At the first sign of contact dermatitis, clean the skin area immediately. Patch
testing may be needed to determine the causative factor. Apply wet dressings
containing Burow’s solution (aluminum acetate), lotions such as calamine that
contain zinc oxide, calcium hydroxide solution, and glycerin. Calamine lotion
may contain the antihistamine diphenhydramine and is used primarily for plant
irritations. If itching persists, antipruritics (topical or systemic diphenhydramine
[Benadryl]) may be used. Topical antipruritics should not be applied to open
wounds or near the eyes or genital area.
Other medications used as antipruritics are:- Systemic drugs such as cyproheptadine hydrochloride (Periactin) and
trimeprazine tartrate (Temaril). - Antipruritic baths of oatmeal such as Alpha-Keri.
- Solutions of potassium permanganate, aluminum subacetate, or normal
saline. - Glucocorticoid ointments, creams, or gels.
Topical glucocorticoids can aid in alleviating dermatitis (see Table 20-2).
These include dexamethasone (Decadron) cream, hydrocortisone ointment or
cream, methylprednisolone acetate (Medrol) ointment, triamcinolone acetonide
(Aristocort), and flurandrenolide (Cordran).
Topical glucocorticoids are systemically absorbed into the circulation depend-
ing on whether it is a cream or lotion, drug concentration, drug composition, and
skin area to which the glucocorticoid is applied.
Absorption is greater at the face, scalp, eyelids, neck, axilla, and genitalia
with prolonged use of the topical drug and if the drug is continuously covered
with a dressing. Prolonged use of topical glucocorticoids can cause thinning of
the skin with atrophy of the epidermis and dermis, and purpura from small-
vessel eruptions.ALOPECIA (MALE PATTERN BALDNESS)
Alopecia occurs when the hair shaft is lost and the hair follicle cannot regenerate.
This results in permanent hair loss. Alopecia is associated with a familial history
and the aging process. Some patients experience alopecia earlier than others.
Some medications can cause temporary alopecia. These include anticancer
(antineoplastic) agents, gold salts, sulfonamides, anticonvulsants, aminoglyco-
sides, and nonsteroideal antiflammatory drugs (NSAIDs) such as indomethacin.(^378) CHAPTER 20 Skin Disorders