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Id Reaction (Autoeczematization) (Treatment)

eMedicine.com, 2011

Treatment Medical Care The goal is to adequately treat the underlying infection or dermatitis, which should lead to prompt resolution of the id reaction.
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.
The strength and administration of a topical corticosteroid should be chosen based upon the extent, location, and morphology of the eruption.
Adult Apply sparingly bid/qid as severity warrants Pediatric Administer as in adults; exercise caution in patients 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.
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.
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.
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.
Diphenhydramine (Benadryl, Benylin, Caladryl, Dermapax) First-generation antihistamine with anticholinergic effects that binds to H1 receptors in the CNS and the body.
Has significant antimuscarinic activity and penetrates CNS, which causes pronounced tendency to induce sedation.
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/m 2 /d divided tid/qid; not to exceed 300 mg/d 5 mg/kg/d IV/IM or 150 mg/m 2 /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.
Adult 10 mg/d PO on empty stomach Pediatric >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 Contents Treatment & Medication: Id Reaction (Autoeczematization)