The dermatitis of contact is a relatively common skin problem. It consists of an inflammation of the skin that happens due to an allergy or irritation. It can occur due to several factors and awaken some characteristic symptoms, such as redness, peeling and itching of the skin.
In many cases, for prevention, it is enough to avoid the causative agent of the allergy. To identify the cause and receive a diagnosis it is necessary to consult a dermatologist. Treatment can be done with ointments and oral medications. Continue reading to better understand the condition:
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What is contact dermatitis?
Contact dermatitis, also known as contact eczema , is an inflammation caused by friction between the skin and some substance that has caused an adverse reaction. It is characterized by the appearance of red and itchy rashes.
The health problem is simple and does not usually present a risk of death. The treatment consists of the application of ointments and some specific medications, and usually lasts a few days or weeks.
The disease can be caused by contact with various substances, without the individual necessarily having to be allergic to any of them. The condition can also be caused by the interaction between a skin product and the sun’s ultraviolet rays.
If left untreated, contact dermatitis can develop into serious bacterial infections, which then pose a risk to the patient’s life.
What is the CID for contact dermatitis?
In the International Classification of Diseases (ICD-10), contact dermatitis is within the code L25 (unspecified contact dermatitis), but it can be divided into the other subclassifications.
- L25.0: Unspecified contact dermatitis due to cosmetics;
- L25.1: Unspecified contact dermatitis due to drugs in contact with the skin;
- L25.2: Unspecified contact dermatitis due to dyes;
- L25.3: Unspecified contact dermatitis due to other chemicals;
- L25.4: Unspecified contact dermatitis due to food in contact with the skin;
- L25.5: Unspecified contact dermatitis due to plants, except food;
- L25.8: Unspecified contact dermatitis due to other agents;
- L25.9: Unspecified contact dermatitis, of unspecified cause.
Types
There are some types of contact dermatitis, which are differentiated by the substance that acts as the causative agent of the disease.
Are they:
Allergic contact dermatitis
As the name suggests, this type of dermatitis happens due to the patient’s allergic reaction to a certain product or substance.
Allergic contact dermatitis is caused by an individual immune reaction. This means that the product that does not cause any particular reaction in one person can cause a major allergy in another.
The problem can also manifest itself the first time the patient comes into contact with the allergenic substance or years after the first contact.
Irritant contact dermatitis
It is the most common type of contact dermatitis. It is characterized by an injury to the skin, caused by contact with a certain acidic or corrosive substance.
Irritant contact dermatitis is not an individual phenomenon, that is, it happens because such products are irritating to all people, and not just to the affected individual. However, the severity of the injury can vary from one patient to another.
The lesion usually happens in the most superficial layer of the skin and is accompanied by an inflammatory process.
Photocontact dermatitis
It is the most unusual type of contact dermatitis – although it is not rare. It is characterized by the appearance of lesions directly caused by the interaction between some product placed on the skin (such as a cream or perfume, for example) and the action of the sun’s ultraviolet rays.
Occupational contact dermatitis
Occupational contact dermatitis is not exactly a medical term, but a legal one. It is used to refer to contact dermatitis that is acquired by the patient due to certain practices and tasks performed in the workplace.
According to data from Santa Casa de Misericórdia de São Paulo, between 2003 and 2006, 10.9% of cases of contact dermatitis admitted to the hospital were related to activities inherent to the patient’s employment.
Causes
All types of contact dermatitis are caused by skin contact with any product, substance, component or chemical reaction to which the patient’s body is sensitive.
This sensitivity can be an individual phenomenon (which is exclusively related to that person’s immune response) or collective (when the causative agent of dermatitis is a product that is bad for any type of skin, in the long or short term).
Causes of allergic contact dermatitis
Allergic contact dermatitis is caused by a product to which the affected patient is allergic, even if he does not know it yet.
Allergies are particular phenomena, that is, they vary from organism to organism. So it is common for a product that is absolutely harmless to one person to be harmful and allergenic to another.
Some products that can cause allergic contact dermatitis are:
- Soaps;
- Perfumes;
- Condoms;
- Body creams;
- Enamels and enamel removers;
- Makeup in general;
- Ointments;
- Paints;
- Food preservatives;
- Dyes;
- Colas;
- Metals, the most common being nickel, used to make jewelry and jeans buttons;
- Plants, such as poison ivy, poison oak and poison sumac;
- Latex;
- Materials used to make henna tattoos;
- Corticosteroids;
- Shampoos;
- Conditioners;
- Shaving creams;
- Deodorants;
- Thimerosal, chemical component of some medicines;
- Benzocaine, a component of some anesthetics;
- Antibiotics such as gentamicin, neomycin, and bacitracin;
- Esparadrapos e band-aids;
- Stickers;
- Fabric dyes;
- Sleeve shell.
