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Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.

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Treatments for Contact Dermatitis
Dietary Supplements and Cardiovascular Health

Treatments for Contact Dermatitis

Contact dermatitis is an acute inflammation of the skin that may be the result of exposure to irritants or allergens.¹

This condition may be classified as irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD).^1,2 ICD is the most prevalent form of contact dermatitis, accounting for more than 80% of all cases. It is an inflammatory reaction of the skin because of exposure to an irritant, such as chemicals, soaps, or various household cleaning products (Table), and usually resembles a burn.^1,2

The majority of ICD cases occur on exposed or unprotected areas of the skin.² An estimated 80% of ICD cases occur on the hands, and another 10% involve areas of the face.² Typically, ICD is associated more with pain than itching. The most common symptoms include inflammation, edema, erythema, as well as crusting and formation of pustules or vesicles.^1,2

Table

ACD is an inflammatory reaction of the skin to an allergen, such as poison ivy, oak, or sumac; metal, cosmetics, and the use of some skin-care products also can cause ACD (Table).^1-3

The signs and symptoms of ACD may include localized pruritus, rash, pain, and the formation of blisters.² Differentiating ACD from ICD may be difficult, especially if the contributing factor is unknown; however, ACD is typically confined to the contact area, whereas ICD may be more widespread.⁴

Many Treatment Options

Hydrocortisone is considered to be beneficial and the most effective topical therapy for treating the symptoms of mild to moderately severe cases of ICD and ACD that do not involve widespread dermal areas and edema.² It should not be used in children younger than 2 years of age and should not be used for more than 7 days, unless directed by a physician.

Other OTC products available for contact dermatitis include topical antihistamines, which can be used for temporary relief of pain and itching associated with poison ivy, oak, and sumac.

Patients should be informed that the use of topical antihistamine products can cause sensitivity reactions, and they should not be used concurrently with other antihistamine-containing products, including oral dosage forms, because increased serum concentrations may occur. They should not be applied to large areas of the skin.^2,5

It also is important to remind patients that topical antihistamines should not be applied to broken, blistered, or oozing skin and should not be used for more than 7 days, unless otherwise directed.² In addition, external analgesics, such as phenol, menthol, and camphor, which are available in various dermatologic products, may provide antipruritic and anesthetic relief. Astringent products (eg, aluminum acetate, zinc oxide, zinc acetate) may promote drying of oozing lesions, as well as provide a protective covering for the affected skin.²

Patient Counseling

Prior to recommending any product for contact dermatitis, it is imperative for the pharmacist to ascertain the appropriateness of self-treatment and refer patients to seek further medical evaluation when warranted.

Patients should be instructed on the proper use and duration of the selected product, as well as possible adverse effects, and pharmacists should remind patients to contact their primary health care provider immediately if there are no signs of improvement, if symptoms worsen, or if there are any signs of infection.

Table

References

1. Dermatological Disorders. In: Beers M, ed: The Merck Manual of Diagnosis and Therapy. 18th Edition. Rahway, NJ: Merck Publishing; 2006:956-958.
2. Keefner K. Contact Dermatitis. In: Berardi R, Kroon L, Newton G, et al, eds. Handbook of Nonprescription Drugs. 15th Edition. Washington, DC: American Pharmacists Association; 2006:745-763.
3. Contact Dermatitis. MedlinePlus Web site. www.nlm.nih.gov/medlineplus/ency/article/000869.htm.
4. Contact Dermatitis. MedicineNet Web site. www.emedicinehealth.com/contact_dermatitis/page3_em.htm.
5. Diphenhydramine Drug Information. American Society of Health-System Pharmacists Drug Information Web site. www.medicinescomplete.com/mc/ahfs/current/a382539.htm#cauts.

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Dietary Supplements and Cardiovascular Health

Cardiovascular disease (CVD) is the leading cause of death in the United States among both men and women, and many patients are becoming proactive about decreasing their risk by adapting to healthier diets low in saturated fat and cholesterol and establishing exercise routines.

