Related Therapeutic strategies

Herpes simplex virus (HSV) occurs in 2 common locations: orofacial (usually due to HSV-1) and genital (usually due to HSV-2).

Read more

Seborrheic dermatitis can be limited to the scalp, but it also can involve the face and any hairy or intertriginous area and rarely can even progress to a generalized erythroderma.

Read more

Chancroid

Timothy Berger Bruce Wintroub

Saturday, January 01, 2011

The diagnosis of chancroid is usually clinical, although improved culture techniques allow isolation of the causative organism H. ducreyi. The therapeutic strategy is to eliminate the pathogenic microorganism.

Read more

Therapeutic Strategies

Hymenoptera Stings

Timothy Berger Bruce Wintroub

Saturday, January 01, 2011

Bee, Wasp, and Hornet Stings

Hymenoptera stings cause toxic and allergic reactions. Toxic reactions are called local reactions and result from local tissue effects of the venom. These are often mild, lasting several hours, but can be severe or even fatal if many stings occur. Allergic responses are IgE dependent and present in a previously sensitized individual as a local exaggerated reaction or a generalized systemic (anaphylactic) reaction. Local exaggerated reactions may be recognized when erythema, swelling, and itching extend beyond the site of the sting. Anaphylaxis is a medical emergency requiring prompt diagnosis and immediate therapy, preferably by individuals trained in emergency medical services.

Local Reactions

First Steps

  1. Remove all embedded stingers as promptly as possible, as venom continues to be injected after the stinger is detached from the insect. Do not squeeze or pick up the stinger with the fingers; instead, scrape laterally with a blade or use fine tweezers.
  2. Apply ice (not heat) early, and elevate and rest the affected extremity.
  3. Administer oral antihistamines such as hydroxyzine and a mild analgesic if necessary.
  4. For severe reactions, analgesia and sedation may be required.
  5. For moderate to severe reactions, management as anaphylaxis as described below may be necessary.

Allergic Reactions

Local Exaggerated Reactions

First Steps

  1. Treat as a local reaction as described above.
  2. Consider treatment with oral prednisone 1 mg/kg for 5 days.

Subsequent Steps

  1. Refer the patient to an allergist. Desensitization immunotherapy may be considered.
  2. A medical alert bracelet may be indicated.

Anaphylactic Reactions

First Steps

  1. Begin treatment immediately, and call for local emergency medical services.
  2. Place patient in supine position with legs elevated.
  3. Place a constriction band a few inches above sting site. The band should be tight enough to obstruct venous but not arterial blood flow.
  4. Apply ice to sting site to reduce venom absorption.
  5. Promptly administer epinephrine by subcutaneous injection (0.01 mL/kg of 1:1,000 solution up to a maximum of 0.5 mL per dose.
  6. Control airway and circulation if laryngeal edema and hypotension occur.

Subsequent Steps

  1. Referral to an allergist is recommended, and desensitization immunotherapy should be strongly considered.
  2. The patient should wear a medical alert bracelet and carry an emergency kit containing antihistamines, a bronchodilator, and an epinephrine injection.
  3. Educate the patient on how to avoid being stung (ie, know and avoid areas where hymenoptera live and feed; avoid attractants (cosmetics, perfumes, bright-colored 'flowery' clothing, and long loose hair); and remove nests from the local environment (severely allergic individuals should not do this themselves).

Pitfalls

  1. Local reactions around the mouth or throat may lead to respiratory compromise without a systemic allergic component. Carefully observe these patients.
  2. Local exaggerated reactions around the eyes may be complicated by severe ophthalmic sequelae (eg, atrophy of the iris, cataract, globe perforation, or glaucoma). If eye symptoms develop acutely or later, refer the patient to an ophthalmologist.
  3. Local bacterial infection (cellulitis) may closely simulate the clinical picture of a local exaggerated reaction.
  4. Mastocytosis patients may have severe, life-threatening reactions, which may or may not be true anaphylaxis.

Back to Therapeutic Strategies

CONTENT PROVIDED BY:
Derm101.com Logo

Disclaimer: The material above has been prepared by Derm101.com. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.