE VULGARIS
PATHOPHYSIOLOGY
• Sebum combines with epidermal cells and bacteria causing a plugging of the hair follicle
to form an open comedo (blackhead) or closed comedo (whitehead) Inflammatory
response develops.

CAUSES TREATMENT
• Unknown • Hygiene
• Free fatty acids • Reduce bacterial count on skin
• Endocrine effects • Medications
• Stressors • Cryosurgery
• Heredity • Diet – Low fat
• Infection • Ultraviolet light
• R/O chocolate, cola products
PREDISPOSING FACTORS • Decrease sebaceous gland activity
• Type of Make up • Minimize scarring
• Overuse of Steroids • Eliminate as many predispose factors
• Oral contraceptives – included in
treatment plan NURSING DIAGNOSIS
• Emotional stress • Impaired skin integrity r/t
• Climate inflammatory process
• Certain drugs • Alterations in self esteem r/t body
image changes

SKIN CANCER TYPES

• Basal Cell Carcinoma

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• Squamous Cell Carcinoma

• Malignant Melanoma

BASAL CELL CARCINOMA

• Arises from the basal cell layer of the epidermis or the hair follicles
• Appears on the sun exposed areas

MANIFESTATIONS
• Small • Ulceration and Crustation
• Waxy nodule o Mild
• Rolled • Telangietatic vessels may be present
• Translucent • Invades and erodes adjoining tissue
• Pearly borders • Recurrence is common

SQUAMOUS CELL CARCINOMA

• Arises from the epidermis, normal skin or from preexisting skin lesion
• Appears on sun damaged skin-face, lips, ears, nose, and forehead

MANIFESTATIONS
• Rough
• Thickened
• Scaly
• May have bleeding
• Border is wider
• More infiltrated
• More inflamed in appearance
MANAGEMENT
• Surgical excision
• Micrographic surgery
• Electrosurgery
• Cryosurgery
• Radiation Therapy

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MALIGNANT MELANOMA
• Malignant neoplasm
• Atypical melanocytes are present in the epidermis, dermis, and subcutaneous cells
• Etiology is unknown, but ultraviolet rays are suspected to be the cause

WHO IS AFFECTED THE MOST

• Persons with fair complexions, blue eyes, red or blond hair, freckles
• Persons of Celtic or Scandinavian origin
• Persons who do not tan but BURN

DIAGNOSIS
• History and physical - Biopsy

PROGNOSIS
• Prognosis is poor if lesion exceeds 4mm in thickness
• Lesion is located on the hand, foot, scalp
• Men and elderly have a poor prognosis
• Metastasis occurs to bone, lung, liver, spleen, nervous system and lymph nodes

MANAGEMENT
• Surgical excision
• Chemotherapy may be tried, but few agents have been found to be effective
• Immunotherapy – varied success
• Avoid sun at peak btu – 10am to 3pm

Allergic Disorders
ALLERGIC REACTION
• Manifestation of tissue injury resulting from interaction between an antigen (substance
that induces the production of antibodies or foreign substance) and an antibody (Protein
substance developed by body in response to and interacting with a specific antigen)
• Body overreaction
• Allergy is an inappropriate, often harmful response of immune response of immune
system to normally harmless substances
• Chemical mediators released
• Function and production of immunoglobulins (family closely related proteins capable of
acting as antibodies)

5 CLASSES
• IgG – 75% Total Immunoglobulin
• IgA – 15% Total Immunoglobulin
• IgM – 10% Total Immunoglobulin
• IgE – 0.004% Total Immunoglobulin – ↑ levels

ROLE OF B CELLS - B-LYMPHOCYTE

 • Site of antibody production  outpouring of antibodies for purpose of destroying and
removing antigen
ROLE OF T CELLS - T-LYMPHOCYTE
• Assist B cells in producing antibodies

