eMedicine Specialties > Dermatology > Allergy & Immunology
Id Reaction (Autoeczematization): Treatment & Medication
Updated: Feb 25, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
The goal is to adequately treat the underlying infection or dermatitis, which should lead to prompt resolution of the id reaction. Recurrences are common, especially if the primary source is not treated adequately.
- Treatment of eruption
- Systemic or topical corticosteroids
- Wet compresses
- Systemic or topical antihistamines
Consultations
If a severe underlying infection is present, consult an infectious disease specialist or internist.
Medication
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Corticosteroids
Help lesion resolution and provide symptomatic relief of pruritus. The strength and administration of a topical corticosteroid should be chosen based upon the extent, location, and morphology of the eruption. Systemic corticosteroids may be used for severe or refractory eruptions.
Amcinonide (Cyclocort)
Suppresses mitotic activity and causes vasoconstriction. Stimulates synthesis of enzymes needed to decrease inflammation.
Adult
Apply sparingly bid/qid as severity warrants
Pediatric
Administer as in adults; exercise caution in patients <2 y who have a relatively larger body surface area-to-weight ratio
None reported
Documented hypersensitivity; herpes simplex virus infection; fungal, viral, or tubercular skin lesions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause adverse systemic effects if used over large areas, on denuded skin, under occlusive dressings, or for prolonged treatment periods; systemic absorption may cause Cushing syndrome, reversible HPA axis suppression, and other systemic adverse effects (see below); do not use potent corticosteroids in areas of decreased skin circulation; use weaker-strength topical steroids for facial or intertriginous regions; local adverse reactions include skin atrophy, folliculitis, steroid acne, telangiectasias, and striae; topical steroids have been associated with secondary allergic contact dermatitis
Fluocinonide (Fluonex, Lidex)
High-potency steroid that inhibits cell proliferation. Is immunosuppressive, antiproliferative, and anti-inflammatory. Also has antipruritic and vasoconstrictive properties.
Adult
Apply sparingly bid/qid based on severity
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; herpes simplex infection; fungal, viral, or tubercular skin lesions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause adverse systemic effects if used over large areas, denuded areas, on occlusive dressings, or during prolonged treatment periods
Prednisone (Orasone, Sterapred, Deltasone)
Commonly used oral agent. Indicated for severe, prolonged, or anaphylactic reactions. Decrease late immune-mediated complications. Must be metabolized to the active metabolite prednisolone for effect. Conversion may be impaired in liver disease.
Adult
40-60 mg/d PO divided 1-2 doses/d
Pediatric
0.5-2 mg/kg/d PO divided 1-4 doses/d
Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective-tissue infections, and fungal or tubercular skin infections; GI bleeding or ulceration
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
Methylprednisolone (Depo-Medrol, Medrol, Adlone, Solu-Medrol)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Indicated for severe, prolonged, or anaphylactic reactions. Decrease late immune-mediated complications.
Adult
4-48 mg/d PO
Acetate/Depo-Medrol: 40-120 mg IM single dose
Pediatric
0.16-0.8 mg/kg/d PO divided bid/qid
Sodium succinate/Solu-Medrol: 0.5-2 mg/kg per dose IV/IM repeated at intervals depending on clinical response
Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking medication concurrently with diuretics; grapefruit juice increases concentrations; methylprednisolone and cyclosporine mutually inhibit one another, resulting in increased plasma levels of each drug
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use
Depo-Medrol contains benzyl alcohol, which is potentially toxic when administered locally to neural tissue; administration of Depo-Medrol by other than indicated routes, including the epidural route, has been associated with reports of serious medical events including arachnoiditis, meningitis, paraparesis/paraplegia, sensory disturbances, bowel/bladder dysfunction, seizures, visual impairment including blindness, ocular and periocular inflammation, and residue or slough at injection site
Antihistamines
These agents relieve pruritus. May control itching by blocking effects of endogenously released histamine.
Diphenhydramine (Benadryl, Benylin, Caladryl, Dermapax)
First-generation antihistamine with anticholinergic effects that binds to H1 receptors in the CNS and the body.
Competitively blocks histamine from binding to H1 receptors. Has significant antimuscarinic activity and penetrates CNS, which causes pronounced tendency to induce sedation. Approximately half of those treated with conventional doses experience some degree of somnolence. A small percentage of children paradoxically respond to diphenhydramine with agitation.
For symptomatic relief of symptoms caused by release of histamine in allergic reactions.
Adult
25-50 mg PO q6-8h prn; may administer as single 25- 50-mg qhs dose if somnolence exists; not to exceed 400 mg/d
10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d
Topical: Apply to affected area tid/qid
Pediatric
>10 lb: 12.5-25 mg PO tid/qid or 5 mg/kg/d or 150 mg/m2/d divided tid/qid; not to exceed 300 mg/d
5 mg/kg/d IV/IM or 150 mg/m2/d divided qid; not to exceed 300 mg/d
Topical: Administer as in adults
Potentiates effect of CNS depressants; due to alcohol content, do not give syrup dosage form to patient taking medications that can cause disulfiramlike reactions
Documented hypersensitivity; MAOIs
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction; xerostomia may occur
Loratadine (Claritin, Alavert)
Selectively inhibits peripheral histamine H1 receptors. Tolerated well, with rate of sedation not significantly different from placebo.
Adult
10 mg/d PO on empty stomach
Pediatric
<6 years: Not established
>6 years: Administer as in adults
Ketoconazole, erythromycin, procarbazine, and alcohol may increase levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Initiate therapy at lower dose in liver impairment
More on Id Reaction (Autoeczematization) |
| Overview: Id Reaction (Autoeczematization) |
| Differential Diagnoses & Workup: Id Reaction (Autoeczematization) |
 Treatment & Medication: Id Reaction (Autoeczematization) |
| Follow-up: Id Reaction (Autoeczematization) |
| References |
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References
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Further Reading
Keywords
Id reaction, autoeczematization, autosensitization, pruritic rash, dermatophytids, dermatophytid reactions, dermatophyte infections, stasis dermatitis
