Irritant Contact Dermatitis 接觸性皮膚炎

Treament Goal

To remove the offending

01 agent and to prevent future
exposure to the irritant
To relieve the inflammation,
02 dermal tenderness and
irritation
To educate patient on self-
03 management to prevent or
treat recurrences
Nonpharmacologic Therapy
1. Wash the exposed area with copius amount
of tepid water

2. Cleanse with a mild hypoallergenic soap

Pharmacologic Therapy
• Application of emollient to the affected area
to restore the moisture
• Colloidal oatmeal baths – relieve itching
• Corticosteroid –reduce inflammation and
relieve itching
Avoid to use
• Topical-caine type-Lidocaine
• Propylene glycol 丙二醇
• lactic acid
• urea
• salicylic acid
Preventive measures
• Protective clothing, gloves, equipment

• Frequent changes in coverings

• Emollient, moisturizers, barrier cream-assist in

repairing the epidermis
 Allergic Contact Dermatitis
Treament Goal

to prevent future Relieve

01 exposure to the
irritant
accumulation
04
of debris from
oozing ,crusting,
To relieve the and scaling of
02 inflammation vesicle fluids

To relieve Prevent
itching , 05
03 prevent
secondary
skin infections
excessive
scratching
以下病人直接尋求治療
• 小於2歲的病人
• Eye, eyelids, mouth, genitals involvement
• Over 20% of skin surface
• Signs and symptoms of infection~ >37.8⁰C
• Tenderness(接觸會疼痛) on rash or pus膿
• Numerous large bullae 大水泡
• Rash has not improved within 1-2 weeks
Nonpharmacologic Therapy
• Preventive measures
• Learn the physical characteristics and usual
habitat of Toxicodendron plant
• Cover nose and mouth with a mask and wear
a protective clothing when eradicating the
plants near your residence
Pharmacological Therapy
Itching
• Topical creams, ointment containing
anesthetics, anti-histamine, antibiotics
should not be used
• Sensitizer
• Nightime sedation because of itching-first
generation of antihistamines can be used
• Itching is not alleviated- referred to PCP
Pharmacological Therapy
Weeping
• Astringent-vasoconstriction and reduce blood
flow in the inflamed tissue
• Aluminium acetate solution USP and
Burrow’s solution
( Burow’s solution-softening and removing crust
Mild antipruritic effect)
• Isotonic saline solution
Pharmacological Therapy
Inflammation
• Hydrocortisone (0.5%,1%)
• Mild to moderate ACD-no edema ,extensive
area of skin

(*Urushiol漆酚 ACD may require prescription

corticosteroid)
Scaly dermatoses

i. Dandruff 頭皮屑

ii. Seborrheic Dermatitis

脂漏性皮炎

iii.Psoiasis 乾鮮
Dandruff
Treatment Goal
• Reduce epidermal turnover rate of scalp skin
by reducing the level of Malassezia species
• Minimize the cosmetic embarrassment of
visible scaling
• Minimize itching
General Treatment Approach
• Routine shampooing
• Shampoo containing sodium lauryl sulfate/
sodium lauryl sulfate should be avoided
• Cytostatic agent – pyrithione zinc, selenium
sulfide –recommended initially
• Nonprescription ketoconazole shampoo-anti
fungal shampoo
• Shampoo containing coal tar-second line therapy
• A kerolytic shampoo-containing salicylic acid
/sulfur
Scalp scrubber
Seborrheic dermatitis 脂漏性皮炎
Treatment Goal
• Reduce inflammation
• Reduce epidermal turnover rate of scalp skin
by reducing the level of Malassezia species
• Minimize /eliminate the visible erythema紅斑
and scaling
• Minimize itching
General Treatment Approach
• First line treatment: Antifungal agents
• Medicated shampoos such as pyrithione zinc and
selenium sulfide
• Hydrocortisone ointment- relieve the
inflammation

Infants:
• Use baby oil to massage gently on scalp, followed
by non-medicated shampoo,
• The patient should referred to pediatrician
Psoriasis 皮蘚
Treatment Goals
• To control /eliminate the signs and symptoms(
inflammation,scaling, itching)
• To minimize/ prevent flare-up
General Treatment Approach
• Mild psoriasis
• Self treated : topical agents-hydrocortisone
ointment 1% and emollient
• Bathe with lubricating bath products using
tepid water
• Daily lubrication of skin after a bath
General treatment Approach
• Bathe with lubricating bath products using tepid
water
• Daily lubrication of skin after a bath
立刻找醫生的情況：
• Area>5% involvement of face
• Joint point
• Nonresponding to emollient and nonprescription
hydrocortisone
• Children younger than 2 years
治療Scaly Dermatoses的非處方藥
• Cytostatic Agents
• Antifungal agents
• Keratolytic Agents
• Salicylic acid
• Sulfur
• Topical Hydrocortisone
 Cytostatic Agents
Pyrithione Zinc Selenium Sulfide Coal Tar
效果 anti-Malassezia anti-Malassezia phototoxicity
activity activity