Causes of irritant contact dermatitis
Irritant contact dermatitis is usually caused by products to which the affected person does not necessarily have an allergy.
What happens is that these substances have in their formula some components that irritate the skin naturally. Then, long-term exposure or in very large quantities ends up causing dermatitis.
Some products that may be responsible for irritant contact dermatitis are:
- Detergents;
- Cleaning products in general;
- Solvents;
- Oils for cars and machines;
- Alkaline;
- Acids;
- Dust;
- Cement;
- Plants like me-nobody-can, aglaonema, aroeira-pepper, aroeira-pepper, aroeira-mucuri, dairy-red, hazelnut and filodendrons;
- Feces;
- Urine.
Causes of photocontate dermatitis
Photocontact dermatitis is an allergic reaction that results from the interaction of the sun’s rays with products placed on the skin. Such products can be:
- Sunscreens;
- Bronzers;
- Moisturizing creams;
- Perfumes;
- Makeup.
Dermatites caused by plants
Some apparently harmless plants can be agents that cause contact dermatitis. The species that causes the problem most often is poison ivy, followed by sumac and poison oak.
This is due to the natural presence of a vegetable oil called urushiol , to which a large part of the population is allergic (it is estimated that about 60% of people have problems when coming into contact with this component).
The most common form of contagion is through direct contact of the plant’s leaves with the skin. However, the toxic components of urushiol have the ability to contaminate clothing and objects, increasing the possibilities of exposure to toxins and, consequently, the appearance of contact dermatitis.
In general, the first manifestations of dermatitis caused by plants begin to appear up to 48 hours after the first contact with the allergic agent. Symptoms can last for 2 to 3 weeks on average.
Symptoms
The symptoms of a contact dermatitis are usually totally dermatological, that is, they are limited only to the skin of the affected area. They can appear up to 48 hours after contact with the causative agent (irritant dermatitis) or up to 6 days later (allergic dermatitis).
The most common signs of the disease are:
- Reddish rashes, usually similar to large red plaques;
- Itches and itches;
- Extremely dry skin around the affected region;
- Blisters, which may or may not have secretion;
- Swelling;
- Burning.
The initial manifestations of allergic and irritant dermatitis are slightly different. When the problem appears due to an allergenic substance, the first sign is usually the appearance of such reddish plaques on the skin, which itch a lot.
In irritant dermatitis, the first manifestation is usually an intense redness in the affected region, accompanied by dry, cracked and itchy skin. In more severe cases, the injury can be very similar to a burn.
When can it not just be contact dermatitis?
Although skin rashes caused by contact dermatitis are quite characteristic, it is possible that another health problem is mistaken for the disease.
Therefore, it is important to seek the opinion of a professional as soon as possible if your eruptions:
- They hit your face or genitals;
- They do not improve after a month of treatment;
- They are spreading to other locations;
- They throb or hurt.
In addition, it is also essential to seek medical attention as soon as possible if the patient has a fever (characterized by a temperature above 37ºC).
How is the diagnosis of contact dermatitis made?
The professional best suited to diagnose contact dermatitis is a dermatologist . To arrive at the correct diagnosis, the doctor will observe the pattern of the spots and ask the patient some questions.
In cases of suspected allergic contact dermatitis, it is also possible that the doctor will order some skin tests to detect the source of the problem.
The most common test consists of applying a few dozen allergenic substances to the patient’s skin, using specific adhesives for the test. Thus, it will be possible to observe how the body reacts and find out what products the person is allergic to.
Contact dermatitis is curable?
Yes, contact dermatitis is a condition that can be cured . The treatment usually lasts a few weeks and involves the application of specific ointments to the affected area and the administration of oral medication. Identifying and avoiding the causative agent of the allergy or irritation also contributes to the solution or prevention of the problem.
Contact dermatitis treatment
The traditional treatment for contact dermatitis consists mainly of the use of creams and ointments with steroids in their composition. These medications should be applied directly to skin rashes, according to the guidelines made by the doctor. It is also common for doctors to prescribe oral remedies, such as:
- Antihistamines, which suspend the allergic process;
- Corticosteroids, which reduce and fight inflammation.
In some cases, the health professional may also choose to prescribe antibiotics , which fight any bacterial infections in the areas affected by dermatitis.
This type of medication may be necessary because the problem weakens the skin’s defenses and makes it more susceptible to infection by microorganisms.
