Page 213 - ATP-P 11th Ed

CONTACT DERMATITIS PROTOCOL

SPECIAL CONSIDERATIONS
1. Insect bite(s) as a differential diagnosis – also accompanied by itching, but with
discrete red papular lesions(s).
2. Cellulitis as a differential diagnosis – bright red, painful, nonpruritic, and typi-
cally becomes steadily worse without antibiotics.
3. Fungal infection as a differential diagnosis – not always pruritic; infection site(s)
slowly enlarge without therapy. SECTION 2
4. Effects are particularly dangerous if contact in or around the eyes.

Signs and Symptoms
1. Acute onset
2. Skin erythema
3. Intense itching (pruritis)
4. Edema, papules, vesicles, bullae, discharge, and/or crusting may be visible.
Management
1. Change clothes when possible and bag original clothes until they can be machine
washed.
2. Wash area with mild soap and water.
3. Apply cold wet compress to affected area to help decrease itching.
4. If available, apply 1% hydrocortisone cream to the affected area and cover with a
dry dressing to help prevent spread to other parts of the body or clothing.
5. In severe cases, dexamethasone (Decadron ) 10mg IM/PO daily for 5 days.
®
a. If Poison Ivy, or other Plant-Associated Dermatitis is Suspected, Taper Dose
over 14 days (10mg for 5 days, 8mg for 2 days, etc.)
6. Give diphenhydramine (Benadryl ) 25–50mg PO q6hr prn itching, if tactically
®
feasible. (Sedation may occur.)
Disposition
1. Evacuation not needed for mild cases.
2. Priority evacuation for severe symptoms: intraoral, eye involvement, or >50%
body surface area (BSA) involvement.
3. Monitor for secondary infection; treat per Cellulitis/Cutaneous Abscess Proto-
col if suspected on the basis of increasing pain, redness, or purulent crusting.

202 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 203