Discharge Instructions - Dermatitis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with dermatitis.  Dermatitis is a type of skin rash that can happen after your skin touches something that irritates it or something you are allergic to.

Things that irritate the skin can be found in products you use every day, such as soaps or cleansers.  

Some of the things that can cause skin allergies include:

    -Certain medicines, perfumes, or cosmetics

    -The metal in some kinds of jewelry

    -Plants, such as poison ivy and poison oak

Sometimes you can develop a rash the first time you touch something.  But it is also possible to get a rash from something you have used before without any problems.

If you have a rash, your skin might be red, dry, itchy, or cracked.  If your rash is caused by an allergy, you might also have some swelling or blisters where you have the rash.

Severe symptoms include:

    -Pain

    -Widespread swelling

    -Blisters, oozing, or crusting of the skin

When you have dermatitis, you should:

    -Avoid using or touching whatever might have caused your rash

    -Protect your skin from anything that might irritate it or cause an allergy (wear gloves).

    -Try using soothing skin products to help with the itching and discomfort.

Things that might help with rash include:

    -Unscented, thick moisturizing cream or petroleum jelly

    -A special kind of bath called an oatmeal bath

In the Emergency Department you may have been prescribed:

-Steroid creams and ointments – These are not the same as the steroids some athletes take illegally.They go on the skin, and they relieve itching and redness.

-Steroid pills – You might need to take these for a short time if your rash is severe.  But your doctor or nurse will want to take you off steroid pills as soon as possible.  Even though these medicines help, they can also cause problems of their own.

-Wet or damp dressings – These can be helpful for skin that is crusting or oozing.  To use a wet or damp dressing, you will need to wear 2 layers of clothing.  First, you put on a layer of damp cotton clothes over your rash.  Then, you put on a layer of dry clothes on top of the damp ones.  People who need these dressings often wear them at night when they sleep.

Return to the Emergency Department if you develop a fever (≥38.0 °C or 100.4 °F), your rash worsens, or you develop any other new or concerning symptoms.

Discharge Instructions - Poison Ivy Dermatitis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with a contact dermatitis from exposure to poison ivy or poison sumac.  Poison ivy is a plant that can cause an itchy, red skin rash.  When people have this rash, they often say, "I got poison ivy."

The same substance that causes the poison ivy rash is also found in poison oak, poison sumac, the ginkgo fruit, and mango peels.

You might have gotten poison ivy if you:

  -Touched a poison ivy plant

  -Touched something that had the plant's oils on it (such as clothing, animal fur, or garden tools)

  -Were nearby when poison ivy plants were being burned

Poison ivy and poison oak have 3 leaves coming off a single stem.  That's why there is a saying, "leaves of 3, let them be."  The leaves start out green, but they can turn red or brown.  Even dead plants can cause the rash.

Your rash should go away within 1 to 3 weeks, but it might form blisters before it does.  Blisters are little bubbles of skin that are filled with fluid.  They can show up in different places at different times.  But that does not mean that the rash is spreading.  Touching the blisters or the fluid inside the blisters will not spread the rash.

You can:

  -Avoid scratching (that makes the itch worse)

  -Try putting a cold, wet cloth or paper towels on your rash

  -Use calamine lotion

  -If your blisters have started to pop, use skin products that have Aluminum Acetate in them (examples include Burrow's solution and Domeboro)

The products listed below sometimes cause a reaction that makes your skin more itchy or irritated:

  -Antihistamine creams or lotions

  -Numbing products that have Benzocaine

  -Antibiotic ointments that have Neomycin or Bacitracin in them

Return to the Emergency Department if you develop a fever (≥38.0 °C or 100.4 °F), your rash worsens, or you develop any other new or concerning symptoms.

MDM - Scabies

[##]-year-old [male/female] with [rash] with history and exam consistent with likely scabies.

Initial considerations in this patient included scabies, bed bug bites, impetigo, cellulitis, lice, fleas, drug rash, dermatitis herpetiformis, and contact dermatitis among others.

Patient presented with [generalized eruption/rash to the LOCATION] with associated linear burrows suggestive of scabies.  Patient [reports/denies] household contacts with similar symptoms.  Patient reports pruritis [that is worse at night].  Patient denies visualized bed bugs in the [home/barracks/hotel] making this diagnosis less likely.  Patient denies fever or other systemic infectious symptoms.  Discussed the importance of washing all linens and clothes in hot water or sealing all bulky items and keeping them sealed for 2 weeks.

We discussed discharge with [topical/oral] scabicidal agent for [patient/patient and all household members].  We discussed return precautions for evidence of worsening infection and recommended follow up with primary care doctor within one week and the patient demonstrated understanding and agreement with this plan.

MDM - Poison Ivy Dermatitis

[##]-year-old [male/female] with [rash] with history and exam consistent with likely contact dermatitis from poison ivy or sumac.

Initial considerations in this patient included contact dermatitis from poison ivy or sumac, shingles, bullous pemphigoid, contact dermatitis from other irritants, disseminated gonoccal disease, and other infectious and non-infectious etiologies of rash among others. 

Patient presented with an erythematous, pruritic rash with associated blisters and a recent history of exposure to likely poison ivy or sumac from [describe activity] consistent with contact dermatitis.  No evidence of fever, systemic infectious symptoms, or other evidence suggestive of significant infectious rash.   

We discussed symptomatic treatment with cool, wet compresses, oatmeal baths, topical calamine lotion, and oral antihistamine.  We discussed discharge with steroid taper over 15 days to avoid rebound dermatitis, and the patient demonstrated understanding and agreement with this plan.  We discussed return precautions and recommended follow up with primary care doctor within one week.