There is then a basic line of attack:
Cool The Wound ; Clean The Wound ; Protect The Wound ; Apply Medicine ; Rest
A professional Doctor would:
* Apply an aqueous cream to moisturise and cool the skin,
* Sedation may be required. Infection must be treated with antibiotics.[11]
* Cold compress of water applied to area at half hour intervals.
* Foreign bodies must be removed .
* Apply one of the anti inflammatory topical corticosteroids sparingly. There is a limitless supply
of types. Choice must be made carefully depending on the cause, person etc. It is used sparingly
on the groin and face. In chronic cases antipuritic coal tar on compound zinc paste lessens the
damage and allows healing.
* Cover with a moist cotton bandage, cotton gloves, polythene, occlusive dressing or air tight
dressing to improve penetration of medicines. depending on site and needs of patient. If chronic,
apply a soaked bandage and lotion.
* When a subacute phase has been reached an aluminium acetote lotion and calamine lotion may
be applied prior to soaking in a weak solution of potassium permanganate.
* Clean with emulsion of water and olive oil or lotions to reduce the temperature.
* Change The Bandages Regularly
* Rest and eat well, but return patient to work as quickly as possible to avoid extra stress, if possible providing adequate protection and avoidance of cause is maintained. Those with good morale will settle back. With the elderly, in severe cases and those with inadequate personalities it will be difficult to settle and heal, and they may have to give up work.
11.1 Topical Steroids
These consists of vehicles which are used to convey active constituents into the skin, lessening the water content of the keratin, and by co-operation lower the skin temperature. They also control the allergic reaction. and have an anti-mitotic affect. They are prescribed in lotions, ointments and liquids.
12.0 Problems Associated With This Treatment.[9]
The field of dermatology, being such a wide an varied subject, cannot offer the patient a guaranteed successful recovery, because the affliction is almost always individual, therefore they often treat this area as an experimenting ground for the new and varied array of medicines, and if they are unsure
of the case, they will stick to favourites.
The course of treatment (11.0) works, if the patient follows the advice to the letter, but the Doctor will often misdiagnose the cause, because of the complexities of cross reactions, history of the patient, and lack of training. The dermatologist can only spend a certain amount of time with a patient, as they are very busy people. They may also be ignorant of the chemicals in plants, as it is not classed as an industrial disease or injury, ( See Chap 16.0) so if the doctor were working in a Social Security Department, he does not have to recognise the cause of the affliction. Doctors will often make the case worse by mis-treatment, or treat the wound, even though it would heal naturally, just for the fee.
Also "patients do not listen to what the doctors tell them", as the BBC radio 4 Medicine Now stated in Jan 97. These patients may therefore apply medicaments more thinly or sparingly or at the wrong times, damaging the skin, and failing to heal the wound. The person may dirty or forget to change the bandage, causing a secondary disease, or lack of healing.
Further more, many people do not even recognise they have the disorder, and continue working until
it is too late, and then find that they cannot work because they are in so much pain.(6.2)
Also steroids, although beneficial in tiny amounts, if applied correctly,
will cause serious damage to the skin if applied incorrectly. They replace the natural steroids and immunity cells in the skin, especially in the young and the old and those with secondary illness, when their skin is weak, because it is forming or dying. They also damage the collagen. They may also cause
a form of Atrophy striaee. If the immune system is damaged in this way, rebound pustulation, hypertension, suppression of adrenal glands and higher incidence of viral infection and dermatitis may occur which will be more intense next time.
Therefore a person treated for dermatitis by steroids, who may have underlying emotional problems
or primary physical injury, and a weak immune system, will go back to work with a weak skin, demoralised, with lack of drive from damage to adrenal glands. If he is exposed to any further allergens, he may have to retire completely, without compensation,(Chap.19.0) The drugs used in association
with steroids can also have serious side affects, Antihistamines can cause itching, sedation, Promethazine hydro chloride can cause retention of urine and mental confusion of the elderly, the main benefactors of treatment. It is advocated by the author that steroids are only used in severe cases.
Patch Testing to determine the cause of the dermatitis is a messy affair that can only be carried out by
a trained physician, over 48 hours, and is expensive. It will often cause sensitisation or acute dermatitis,
especially when the cause in unknown
Dermatitis In the Horticulture Industry By James M. Burton In Association With Pencoed College Copyright 1997