Home treatment for contact dermatitis?
There are some home treatments for contact dermatitis that can positively contribute to the recovery of the patient who is experiencing the problem.
However, it is important to remember that these treatments have no scientific evidence and should not replace the conventional treatment recommended by the doctor. Use these tips only as a complement.
Plantain tea
Very popular in India and the United States, plantain tea can be used to treat various health problems. In its cold version, it is ideal to help the recovery of people who are suffering from contact dermatitis.
One of the main properties of the plantain leaf is precisely to be antihistamine – which means that the plant has the ability to fight allergies.
To make your plantain tea, just follow a few simple steps. You will need:
- Two tablespoons of dried plantain leaves;
- A liter of water.
To prepare:
- In a saucepan, mix the water and plantain leaves;
- Bring to the fire and wait until it starts to boil;
- Turn off the heat and place something on the pot to smother the infusion. It can be the lid itself or a plate, for example;
- Let it sit for about 15 minutes;
- Strain your tea and let it cool well;
- Place in a bottle with a lid and store in a cool, well-ventilated place.
The recommendation is to drink two cups (250mL each) of tea daily, while suffering from contact dermatitis.
Green tea
Green tea has in its composition two allies in the fight with dermatitis: catechin and keratin. Both components are antioxidants, that is, they protect certain cells in the body from some types of structural damage.
To prepare your green tea, you will need:
- 10g of specific leaf for the preparation of green tea;
- 1 cup (250mL) of water.
When making tea, just follow these steps:
- Heat the water in a kettle. Let it boil;
- Pour the water into a mug with the green tea leaves. Cover with a cloth to speed up the infusion process;
- Let stand for about 15 minutes;
- Then, just drink!
To combat contact dermatitis, drink 2 to 3 cups of green tea a day. It is important not to exceed this limit.
Green tea has a slightly bitter taste. However, it is essential to resist the temptation to add sugar or sweetener, so that the medicinal effects of the drink are maximized.
Sodium bicarbonate
When sodium bicarbonate is mixed with water, an endothermic chemical reaction (that is, related to the change in physical state that results from the fusion of the two substances) occurs that maximizes the antiseptic properties of the mixture.
Therefore, making a paste of baking soda and water can be an excellent option to complement the treatment of contact dermatitis.
To do your treatment with baking soda paste, just follow a few steps:
- In a container, place a cup (250mL) of dry baking soda;
- Add two tablespoons of hot water;
- Stir well, until the consistency of the mixture is similar to a thick paste, but with a smooth surface, without wrinkles (very similar to the icing of birthday cakes);
- Apply the paste on the dermatitis. Let it act for 20 minutes;
- With a damp cotton towel, clean the area well, without leaving any remnants of the paste;
- Dry well;
- Repeat the procedure at least once a day, while you have dermatitis;
- After applying the baking soda paste, apply a thin layer of the treatment ointment recommended by your doctor. Thus, the region will remain hydrated.
Before applying the paste , however, it is important to take some precautions, such as:
- Dermatitis makes your skin sensitive. Therefore, before applying the baking soda paste for the first time, it is important to test whether the surface is strong enough for this. To do the test, just apply a small amount of the mixture in a place close to dermatitis and wait a few minutes, watching how the skin reacts. If there is redness or itching, do not continue the application;
- Wash the affected area thoroughly under running water before applying baking soda paste. Remember to dry before applying the mixture.
Oatmeal flour
A home remedy made from oatmeal is a well-known alternative way to treat contact dermatitis. You will need to prepare a bath with the flour to get the desired effects.
To bet on this type of treatment, just follow a few simple steps.
You will need:
- Two cups (250 mL) of oatmeal;
- Water.
Preparation method:
- Heat the water to a pleasant temperature for bathing. It is not necessary to boil it;
- When the water is at the ideal temperature, place it in a bathtub or basin and add the flour;
- You will need to bathe with this water. The goal is to relieve the irritation and itching caused by contact dermatitis.
Phototherapy
Phototherapy is a treatment with anti-inflammatory properties used to combat allergies, skin blemishes, aging and other dermatological phenomena.
It is usually more suitable for the treatment of another type of dermatitis, called atopic dermatitis . However, it can also be recommended by a dermatologist for more serious cases of contact dermatitis.
Phototherapy sessions should be done in specialized clinics. In them, the patient is placed inside a special chamber with the eyes protected. There, inside that structure, the person will receive a kind of “bath” with the type of light most suitable for their treatment for a few minutes, as if it were an artificial sun bath.
