Internal Medicine

0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54

398 Constrictive Pericarditis Contact Dermatitis

follow-up

■serial clinical evaluation of neck veins

■serial echos to follow hemodynamics

complications and prognosis

Prognosis

■untreated, generally carries a high mortality rate of 5–25%/year

Contact Dermatitis...................................

J. MARK JACKSON, MD

history & physical

■History – pruritic eruption, patient may consider contact as a possi-

bility

■Physical usually dermatitis in site of exposure, occasionally beyond

➣Linear lesions are common in acute contact dermatitis – e.g.,

Rhus dermatitis

➣Follows pattern of contactant – e.g., nickel allergy under jewelry

For eyelid dermatitis, consider agents touched by hands that may the

affect the eyes (even if hands are clear).

tests

■Patch tests by experienced physician

■ROAT (repeat open application test) on normal uninvolved site – e.g.,

antecubital fossa

differential diagnosis

■Same as above plus irritant dermatitis, r/o with patch testing

management

What to Do First?

■Identify causative agent and eliminate

■Treat involved skin same as atopic dermatitis

specific therapy

■Specific Therapy, Follow-up, and Treatment

■Acute contact dermatitis – 10 to 16-day course of oral prednisone

■Chronic contact dermatitis eliminate cause, topical corticosteroids

or other agents, oral antihistamines, systemic therapy similar to

atopic dermatitis