Approach to the critical patient
›First 5 minutes
›Escalation triggers
›Airway compromise
›Hypotension
›Rapidly progressive rash with systemic symptoms
›Immediate actions
›Cardiorespiratory monitoring
›IV access if unstable
Remove trigger and supportive skin care
›Trigger control and barrier repair
›Discontinue suspected product exposure
›Gentle cleanser fragrance free
›Emollient thick ointment or cream multiple times daily
Topical anti inflammatory therapy
›Topical corticosteroids
›Low potency
›Face and intertriginous areas
›Example hydrocortisone 1 percent to 2.5 percent topical thin layer 1 to 2 times daily up to 7 to 14 days
›Medium potency
›Trunk and extremities
›Example triamcinolone 0.1 percent topical thin layer 1 to 2 times daily up to 14 days
›High potency
›Thick plaques on palms or soles
›Avoid face groin axilla
›Topical calcineurin inhibitors
›Tacrolimus 0.1 percent topical to face or eyelids 1 to 2 times daily
›Pimecrolimus 1 percent topical to sensitive areas 1 to 2 times daily
›Anti itch strategies
›Non sedating antihistamine
›Cetirizine 10 mg PO daily
›Loratadine 10 mg PO daily
›Nighttime itch with sleep disruption
›Diphenhydramine 25 to 50 mg PO at bedtime
›Sedation and anticholinergic cautions
›Non pharmacologic
›Cool compress
›Short nails
›Cotton clothing
Wet wrap and occlusion strategies
›Adjunctive therapy for moderate to severe flares
›Wet wrap therapy
›After emollient and prescribed topical
›Limited duration to reduce maceration
›Occlusion
›Short term for hands and feet
›Avoid if infection suspected
Systemic therapy and escalation
›Systemic therapy considerations
›Systemic corticosteroid use
›Prefer avoid in routine atopic dermatitis due to rebound risk
›Consider short course only for severe allergic contact dermatitis with extensive involvement and no infection concern
›Biologics and advanced therapy referral
›Dupilumab for moderate to severe atopic dermatitis
›JAK inhibitors specialist managed due to safety monitoring
Secondary infection management
›Bacterial infection pathways
›Impetigo limited
›Mupirocin topical 2 percent 2 to 3 times daily for 5 days
›Reassess if no improvement 48 to 72 hours
›Cellulitis or systemic symptoms
›Oral antibiotics per local protocol dependent
›MRSA risk guided coverage
›Culture indications
›Purulence
›Recurrent infection
Eczema herpeticum pathway
›HSV related escalation
›Start antivirals if concern
›Acyclovir 400 mg PO 5 times daily for 7 to 10 days
›Severe disease or immunocompromised consider IV therapy and admission
›Ophthalmology consultation triggers
›Periorbital lesions
›Eye pain
›Vision change
›Reassessment timing
›ED reassessment in 30 to 60 minutes if systemic symptoms or anaphylaxis treatment
›Outpatient reassessment in 48 to 72 hours if infection concern
›Earlier return if rapid progression