Contact Dermatitis Nursing Care Plan & Management
Definition
- Contact dermatitis is an inflammatory reaction of the skin to physical, chemical, or biologic agents.
- It may be of the primary irritant type, or it may be allergic.
- The epidermis is damaged by repeated physical and chemical irritation.
- Common causes of irritant dermatitis are soaps, detergents, scouring compounds, and industrial chemicals.
- Predisposing factors include extremes of heat and cold, frequent use of soap and water, and a preexisting skin disease.
Other types of dermatitis
- Contact dermatitis is caused by an allergen or an irritating substance. Irritant contact dermatitis accounts for 80% of all cases of contact dermatitis.
- Atopic dermatitis is very common worldwide and increasing in prevalence. It affects males and females equally and accounts for 10%–20% of all referrals to dermatologists. Individuals who live in urban areas with low humidity are more prone to develop this type of dermatitis.
- Dermatitis herpetiformis appears as a result of a gastrointestinal condition, known as celiac disease.
- Seborrheic dermatitis is more common in infants and in individuals between 30 and 70 years old. It appears to affect primarily men and it occurs in 85% of people suffering from AIDS.
- Nummular dermatitis is a less common type of dermatitis, with no known cause and which tends to appear more frequently in middle-age people.
- Stasis dermatitis is an inflammation on the lower legs which is caused by buildups of blood and fluid and it is more likely to occur in people with varicose.
- Perioral dermatitis is somewhat similar to rosacea; it appears more often in women between 20 and 60 years old.
- Infective dermatitis is dermatitis secondary to a skin infection
Clinical Manifestations
- Eruptions when the causative agent contacts the skin.
- Itching, burning, and erythema are followed by edema, papules, vesicles, and oozing or weeping as first reactions.
- In the subacute phase, the vesicular changes are less marked and alternate with crusting, drying, fissuring, and peeling.
- If repeated reactions occur or the patient continually scratches the skin, lichenification and pigmentation occur; secondary bacterial invasion may follow.
Medical Management
- Soothe and heal the involved skin and protect it from further damage.
- Determine the distribution pattern of the reaction to differentiate between allergic type and irritant type.
- Identify and remove the offending irritant; soap is generally not used on site until healed.
- Use bland, unmedicated lotions for small patches of erythema; apply cool wet dressings over small areas of vesicular dermatitis; a corticosteroid ointment may be used.
- Medicated baths at room temperature are prescribed for larger areas of dermatitis.
- In severe, widespread conditions, a short course of systemic steroids may be prescribed.
Nursing Management
Instruct patient to adhere to the following instructions for at least 4 months, until the skin appears completely healed:
- Find out the cause of the problem.
- Avoid contact with the irritants, or wash skin thoroughly immediately after exposure to the irritants.
- Avoid heat, soap, and rubbing the skin.
- Choose bath soaps, detergents, and cosmetics that do not contain fragrance; avoid using a fabric softener dryer sheet.
- Avoid topical medications, lotions, or ointments, except when prescribed.
- Make sure gloves are cotton-lined; do not wear for more than 15 to 20 minutes at a time.
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Exam
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Nursing Care Plan
Nursing Diagnosis
Impaired Skin Integrity
Common Related Factors
- Contact with irritants or allergens
Defining Characteristics
- Inflammation
- Dry, flaky skin
- Erosions, excoriations, fissures
- Pruritus, pain, blisters
Expected Outcomes
- Patient maintains optimal skin integrity within limits of the disease, as evidenced by intact skin.
