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There are different types of skin conditions that can affect patients during their life spam. Some conditions might be chronic or acute and, on many occasions, may cause physical and social discomfort in the patient due to dermatological appearance in the body parts that are exposed. In this discussion board, this writer will address allergic dermatitis. Contact dermatitis is blanched into two types of dermatitis which are irritant and allergic dermatitis and it is confined to contact with the irritant or the allergen (Woo, 2020). Therefore, in this discussion post, this writer will address allergic dermatitis, including a drug choice and its pharmacokinetics, pharmacodynamics, interactions, side effects, monitoring, and patient education for the patient.
Irritants that can cause allergic dermatitis are all over the environment, and each person might be inclined to react to a particular irritant. Allergic contact dermatitis is a reaction or response to an allergen (Woo, 2020). The treatment options for this condition can only be defined after the interaction with the allergen and there is no preventative treatment. Except to protect itself when a known allergen such as poison ivy, poison oak, or other well-known allergens are present. Treatment may be based on the patient’s history of allergies and is mostly topically applied, except when the condition is exacerbated or would not have a good outcome with the topical treatment.
Among different options for treatment, this writer will address the treatment of allergic(contact) dermatitis by using a low potency medication hydrocortisone. The medication hydrocortisone is a good choice of treatment and is available over the counter as a cream, lotion, and ointment (Lexicomp, 2020). The good thing about the treatment is the facility to be obtained OTC and is easily applied by the patient on different occasions. The pharmacokinetics/pharmacodynamics of hydrocortisone is that it is a corticosteroid and acts as a glucocorticoid and mineralocorticoids, absorbed primarily in the skin, and a small amount absorbed into the systemic circulation is metabolized by the liver and inactive compounds (PubChem, 2020). The advantage of hydrocortisone is that being applied topically it does not affect the systemic circulation as other medications are taken by other routes during treatment.
Hydrocortisone, like any other, still has some adverse effects which can be minimal compared to other medications in its class. Although the systemic circulation does not absorb a significant amount of the medication it is important to monitor for glucose levels, electrolytes, blood pressure, weight, itchiness to the site, and increased redness (Dastgheib et a., 2017). The clinician needs to teach the patient about those adverse effects and any other abnormalities that affect the patient during the treatment.
The use of hydrocortisone cream can be used in all populations, including children > 3 months old (Lexicomp, 2020). However, monitoring and dosage need to be observed for patient safety. The treatment should be graded from a low potency to a higher potency which can be divided into creams and lotions. The initiation of treatment should start with cream which a lotion which is the least potent, then to a less occlusive cream, and then ointments which is more occlusive and more potent (Woo, 2020). The clinician should also bear in mind the price range that the patient can pay for the medication and the time on which the medication should be used for the treatment of the condition.
The clinician needs to educate the patient to apply the amount prescribed as ordered by the clinician. It should also do not cover the area with an occlusive dressing, which can cause increased absorption of the medication, children should be supervised when medication is applied (Woo, 2020). The prescribing of a more or less potent should be done related to the seriousness of the skin condition. The patient should be aware of the risk of taking any other medication that may interact with this medication.
Eczema or atopic dermatitis is a chronic skin disorder that affects individuals of all ages. It often begins in infancy and affects approximately 10-15% of children. Eczema may subside in adolescence and may reoccur in adulthood. Eczema rashes have a different appearance depending on the age that is affected. In infants, they may appear as a red, vesicular rash on the face, scalp, trunk, and extremities. Meanwhile, eczema in adults may appear as scaly, dry, thick, and leathery on the flexure surfaces of hands, face, neck, and upper chest. Eczema also tends to be worse in cold and winter season (Woo & Robinson, 2020).
Rational Drug of Choice
Rational drug selection aims to decrease the severity of symptoms when an acute attack is present and then preventing further exacerbations. The rational drug of choice would be a low potency topical steroid such as 1% hydrocortisone cream. Creams are the least potent and contain the most water compared to ointments (Woo & Robinson, 2020). Low potency topical steroids such as 1% hydrocortisone are the safest agents for long-term use, on large surface areas, on the face, and on areas with thinner skin for children (Rathi & D′souza, 2012). Because of the safety and efficacy of all ages, low cost, and availability over the counter, 1% hydrocortisone would be the appropriate initial drug of choice.
Hydrocortisone cream contains anti-inflammatory properties. It works by suppressing the release of proinflammatory cytokines, inhibits the formation and release of endogenous mediators involved in the inflammatory process, and inhibits the migration of macrophages and leukocytes into the effected area. This then reverses the vascular dilatation and permeability, and development of edema, erythema, and pruritis at the effected site. Absorption of the drug depends on where on the body it is applied, body temperature, and hydration status. Infants and young children should be prescribed the lowest yet most effective topical steroid to prevent systemic effects from the drug. The recommended amount of topical steroids applied will differ among age and where anatomically it is applied. Adults will require a larger dose compared to infants. Topical steroids are pregnancy category C and should not be used extensively or long-term in these patients. Side effects of hydrocortisone cream include acne, dry, scaly skin, mild burning or tingling at site, and change in skin color. Topical steroids can also be rapidly absorbed into the bloodstream. Therefore, the patient should call her doctor if she experiences weight gain, thinning of hair, increased body hair, muscle weakness, fatigue, or irritability (Hydrocortisone, 2019). Some drug interactions with hydrocortisone include mifepristone, aspirin, ibuprofen, and Lasix. Hydrocortisone should not be used in premature infants, patients with PUD, GI perforation and in patients with active infections (Hydrocortisone Drug Interactions, 2020).
Monitoring for patients using 1% hydrocortisone will include the effectiveness of the treatment, presence of any side effects, or development of secondary infections (Woo & Robinson, 2020). If initial therapy of 1% hydrocortisone is ineffective, then a topical steroid with an intermediate or higher potency may be necessary. If that therapy remains ineffective, then the use of oral corticosteroids and immunomodulators may be necessary. The patient should be educated on how to use the prescribed drug, importance on adherence to drug regimen to decrease severity of symptoms, and report to healthcare provider if eczema symptoms do not resolve in a couple of weeks, signs and symptoms of systemic reaction to steroids or signs and symptoms of a secondary infection are emerging. Avoid getting hydrocortisone cream in your eyes or mouth. In addition to the use of the topical steroid, the patient can be educated on avoiding skin irritants, avoid scented lotions or perfumes, taking warm baths may help with skin hydration and apply topical steroid after bath (Woo & Robinson, 2020)
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