Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Corticosteroids
Class Summary
Corticosteroids help lesion resolution and provide symptomatic relief of pruritus. The strength and administration of a topical corticosteroid should be chosen based on the extent, location, and morphology of the eruption. Systemic corticosteroids may be used for severe or refractory eruptions.
Amcinonide (Cyclocort)
Amcinonide suppresses mitotic activity and causes vasoconstriction. It stimulates the synthesis of enzymes needed to decrease inflammation.
Fluocinonide (Fluonex, Lidex)
Fluocinonide is a high-potency steroid that inhibits cell proliferation. It is immunosuppressive, antiproliferative, and anti-inflammatory. It also has antipruritic and vasoconstrictive properties.
Prednisone (Orasone, Sterapred, Deltasone)
Prednisone is a commonly used oral agent. It is indicated for severe, prolonged, or anaphylactic reactions. It decreases late immune-mediated complications. Prednisone must be metabolized to the active metabolite prednisolone for effect. Conversion may be impaired in liver disease.
Methylprednisolone (Depo-Medrol, Medrol, Adlone, Solu-Medrol)
Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. It is indicated for severe, prolonged, or anaphylactic reactions. It decreases late immune-mediated complications.
Antihistamines
Class Summary
These agents relieve pruritus. They may control itching by the blocking effects of endogenously released histamine.
Diphenhydramine (Benadryl, Benylin, Caladryl, Dermapax)
Diphenhydramine is a first-generation antihistamine with anticholinergic effects that binds to H1 receptors in the CNS and the body.
It competitively blocks histamine from binding to H1 receptors. It has significant antimuscarinic activity and penetrates the CNS, which causes a 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.
It is for symptomatic relief of symptoms caused by the release of histamine in allergic reactions.
Loratadine (Claritin, Alavert)
Loratadine selectively inhibits peripheral histamine H1 receptors. It is tolerated well, with a rate of sedation not significantly different from placebo.
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Id reaction (autoeczematization). Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/dermatitis/a-ecz2.jpg).