劑量 FDA 建議劑量： 1%shampoo 0.5-5% creams,

0.3-2.0%-dandruff 2.5% lotion – lotions, paste,
0.95-2.0%-seborrheic resistant cases bath oils,
dermatitis shampoo.
1%/2%-shampoo soaps. gels

Adverse Discoloration of light, Stain to skin ,

effect dyed hair Photosensitization,
Iritant contact
dermatitis
 Antifungal agents*
Ketoconazole

Dose: Ketoconazole 1% use twice a week for 4

weeks
Adverse effect：Hair loss , skin irritation,
abnormal hair texture ,dry skin
Keratolytic agents 去角質劑*
• Treat dandruff and serrboheic dermatitis
• Loose and lyse keratin aggregates
Salicylic acid*
• Increased hydration of keratin
• Useful for psoriasis
• 1.8%-3% to self-treat
Sulfur *
• Cause increased of sloughing of cells and
reduce corneocyte counts
• 2%-5% self treat dandruff
• Always combine with salicylic acid
• No significant adverse effect
Topical hydrocortisone*
• Concentration: 0.5%-1%
• Treat allergic contact dermatitis,insect
bites,eczema,psoriasis,soborrheic dermatitis
,mild psoriasis
• Adverse effect: local atrophy ,systemic
sequelae
Atopic dermatitis異位性皮膚炎
• Hydrocortisone relieve itching and
inflammation
• Cream often preferred
• Ointment – on area of thick skin
• Ointment should be avoided if AD lesions is
weeping
• All hydrocortisone drugs should be avoided if
the skin is open, infected, or cracked
Treatment Goals
• STOP the itch-scratch cycle
• Maintain skin hydration and barrier function
• Minimize the factor that trigger the disorder
• To prevent secondary infection
Non pharmacological treatment
• Use cotton sheets, laundering them in gentle
detergents, using two rinse cycle
• Laudering new clothes with gentle detergents
• Avoid liquid softener
• Bathing-- hydration and remove bacteria
• Moisturizers
• Mild non-soap cleansers
• Food allergies-egg,milk peanut
• Humidifier
• Fingernails short ,clean
• Emollient
Moderate to severe AD
• diluted bleach bath
• intranasal mupirocin
• Wet wraps濕敷療法 – increases skin
hydration
• Oral histamines help with sleep
• Probiotics in infants
• Phototherapy is benefit
Refractory Atopical dermatitis
Topical calcineurin inhibitor
• Tacrolimus
• Pimecrolimus
Systemic immunomodulatory
• cyclosporine
• Azathioprine
• methotrexate

*處方藥物為主
DRY SKIN 皮膚乾燥
Product containing humectant to enhance
hydration
• Glycerin, urea, lactic acid
• Alpha hydroxyl acids and lipid moisturizers
such as phospholipids and ceramides

*responds minimally to corticosteroid therapy

Nonpharmacologic treatment
• Emollients
• Modification bathing habits
• Bath oils，emollient，moisturizers，
humectant，keratolytic agents
Pharmacologic treatment
• Humectants
• Emollient
• Moisturizers-alpha hyroxyl acids, phospholipid,
ceramides
• Minimal use of hydrocortisone
 藥物總表
DRUG ICD ACD Dandruff Seborrhatic Psoriasis Atopic Dry
Dermatitis dermatitis skin
emollient
v v v v
Colloidal
oatmeal v v
Hydrocortisone
v v v v v v
Astringent
v
Calamine
v
Antihistamine
v v
Al acetate
v
DRUG ICD ACD Dandruf Seborrhati Psoriasis Atopic Dry
f c dermatitis skin
Dermatitis
Cytostatic
agent v
Ketaconazole
V V
Coal tar
V
Kerolytic X
V V
Humectant
V
Moisturizers
V V
 Ketoconazole 2% w/w
• 適應症：減少因黴菌所引起之頭
皮屑治療之輔助劑
• 用法：搓揉按摩3-5分鐘，以清水
清洗
• 注意事項：
• 長期使用類固醇治療患者，馬上
改用此洗髮精可能會有刺激現象。
• 成分過敏者，不宜食用
• 只限外用
 Selsun Suspension
成分：selenium sulfide 25mg/ml
適應症：脂溢性皮炎，汗斑,頭皮屑

使用方法：先將頭髮弄濕，搓揉產
生泡沫，讓藥品停留在皮膚上3mins，
之後用清水清洗，反复沖洗確保清
洗乾淨。

一個星期裡使用兩次，長期使用必
須要資訊醫師。

注意事項：只限外用
 允消優膚乳膏
• 成分：Urea 100mg
• 適應症：去角質
• 作用：皮膚保濕劑，角質軟化劑，能有效
的促進乾裂粗糙之皮膚柔嫩潤滑。
• 用法：1-2次/天，取出適量塗抹患部
• 副作用：部分患者偶有局部灼熱、疼痛感、
潮紅及瘙癢現象