For more information on dietary supplements, visit the National Institutes of Health Office of Dietary Supplements Web site at dietary-supplements.info.nih.gov.

Many patients also may consider incorporating the use of dietary supplements. These supplements include omega-3 fatty acids, single-entity vitamin formulas, multivitamin products (particularly for cardiovascular health), and products containing plant sterols.

Omega-3 Fatty Acids

Although research investigating the role of omega-3 fatty acids in the reduction of CVD continues, various studies have demonstrated that omega-3 fatty acids can^1,2:

• Lower the risk of arrhythmia
• Reduce triglyceride levels
• Lower blood pressure
• Decrease the growth rate of atherosclerotic plaque
• Decrease the incidence of thrombosis
• Improve arterial health

Table

Omega-3 fatty acids are being studied in a variety of other medical conditions as well. The American Heart Association (AHA) recommends the consumption of omega-3 fatty acids from fish and plant sources at least twice a week (Table). Fatty fish contain 2 kinds of omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Tofu and other forms of soybean, walnuts, flaxseed, and canola oils contain alpha-linolenic acid, which can become omega-3 fatty acids in the body.¹

Although the consumption of omega-3 fatty acids through diet is the preferred option, some patients may elect to use omega-3 dietary supplements because of personal preference or inability to consume enough omega-3 fatty acids through diet alone.

Currently, a variety of omega-3 fatty acid supplements are available in various dosage forms and strengths. Patients with existing medical conditions and those taking any medications should always discuss the use of these supplements with their primary health care professional prior to use. Patients with allergy or hypersensitivity to any of these products should avoid them. Common adverse effects include acid reflux/heartburn/indigestion, nausea, diarrhea, and increased burping.^3,4 Gastrointestinal side effects can be minimized if fish oils are taken with meals and if doses are started low and gradually increased.³

The use of omega-3 supplements has been associated with interactions with certain drugs. Examples include aspirin, anticoagulants, antiplatelet agents, and some herbal supplements.^3,4 In addition, caution should be exercised by diabetics, because fish oil supplements may slightly lower blood glucose.^3,4

Patients who take >3 g of omega-3 fatty acids from capsules should do so only under a physician's care—high intake could cause excessive bleeding or worsen heart rhythm in patients with arrthymias.^1,5 Prolonged use of fish oil supplements may cause a deficiency of vitamin E; therefore, vitamin E is added to many commercial fish oil products.^3,6 Regular use of vitamin E–enriched products may lead to elevated levels of this fat-soluble vitamin, so patients should be monitored.³

Plant Sterols

Various clinical studies report that dietary intake of plant sterols is effective in lowering low-density lipoprotein (LDL) cholesterol levels. The best dietary sources of plant sterols are vegetables, seeds, and nuts; however, supplements containing plant sterols also are available. According to the AHA, key facts about plant sterols/ stanols include⁷:

• They may be beneficial for individuals with elevated LDL cholesterol
• Maximum effects have been observed at intakes of 2 g/day
• Daily consumption is necessary to sustain LDL reductions

Table

References

1. Fish and Omega-3 Fatty Acids. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=4632.
2. New guidelines focus on fish, fish oil, omega-3 fatty acids. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=3006624.
3. Omega-3 Fatty Acids, Fish Oil, Alpha-linolenic Acid. Medline Plus Web site. www.nlm.nih.gov/medlineplus/druginfo/natural/patient-fishoil.html.
4. Omega-3 Fatty Acids. Drug Digest Web site. www.drugdigest.org/DD/DVH/Uses/0,3915,8747%7COmega%252D3%2Bfatty%2Bacids,00.html.
5. Omega-3 Fatty Acids: A Way to Improve Heart Health. Mayo Clinic Web site. www.mayoclinic.org/news2007-mchi/4219.html.
6. Omega-3 Fatty Acids, Fish Oil, Alpha-linolenic Acid. Mayo Clinic Web site. www.mayoclinic.com/health/fish-oil/NS_patient-fishoil.
7. Association releases new diet and lifestyle recommendations. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=3040209.