HYPERSENSITIVITY
• Abnormal, heightened reaction to any type of stimuli
• Usually does NOT occur with 1st exposure to allergen
• ↑ exposure causes more of an ↑ in reaction
• Reaction follows reexposure after sensitization in predisposed individual
• Sensitization initiates hormonal response or buildup of antibodies

FOUR TYPES OF REACTION

TYPE 1 - ANAPHYLACTIC - HYPERSENSITIVITY

• Immediate reaction beginning within minutes of exposure to an antigen
• Reaction mediated by IgE antibodies
• Requires previous exposure to specific antigen  plasma cells produce IgE antibodies in
lymph nodes (where T cells help with promoting reaction)  bind to membrane receptors
and mast cells found in CT and basophiles.
• May include both local and systemic anaphylaxis

TYPE 4 - DELAYED TYPE - HYPERSENSITIVITY

(CELLULAR HYPERSENSITIVITY)
• Occurs 24-72o after exposure to allergen
• Mediated by sensitized T Cell and Macrophages
• Example: Intradermal injection of tuberculin antigen or purified protein derivative (PDD)
• Example Reaction: Contact dermatitis resulting from exposure to allergens
o Such as: Cosmetics, adhesive tape, top meds, med additives, plant toxins
• Primary exposure results in sensitization
• Symptoms: Itching, Erythema, Raised Lesions

DIAGNOSTIC EVALUATION
• CBC With Differential
o WBC normal except during infective states
o Eosinophils – 5-15% nonspecific but does suggest allergic reaction
 Moderate eosinophilia: 15-40%
• Allergic disorders Patients with malignancy
• Immunodeficiencies Parasitic infections
• Congenital heart disease Peritoneal dialysis
• Total Serum Immunoglobulin E Levels
o High total serum IgE levels support diagnosis of atopic disease
o Normal IgE level does NOT exclude diagnosis of allergic disorder

• Skin Test
o Entails simultaneous intradermal injection or superficial application (epicutaneous)
of several solutions at separate sites
 o Several Precautionary Steps Observed Before Skin Testing:
 Testing not performed during periods of bronchospasm
 Epicutaneous tests (scratch or prick tests) performed before other testing
methods in an effort to minimize risk of systemic reaction
 Emergency equipment must be readily available to treat anaphylaxis
 Corticosteroids and Antihistamines (including allergy meds) suppress skin
test reactivity and should be withheld 48-96 hours before test

• RAST Test
o RAST test may be performed if doubt about validity of skin tests
o Measures allergen-specific IgE
o Sample serum exposed variety suspected allergen particle complexes 
antibodies present combine with radiolabeled allergens.
o Indicates quantity of allergen necessary to evoke an allergic reaction  report on
scale 0-5. 2+ or greater: considered significant

ANAPHYLAXIS
• Clinical response to immediate (Type 1 Hypersensitivity) immunologic reaction between
specific antigen and antibody
• Reaction results from IgE antibody

3 CATEGORIES OF CLINICAL MANIFESTATIONS

• Mild Systemic Reactions
o Peripheral tingling
o Sensation of warmth
o Possible accompanied by fullness in mouth and throat
o Nasal congestion
o Periorbital swelling
o Pruritis
o Sneezing
o Tearing of eyes
o Onset symptoms begins within first 2 hours of exposure
• Moderate Systemic Reactions
o Above symptoms with added:
o Flushing
o Warmth that increases in intensity
o Anxiety
o Itching that increases in intensity
o Serious Reactions
 Bronchospasm and edema of airways or larynx and dyspnea, cough and
wheezing
o Onset same as mild
 Begins within the first 2 hours of exposure
• Severe Systemic Reactions
o Abrupt onset with same S/S as mild and moderate
 o Within approx 30 min:
 CV, Resp, GI, Integumentary are affected
o Progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis
o Dysphasia (difficulty swallowing)
o Abdominal cramping due to increased GI secretions
o Vomiting
o Diarrhea
o Seizures
o Rarely: Cardiac arrest and coma result
PREVENTION
• Single most important aspect for client at risk for anaphylaxis
• People sensitive to insect bites and stings
o Those experience food or medication reaction
o Those experience idiopathic or exercise induced anaphylactic reaction (EPI-PEN)
• Careful History any sensitivity to suspected antigens obtained before administration of
any medications particularly parenteral form because this route associates with most
severe anaphylaxis
• Clients predisposed to anaphylaxis should wear some form of identification (Medic Alert
Bracelet: Naming allergies to meds, food, and other substances)
• Epi Pen 0.3mg
• Epi Pen Jr 0.15mg
o Administer mid portion of thigh
• Client allergic to insect venom may require venom immunotherapy
o Used as a control measure and not a cure
• Insulin-allergic diabetic clients and penicillin-sensitive clients may require desensitization
o Desensitization based on controlled anaphylaxis with gradual release of mediators
o Clients who undergo desensitization cautioned there should be no lapses in
therapy because may lead to reappearance of allergic reaction when medication is
reinstituted

