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Differential Diagnosis
- Allergic contact dermatitis
- Hogweed dermatitis
- Poison ivy-oak-sumac dermatitis
- Arthropod bites or stings
Diagnosis
This patient was diagnosed with allergic contact dermatitis due to exposure to poison ivy, poison oak, or poison sumac.
Learnings/What to Look for
- This is a hypersensitivity reaction to an oily resin found on the leaves and in the stems and roots of plants in the Rhus genus
- This dermatitis occurs in previously sensitized individuals, usually appearing 48 hours after antigen exposure
- Typically presents as erythematous, linear plaques with associated vesicles and bullae
- Pruritis is generally severe
Pearls for Urgent Care Management and Considerations for Transfer
- Treatment includes a course of oral prednisone, starting at 1 mg/kg/day (up to 80 mg), tapering over at least 14 days (or longer, for severe reactions)
- A 6-day tapering Dosepak should not be prescribed, as the reaction may rebound once the short course concludes
Acknowledgment: Images and presentation courtesy of VisualDx.
A 43-Year-Old Man with Pruritic, Scale Plaque and Vesicles on His Hands and Arms
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