Page 1 of 1: Allergy

goldenhand · Credits: 19466 My Scrapbook

A 21-year-old college student comes to your clinic concerned about an itchy rash on her hands. Past medical history is significant for childhood asthma and allergic rhinitis. She has no known drug allergies. Upon further questioning, she recalls having some itchy red patches in the flexures of her arms and legs as a child. Although she does not recall the details, she thinks that the skin lesions were treated with a prescription cream. She has not had any such problems in many years. Her brother, she recalls, had a similar condition, but on his face. As an infant, he had a severe, red, scaly facial rash that was also treated with skin ointments. Examination shows weeping, crusting lesions on the patient's hands and fingers, with widespread erythema. There are a few scattered vesicles and edematous papules. You give her some prescription-strength steroid ointment. Which of the following is an appropriate additional recommendation to help with her condition?

A. Chronic use of antihistamines to minimize atopic response
B. Frequent use of soap
C. Regular use of over-the-counter skin moisturizer
D. Shower frequently with warm water to remove bacterial debris
E. Low-humidity environments

botak 1 · Credits: 12608 My Scrapbook

C. Regular use of over-the-counter skin moisturizer

goldenhand · Credits: 19466 My Scrapbook

Right Dr.Botak
The correct answer is C. This patient has atopic dermatitis, a chronic inflammatory disease of the skin with a chronic, relapsing course. Key elements of the diagnosis include a history of atopy, pruritus, and eczematous lesions. Other features that support the diagnosis include pruritus, family history of atopy, personal history of atopy, young age-of-onset of atopic symptoms, chronic relapsing course, and a distribution consistent with atopic dermatitis. Steroid ointments can help with severe symptoms, though milder steroids need to be used in thin-skinned areas such as the face, groin, and fingers. Keeping the skin moist with over-the-counter skin moisturizers immediately after bathing/showering is one of the mainstays of therapy.
Chronic antihistamines (choice A) should not be used because they have not been proven to have long-term effectiveness. They are indicated, however, for the management of allergic rhinitis. In acute eczema, sedating antihistamines may be used at night to help a patient sleep by preventing pruritus. They are generally thought to work because of their sedative, rather than antihistamine, properties.
Frequent use of dehydrating soaps (choice B) and frequent showering (choice D) should be avoided because these will remove the body's natural protective oils. Moisturizing nonsoap cleansers should be used.
Humidity can help reduce symptom flares. Thus, low-humidity environments (choice E) should be avoided. Low humidity, which leads to xerosis, can be countered with a humidifier.

peace · Credits: 1659 My Scrapbook

i think

Chronic use of antihistamines to minimize atopic response

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