MEDICAL MANAGEMENT
• Depends on severity of reaction
• Cardiovascular and respiratory function evaluated closely
• Increase O2 Concentration
• Epinephrine 1:1000 dilution: given SQ in upper extremity or thigh and may be followed
by continuous IV infusion – Why Given????????????
• Antihistamines and Corticosteroids: May be given to prevent recurrences of reaction and
treat urticaria and angioedema
• Volume Expanders and Vasopressor Agents (Dopamine): Given to maintain BP and
normal hemodynamic status (LR, Plasma)
o Brings Blood Pressure Up
• Aminophylline and Corticosteroids: Administer to improve airway patency and function
o Episodes bronchospasm or history of bronchial asthma or COPD
• Glucagon IV: Hypotension unresponsive to vasopressors; administer IV; also acute
inotrophic and chronotriophic effects
o Improves muscle contractility in heart
 • Severe reaction observed closely 12-14 hours because potential recurrence even with
mild reactions must be educated concerning risk

ALLERGIC RHINITIS
• Inflammation of nasal mucosa; hay fever, chronic allergic rhinitis, pollinosis
• Most common form of respiratory allergy presumed to be mediated by an immediate
(Type 1 Hypersensitivity) immunologic reaction affecting about 8-10%
• If left untreated many complication may result:
o Allergic asthma
o Chronic Nasal Obstruction
o Chronic Otitis Media with hearing loss
o Anosmia – Absence of sense of smell
o Children: Orogacial dental deformities
• Early diagnosis and adequate treatment are essential
• Allergic rhinitis induced by airborne pollens or molds
• Characterized by seasonal occurrences:
o Early Spring: Tree pollen – oak, elm, poplar
o Early Summer: Rose pollen (rose fever), Grass pollen (Timothy, red-top)
o Early Fall: Weed Pollen (ragweed)
• Each year attacks begin and end about same time
• Airborne mold spores require warm, damp weather
o No rigid seasonal pattern spores appear early spring, rampant during summer and
taper off and disappear by first frost
PATHOPHYSIOLOGY
• Sensitization begins by ingestion or inhalation of antigen
• Reexposure nasal mucosa reacts by slowing ciliary action, edema formation, and
leukocyte (primary eosinophil) infiltration
• Histamine major mediator of allergic reactions in nasal mucosa
• Tissue edema results from vasodilatation and increased capillary permeability

CLINICAL MANIFESTATIONS
• Nasal congestion Clear, watery nasal discharge
• Intermittent sneezing Nasal itching
• Itching throat and soft palate common
• Drainage nasal mucus into pharynx initiates multiple attempts to clear throat and results
in dry cough or hoarseness
• Headache, pain over paranasal sinuses and epistaxis
• Symptoms chronic condition depend on environmental exposure and intrinsic host
responsiveness
ASSESSMENT AND DIAGNOSTIC FINDINGS
• Based on history and Physical Exam
• Diagnostic Tests
o Nasal smears Peripheral Blood counts
o Total serum IgE Epicutaneous and intradermal testing
o RAST Food elimination and challenge
o Nasal provocation tests
• Results indicative of allergy as cause
 o  IgE and eosinophil levels
o Positive reactions on allergen testing
o False-positive and false-negative responses to tests
MEDICAL MANAGEMENT
• Goal of therapy provide relief from symptoms
• Knowledge of general concepts regarding assessment and therapy in allergic disease is
important

