Health Medical Homework Help

FIRST POST          

Based off the case scenario information provided, it is likely the 30-year-old woman’s rash is a result of allergic contact dermatitis, induced by contact with poison ivy. In contact dermatitis, one forms a rash caused by an immune reaction to an antigen that touches the skin. In this patient’s case the antigen is poison ivy. Contact dermatitis results because the antigens is recognized and induces a cell-mediated response. However, there will be no result in primary contact with the antigen because the antigens are sensitizing an immune response and are producing memory T cells, which explains why the patient never developed a reaction or rash when she was exposed to poison ivy the first time (McCance & Huether, 2019). When exposed to the antigen a second time, it activates a response and dermatitis due to a delayed hypersensitivity reaction. The allergic reaction to poison ivy may occur within 24 to 72 hours after exposure (John Hopkins Medicine, 2021). The contact with poison ivy causes itchy, red rashes, that blister, ooze, and crust over, just as the patient described (Adler & DeLeo, 2021). The rash also presents at the areas of direct skin contact, but they may spread, like presented in this case (John Hopkins Medicine, 2021). The rash may also take weeks to heal. Common causes of contact dermatitis are other allergens such as moisturizers, shampoos, or other personal care products, metals, topical medications, or plants as in this scenario. A risk factor for a poison ivy contact dermatitis reaction, in particular, would be those who participate in outdoor activities, such as hiking. One can avoid the condition by familiarizing themselves with plants that should be avoided and wearing clothing that covers such as pants, socks and gloves when outdoors. Since the oil from poison ivy can stay on clothing it is also important to always clean clothing and shoes after being outdoors, as well as washing skin immediately if one comes in contact (John Hopkins Medicine, 2021). For contact dermatitis, in general, one should stay away from the substances that cause them an allergic reaction and can seek treatment to alleviate symptoms due to the reaction.

     

SECOND POST        

Contact Dermatitis

In the patient’s data, there is no history of atopy or related symptoms. Therefore, the condition cannot be atopic dermatitis even though some of its symptoms are present in the information provided. Since it involves the scalp and the face, the condition cannot be seborrheic dermatitis, though some of the symptoms mentioned are like that of the disease. The APRN can rule out a fungal infection because the pace of the development of the rash is too high and is consistent with that of dermatitis. Scabies is also ruled out because the disease has not progressed to the intertriginous areas. Even though the symptoms point to several diseases, some features provide strong evidence for contact dermatitis.  One of them is a pattern of development of the condition in exposed areas of the body (Murphy, Atwater, & Mueller, 2020). The second one is a streaked appearance, while the final feature is recent exposure to a suspicious antigen known as poison ivy. Therefore, the possible condition is contact dermatitis.

The condition’s pathophysiology begins with skin contact with an allergen that penetrates the skin’s stratum corneum part. Upon reaching the stratum corneum, the allergen is taken up by the Langerhans cells, and when the cells process them, they get displayed on the cell’s surface (Murphy, Atwater, & Mueller, 2020). Subsequently, the cells migrate in the direction of the regional lymph nodes, and the antigens on the cells’ surface encounter the nearby T-lymphocytes (Murphy, Atwater, & Mueller, 2020). The process of clonal expansion occurs together with cell proliferation induced by cytokines, leading to the creation of antigen-specific T-lymphocytes, which travel through the blood and reach the epidermis (Murphy, Atwater, & Mueller, 2020). The process is referred to as the sensitization phase. “Contact dermatitis is type IV delayed hypersensitivity reaction, which requires prior exposure to the allergen” (Carle, 2021). When one is exposed again to the same antigen, the second cytokine-induced proliferation process creates a localized inflammatory response, resulting in an eruption.

The condition has several clinical manifestations. The most common ones are hives and oozing blisters, and the presence of dry, flaky, and scaly skin.  People with contact dermatitis also have skin that seems leathery or darkened (Murphy, Atwater, & Mueller, 2020). In some people, the skins appear red. A burning sensation can be felt on the skin in most cases, while almost everyone who contracts the disease experiences extreme itching. People with contact dermatitis are sensitive to the sun and may experience swelling, especially in the face, groin region, or eyes (Murphy, Atwater, & Mueller, 2020).  The above symptoms are for contact dermatitis that arises from an allergy. However, there is another form of the disease known as irritant contact dermatitis. Some of its clinical manifestations include extreme skin dryness, which leads to cracks, formation of blisters, tight or stiff skin, swelling, and ulcerations.  Some people may have open sores that lead to the formation of crusts.

Contact dermatitis is caused by skin contact with a substance to which one is sensitive. These substances are known as allergens, and they trigger an immune reaction that affects the skin. Some of the allergens include nickel, antibiotic creams, poison ivy, oral antihistamines, balsam of Peru, ragweed pollen, and spray insecticides. Diapers, wet wipes, and sunscreens can expose babies to contact dermatitis (Murphy, Atwater, & Mueller, 2020).  The main risk factor is jobs that expose people to allergens. Healthcare workers, metal workers, cosmetologists and hairdressers, gardeners, cleaners, cooks, auto mechanics, and construction workers are at a high risk of contracting the disease.