Allergic Contact Dermatitis (ACD)

Allergic contact dermatitis (ACD) is a condition where patients develop inflammatory skin changes owing to contact with an allergen. Scientifically speaking allergic contact dermatitis is a delayed type of induced sensitivity. Manifestations of allergic contact dermatitis are redness of the skin (erythema), swelling (edema) and blistering (vesiculation). Allergic contact dermatitis is differ from contact dermatitis, which is due to the chemicals that directly damage the skin ( Irritant Contact Dermatitis).

Jadassohn was the first person who described allergic contact dermatitis (ACD). Sulzberger also contributed his knowledge to develop the patch test, which is used to identify the specific allergen.

Prevalence of different substances like pollens, chemicals and metals in the environment and genetic makeup of the individuals are the main determinants of allergic contact dermatitis (ACD).

Detailed history regarding allergies and patch test are important in identifying the allergen which causing allergic contact dermatitis. And avoidance of the identified allergen is the mainstay of the treatment. Topical corticosteroid and antihistamines play a big role in treatment of allergic contact dermatitis.

Amitriptyline hydrochloride (dose, side effects, indications)

Amitriptyline hydrochloride is and antidepressant drug. It belongs to the tricyclic antidepressant group. It is one of the widely used tricyclic antidepressants.

Indications for Amitriptyline hydrochloride

Amitriptyline hydrochloride can be used in following conditions

• Depressive illness
• Nocturnal enuresis in children
• Neuropathic pain
• Migraine (as a prophylactic drug)

Prescribing physician should take extra precautions to avoid unnecessary side effects if a patient has a history of cardiac diseases, epilepsy, hepatic impairment, thyroid diseases, mania, angle closure glaucoma and urinary retention. It is advisable to avoid Amitriptyline hydrochloride in elderly and during breast feeding.

Contraindications for Amitriptyline hydrochloride

There are several conditions where Amitriptyline hydrochloride cannot be used. Recent heart attacks, arrhythmias, constipation and delirium are the commonest conditions where Amitriptyline hydrochloride is contraindicated.

Dose of Amitriptyline hydrochloride

• Depression; initially 75 mg (elderly and adolescents 30–75 mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary to 150–200 mg; CHILD under 16 years not recommended for depression
• Nocturnal enuresis; CHILD 7–10 years 10–20 mg, 11– 16 years 25–50 mg at night; max. period of treatment (including gradual withdrawal) 3 months—full physical examination before further course
• Neuropathic pain; initially 10– 25 mg daily at night, increased if necessary to 75 mg daily; higher doses under specialist supervision
• Migraine prophylaxis; initially 10 mg at night.

Side effects of Amitriptyline hydrochloride

Common side effects of Amitriptyline hydrochloride are arrhythmias, heart block, drowsiness, dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation, and urinary retention (all attributed to antimuscarinic activity), and sweating