Pharmacological Therapy
• Antihistamines (H1 Receptor Antagonists)
o Used in managing mild allergic disorders
o Prevent action of histamines at site NOT release of histamine from mast and
basophils
o Major Side effect:
 Sedation
o Contraindicated:
 3rd trimester, nursing mothers, and newborns
 Children and elderly
 Clients who condition aggravated by muscannic blockade (asthma, urinary
retention, open angle glaucoma, hypertension, prostatic hyperplasia)
• Second Generation or Nonsedating H1 Receptors Antagonists
o DO NOT cross blood / brain barrier
o More Expensive
o Generally well tolerated
• Adrenergic Agents – Vasoconstrictors of Mucosal Vessels
o Used topically (nasal and ophthalmic), oral
o Drops and sprays cause fewer side effects; use limited to few days to avoid
rebound congestion
o Nasal decongestants: used for relief nasal congestion when applied topically to
nasal mucosa
o Topical ophthalmic drops used symptomatic relief eye irritations due to allergies
o Potential side effects:
 HTN Dysrhythmias Palpitations CNS
stimulation
 Irritability Tremor Tachyphylaxis
• Mast Cell Stabilizers
o Intranasal cromolyn sodium (Nasal crom) spray acts by stabilizing mast cell
membrane, thus inhibiting release of histamine and other mediators of allergic
response
 Used prophylactically before exposure to allergen or therapeutically chronic
allergic rhinitis
• Corticosteroids
o Indicated in more severe cases of allergic and perennial rhinitis. Cannot be
controlled by more conventional medications such as: decongestants,
antihistamines, intranasal cromolyn
o Medications Include:
 Becolomethasone – Beconase, Vancenase
  Budesonide – Rhinocort
 Desamethasone – Decadron Phosphate Turbinaire
 Flunisolide – Nasalide
 Fluticasone – Activate, Flonase
 Triamcinolone – Nasa cort
o Administer by metered spray devices
o Systemic with dexamethasone use limited to 30 days
o Instructed NOT to stop taking medication abruptly or without specific instructions
from MD

Immunotherapy
• Indicated only with IgE hypersensitivity demonstrated to specific inhalant allergens client
cannot avoid (house dust, pollens)
• Injections begin with small amounts and gradually  (usually at week intervals) until
maximum amount tolerated dose has been attained
o Maintenance “booster” injection given at 2-4 weeks intervals frequent for period of
several years before max benefit achieved
• Three Methods of Injection Therapy:
o Coseasonal Basis
 Therapy initiated during season which client experiences symptoms; proved
ineffective thus used less freq.; Increased Risk for systemic reaction
o Preseasonal Therapy
 Injection given 2-3 months before symptoms expected, allowing time for
hyposensitization to occur; treatment D/C’d after season begins

