Rarely in severe cases, one may require immunosuppressive agents like mycophenolate.
ACDSEE 20 REVIEW PLUS
Some patients may benefit from phototherapy using UV A plus psoralen. The use of moisturizers is a recommended adjunct.įor severe cases, topical immunomodulators like tacrolimus may be beneficial. Symptomatic management includes oral antihistamines, topical hydrocortisone, and cool water soaks. Vesicles should not be ruptured as there is a risk of infection. Upon identification of the allergen, strict avoidance is necessary to prevent a recurrence.
ACDSEE 20 REVIEW SKIN
If ACD involves a delicate area such as skin folds or eyelids, topical calcineurin inhibitors or PDE4 inhibitors may also be effective. First-line medical therapy includes topical steroids when ACD is confined to less than 20% of the body, and oral corticosteroids when greater than 20% of the body is involved. The only definitive treatment of ACD is the identification and removal of the offending agent, and all patients with suspected or confirmed ACD should be advised of this.
This proliferation, in turn, creates a localized inflammatory response. The Langerhans cells containing the antigen interacts with the antigen-specific T-lymphocytes for that antigen, which triggers a cytokine-induced proliferation process. The elicitation phase is what occurs after reexposure to the antigen takes place. This process collectively is known as the sensitization phase of allergic contact dermatitis. These lymphocytes may then travel through the blood and into the epidermis.
Due to the process of clonal expansion as well as cytokine-induced proliferation, antigen-specific T lymphocytes get created. The antigens taken up by these cells come in contact with the adjacent T-lymphocytes. Langerhans cells then migrate towards regional lymph nodes. The antigens subsequently undergo processing by these cells and get displayed on their surface. This allergen penetrates that stratum corneum of the skin and is taken up by Langerhans cells. The pathophysiology of allergic contact dermatitis starts with the contact of the allergen to the skin.
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