Diagnosis Choose one Title
Poison ivy dermatitis Irritant contact dermatitis Allergic contact dermatitis
Extent Choose one First line
Localized Widespread
Likely trigger Choose one
Most consistent with contact with poison ivy, oak, or sumac Most consistent with nickel in jewelry, snaps, or belt buckles Most consistent with a reaction to a soap, lotion, fragrance, or other skin product Most consistent with a reaction to wipes or diaper-area products Most consistent with toilet seat contact, on the buttocks and back of the thighs Most consistent with shoe materials, on the tops of the feet Most consistent with a reaction to an antibiotic ointment Trigger not clear from the history
Location Choose any
face eyelids neck hands arms abdomen legs feet buttocks genitals
Secondary infection Choose one
No signs of secondary bacterial infectionDefault Secondary bacterial infection with honey-colored crusting or spreading redness
Treatment decision Choose one
Started Hydrocortisone 2.5% to affected areasDefault Started Hydrocortisone 2.5% for the face and Triamcinolone 0.1% for the body Started Triamcinolone 0.1% given more inflamed areas on the body Recommended hydrocortisone 1% and calamine as needed for itch Started Prednisone with a taper given severe or widespread dermatitis Started Prednisone with a taper given facial or eyelid swelling Started Orapred with a taper given severe or widespread dermatitis
Antibiotic Choose one
Started Keflex for secondary bacterial infection Started Clindamycin for secondary bacterial infection given Penicillin allergy
Itch Choose any
Okay to use benadryl at bedtime when itch disrupts sleep Okay to use zyrtec during the day for itch
Avoidance Choose one
Discussed avoiding the suspected triggerDefault Discussed recognizing the plant, washing skin and nails soon after contact, and washing clothes, gear, and pets that touched it Discussed avoiding nickel and covering snaps and buckles Discussed stopping the suspected product and using fragrance-free products Discussed toilet seat covers and changing the home seat or cleaner Discussed tracking new products and exposures before flares
Referral Choose one
Dermatology or allergy referral if not improvingDefault Referred to dermatology for patch testing given recurrent dermatitis Referred to allergy for patch testing given recurrent dermatitis
Follow-up Choose one
if worsening or not improvingDefault in 1 week as needed
Counseling paragraph Choose one Paragraph
Contact dermatitis settles once the trigger is avoided, usually over 1-3 weeks with treatment. Recommended supportive care with OTC medications as needed with an emphasis on a fragrance-free moisturizer, cool compresses for itch, short nails, and avoiding the trigger.Default Poison ivy is not contagious, and fluid from the blisters does not spread it; new spots can appear for several days as the reaction develops or from oil left on skin, clothes, or pets, and the rash usually lasts 2-3 weeks. Recommended supportive care with OTC medications as needed with an emphasis on cool wet compresses, lukewarm oatmeal baths, calamine, short nails, and washing clothes and pets that touched the plant.
Steroid counseling Choose any Paragraph
Discussed finishing the full steroid taper even after the rash improves, since stopping early can bring the rash back.
Counseling
Return precautions given including spreading redness, pus or honey-colored crusting, fever, swelling around the eyes, a rash that is not improving, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
Note when inserted as is
Copy Use in Workspace
Contact dermatitis
• No signs of secondary bacterial infection
• Started Hydrocortisone 2.5% to affected areas
• Discussed avoiding the suspected trigger
• Dermatology or allergy referral if not improving
• Follow up if worsening or not improving
Contact dermatitis settles once the trigger is avoided, usually over 1-3 weeks with treatment. Recommended supportive care with OTC medications as needed with an emphasis on a fragrance-free moisturizer, cool compresses for itch, short nails, and avoiding the trigger. Return precautions given including spreading redness, pus or honey-colored crusting, fever, swelling around the eyes, a rash that is not improving, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.