Skin disorder related to

chemical or physical contacts

Contact Dermatitis
Contact dermatitis is an inflammatory reaction of the
skin to chemical substances, natural or synthetic, that
evoke a hypersensitivity response or direct irritation.
Initial reaction occurs in an exposed region, most
commonly the face and neck, backs of the hands,
forearms, male genitalia, and lower legs.
Characteristically a sharp demarcation between
inflamed and normal skin that ranges from a faint,
transient erythema to massive bullae on an erythema
swollen base.
Itching is a constant symptoms.
Cause may be a primary irritant or a sensitizing agent.

Primary irritant is one that irritates any skin.

Sensitizing agent produces an irritation on those individuals
who have encountered the irritant or something chemically
related to it, have undergone an immunologic change, and
have become sensitized.

The most frequent offenders are plant (poison ivy, oak, or

sumac), animal (wool, feathers, and furs), and metal irritants
(nickel found in jewelry and the snaps o sleepers and denim).

In infants, contact dermatitis occurs on the convex surfaces of

the diaper area. Other agents that produce contact dermatitis
include vegetable irritants (oldeoresins, oils, and turpentine),
synthetic fabrics (e.g., shoe components, dyes cosmetics,
perfumes, and soaps (including bubble baths.
Nursing care Management
Nurses frequently detect evidence of contact dermatitis
during routine physical assessments. Skin
manifestations in specific areas suggest limited
contact, such as around the eyes (mascara), areas of
the body covered by clothing but not protected by
undergarments (wool), or areas of the body not
covered by clothing (ultraviolet [UV] injury).
Generalized involvement is more likely to be caused by
bubble bath, laundry soap, body soap or lotion. Often
nurses can determine the offending agent and counsel
families regarding management. If the lesions persist,
are extensive or show evidence of infection, medical
evaluation is indicated.
POISON IVY, OAK AND SUMAC
Contact with the dry or succulent portions of any of
three poisonous plants produces localized, streaked or
spotty oozing, and painful impetiginous lesions that
are often highly urticarial.
The offending substance in these plants is an oil,
urushiol, which is extremely potent. Sensitivity to
urushiol is not inborn but is developed after one or
two exposures and may change over a lifetime.

Urushiol take effect as soon as it touches the skin. It

penetrates through the epidermis as a mixture of
composed molecules called cathecols. This cathecols
bond skin proteins and initiates immune response
The full-blown reaction is evident after about 2 days
with redness, swelling, and itching at the site of
contact. Several days later, streaked or spotty blisters
oozing serum from damaged cells produced by the
characteristic impetiginous lesions
Nursing care management
The earlier the skin is cleansed, the greater the chance of removing
the urushiol before it attaches to the skin. When it is known that
the child has made contact with plant, the area is immediately
flushed (preferably within 15 minutes) with cold running water to
neutralize the urushiol not yet bonded to the skin.
Once the oil has been removed from the skin, the allergen has been
neutralized. The rash that result from poison ivy cannot be spread
to another child; only direct contact with oil can cause the
response. Harsh soap and scrubbing the exposed skin is
contraindicated because it removes protective skin oils and dilutes
the urushiol, allowing it to spread. All clothing that has come in
contact with the plant is removed with care and thoroughly
laundered in hot water and detergent. Every effort is made to
prevent the child from scratching the lesions. Although the
lesions do not spread by contact with the blister serum or from
scratching, they can become secondarily infected.
Drug reactions
Although drugs can adversely affect any organ of the body;
reactions to medications are seen more often in the skin than
in any other organ. The reaction may be a result of toxicity
related to drug concentration, individual intolerance to the
therapeutic dosage of the drug, or an allergic or idiosyncratic
response. The manifestations may be associated with side
effects or secondary effects of a drug, either of which are
unrelated to its primary pharmacologic actions.
Although any drug is capable of producing a easction in the
susceptible individual, some drugs have a tendency to
produce a particular reaction consistently (e.g., hives after a
dose of antibiotics in an individual with sensitivity), and
others are more likely to produce an untoward effect (e.g.,
nausea, vomiting, and diarrhea).
Manifestations of drug reactions may be delayed or immediate.
A period of 7 days is usually required for a child to develop
sensitivity to a drug that has never been administered
previously. With poor sensitivity the manifestation appears
immediately.
Rashes that are exanthematous , urticarial, or eczematoid are
the most common manifestation of adverse drug reactions in
children. However, individual drug reactions may vary from a
single lesion to extensive, generalized epidermal necrosis
such as that seen in Steven’s Johnson syndrome.

Another common adverse medication response in children is a

fixed eruption. The lesion, a purplish red round or oval plaque
with a sharp border seen most frequently on the extremities,
disappears slowly, and the pigmentation deepens with each
episode.
Nursing care management
The most effective means of management is prevention,
documentation, and assessment. Frequent offenders
in drugs reactions are penicillin and sulfonamides
and nurses must be alert to this posibility.

Parents always remembers details of their child’s severe

reaction. As the nurse takes a careful medical history,
details of a previous drug reaction should include the
name and dose of the drug, nature of the reaction, and
how soon after administration the reaction occurred,
this information should be noted in the medical
record.
A careful nursing assessment (observation, inspection, and
palpation) of the skin is paramount for any child receiving
medication, especially intravenously. Noting the child’s
behavior and frequency of scratching is also critical.

Nurses who identify a new rash after medication to

administered or suspect a medication sensitivity in a
patient whose rash is enlarging, increasingly itchy, or
widespread on the child’s body, should withhold any
further dose and report the eruptions to the practitioner.

Persons who have severe reactions should wear a medical

identification bracelet or necklace in case of emergency or
inadvertent administration of the offending agent.
Foreign bodies
Small wooden glass, or metal splinters and thorns
from plants can usually be safely removed with a
pointed needle and tweezers that have been sterilized
with either alcohol or flame.
The area around the silver is washed thoroughly with
the soap and water before removal is attempted, and
the child should be cooperative and clam before
removal is attempted.
The silver is exposed with the needle and then grasped
firmly by the tweezers and pulled out. Some foreign
bodies, such as a fishhook, pieces of glass, a difficult to
see object, or a deeply embedded object (e.g., a needle
in a front or near a joint), require medical evaluation.
Small cactus or prickles or spines are troublesome to
remove, and attempts may be distressing to the child
and family. Large spines or clumps can be removed
with tweezers. Small prickles or spines may be
removed by the following methods.
Apply a thin layer of water-soluble household glue and
cover it with gauze; when the glue dries, peel off the
gauze.
Apply hair removal was or body sugar, let it dry, and
remove.
Place cellophane tape, sticky side down, over the
spines and lift it off.