o Perennial Therapy
 Administration year round, usually monthly basis, preferred method because
more effective, longer-lasting results
• Remain in office 30 mins after injection
• If local, large swelling develops at injection site next dose is NOT increased because may
be warning sign of possible systemic reaction
• Therapeutic failure evident when client does not experience decrease in symptoms within
12-24 months, develop increased tolerance to known allergies, and decrease use of
meds to decrease symptoms
Avoidance Therapy
• Every attempt made to remove allergens that act as precipitating factors
• Simple measures and environmental controls often effective in decreasing symptoms
• Examples include:
o Use of air conditioners Air cleaners
o Humidifiers and dehumidifiers Smoke free environments
NURSING DIAGNOSIS
• Ineffective breathing pattern R/T allergic reaction
• Knowledge deficit about allergy and recommended modifications in lifestyle and self care
practices Education
• Impaired individual coping with chronicity of condition and need for environmental
modifications
Primary goal is relief of symptoms or cause of problem
CONTACT DERMATITIS
• Dermatitis Venenata
• Type IV delayed hypersensitivity reaction response
• Often eczematous condition caused by skin reaction to variety of irritating or allergenic
materials
• Poison Ivy is the most common cause
• Frequent Offenders: Cosmetics, Soaps, Detergents, and industrial chemicals
• Skin sensitivity may develop after brief or prolonged exposure
• Clinical picture may appear hours or weeks after sensitized skin has been exposed
CLINICAL MANIFESTATIONS
• Symptoms
o Itching, Burning, erythema, Skin lesions (vesicles) and Edema
• Followed by
o Weeping, Crusting then Drying and peeling of skin
• Repeated Reaction
o Thickening of skin and Pigmentary changes
• Severe Responses
o Hemorrhagic Bullae
• Secondary Invasion By
o Bacteria may develop with abraded by rubbing or scratching
4 BASIC TYPES
• Allergic
o Results from contact of skin and allergenic substance has sensitization period of
10-14 days
 Clinical Presentation:
• Vasodilation and perivascular infiltrates on dermis
• Intracellular edema
• Usually seen dorsal aspect of hand
• Irritant
o Results from contact with a substance that chemically or physically damages the
skin on nonimmunologic basis; occurs after first exposure to irritant or repeated
exposures to milder irritants over an extended time.
 Clinical Presentation:
• Dryness lasting days to months
• Vesiculation, fissures, cracks on hands and lower arms most
common areas
• Phototoxic
o Resembles irritant type but requires sun and chemical in combination to damage
epidermis
 Clinical Presentation:
• Similar to irritant dermatitis

• Photallergic
o Resembles allergic dermatitis but requires light exposure in addition to allergen
contact to produce immunologireactivity
 Clinical Presentation
• Similar to allergic dermatitis
FOOD ALLERGY
• Almost any food can cause Type 1 Hypersensitivity
MOST COMMON OFFENDERS • Cough
• Nuts – Especially peanuts • Laryngeal edema
• Eggs • Angioedema
• Milk GI Symptoms
• Soy • Itching
• Wheat • Swelling of lips, tongue, palate
• Chocolate • Abdominal Pain
CLINICAL MANIFESTATIONS • Nausea
• Urticaria • Cramps
• Atopic dermatitis • Vomiting
• Wheezing • Diarrhea

LATEX ALLERGY
POPULATION MOST AT RISK
• Health care workers
• People with atopic allergies
• Multiple surgeries
• People working factories manufacturing latex products
• Females
• Person with Spina Bifida
CROSS RX REPORTED IN PEOPLE WHO ARE ALLERGIC TO CERTAIN FOODS
• Kiwis
• Bananas
• Pineapples
• Passion Fruit
• Avocados
• Chestnuts
CLINICAL MANIFESTATIONS
• Range from mild contact dermatitis - moderately severe symptoms or rhinitis,
conjunctivitis, urticaria, bronchospasm - severe life threatening anaphylaxis
• Delayed Type - Type IV o Rapid onset
o Symptoms contact dermatitis  Urticaria
 Pruritus  Wheezing
 Edema  Dyspnea
 Erythema  Laryngeal edema
 Vesicles  Bronchospasm
 Papules  Tachycardia
 Crusting and thickening  Angioedema
of skin  Hypertension
• Anaphylactic – Type I  Cardiac arrest

MEDICAL MANAGEMENT
• Only treatment is avoidance of latex products
• Anaphylactic reaction must be counseled to wear medical identification and carry supply
nonlatex gloves; antihistamines and emergency kit containing Epinephrine provided
along with instructions about emergency management.