They usually take two to three weekly phototherapy sessions, until the lesions caused by dermatitis disappear completely, and each session usually costs between R $ 40.00 and R $ 100.00, depending on the clinic where the procedure is performed. it will be done.
Phototherapy is a treatment that offers a small and remote increase in the chances of developing skin cancer .
However, as contact dermatitis is a transient situation and the patient will be exposed to the ultraviolet rays of phototherapy for a limited period of time, such risks are practically non-existent.
Remedies for contact dermatitis
It is very common that treatments for contact dermatitis involve the administration of medications, especially ointments and creams specific to the condition.
Your doctor can refer you to some of the following remedies:
Ointments and creams
The ointments and creams recommended for the treatment of contact dermatitis usually have steroids among their components.
Steroids are hormones that directly influence different parts of the human body, including changes in the skin.
Some of the ointments that can be prescribed by your doctor are:
- Truck-N ;
- Novacort;
- Ketoconazole + Betamethasone Dipropionate + Neomycin Sulfate ;
- Emscort;
- Dexadermil.
Anti histamines
The drugs called antihistamines have the function of inhibiting the production of histamine, a substance released when the body comes into contact with some substance that causes allergy.
Histamine is directly responsible for the physical manifestations of the allergy, such as rashes, itching and swelling. That is why these drugs are also known as antiallergic.
Some of the antihistamines that may be recommended by your doctor are:
- Polaramine;
- Hixizine;
- Celestamine .
Corticosteroids
Corticosteroids (also known simply as corticosteroids) are hormonal substances that regulate the metabolism and the work of blood vessels in the human body, among other functions.
These components are used in allergic conditions because they have a very strong anti-inflammatory action.
Some of the corticosteroids that can be prescribed by your doctor are:
- Decadronal ;
- Deflazacorte ;
- Dexmine.
Antibiotics
Antibiotics are drugs used to fight bacterial infections.
They are extremely necessary in cases of allergies that affect the skin because, when there is any type of injury in a certain organ of the body, that part of the body is more susceptible to infection by bacteria, which, in turn, can cause serious problems.
In cases of dermatitis, these medications can be administered either orally (through tablets) or ded in creams or ointments.
Some remedies with antibiotic properties that may be recommended by your doctor are:
- Sulfato de Neomicina + Bacitracina;
- Nebacimed;
- Ferid .
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Contact dermatitis in babies
Contact dermatitis is a relatively common dermatological problem in babies. In small children, it is more common that the disease appears in regions with fat folds or that are in constant contact with clothing items – such as neck, legs, groin and wrists.
In addition, it can appear in the pelvis region, resulting from prolonged contact with feces and urine in diapers. In such cases, it is known as diaper dermatitis .
As in adults, contact dermatitis manifests itself in babies through red, scaly patches or itchy blisters.
Since, depending on their age, children cannot complain verbally, it is common for them to cry frequently and become irritated during dermatitis.
In such cases, it is essential to pay a visit to the pediatrician so that, through tests, the professional finds out which substance is causing the problem.
In young children, it is common for dermatitis to go away on its own in periods ranging from 2 weeks to 1 month. However, pediatricians generally recommend specific ointments for the disease, which should be applied daily, in thin layers. Serious cases may also require the administration of corticosteroid medications.
Dads and moms of babies with contact dermatitis will also need to always keep an eye out for skin rashes, to ensure that the affected regions are always dry and clean, preventing infections.
Living together
Contact dermatitis is a simple health problem. If properly treated, it usually disappears within a maximum of 10 days. So it is important to go to a doctor’s appointment as soon as possible to get rid of the uncomfortable situation as soon as possible.
Although the itchiness of dermatitis is usually tempting, it is essential to resist as long as possible to prevent the problem from getting worse.
Some tips that can help you during your brief contact dermatitis are:
Avoid the substance that caused the allergic or irritating reaction
One of the first steps your dermatologist should take is to work with you to find out which substance is responsible for your contact dermatitis.
Usually, finding out which product caused irritant contact dermatitis is simple. The search for the agent that causes allergic contact dermatitis, on the other hand, can be a bit more work.
When you find out which substance is causing the problem, it is important to avoid it as much as possible. If the disease is caused by a necessary product in your daily life – such as creams or soaps, for example – discuss with the dermatologist the possibility of changing the brand or even replacing the product with another one that is made especially for you, in handling pharmacies. .
A curiosity is that it is possible for your body to overcome the allergy, if you stay for a long time without contacting the agent causing the problem.
Apply the creams and ointments recommended by the doctor
Your dermatologist should indicate ointments and creams specially designed to treat contact dermatitis. It is important to follow the professional’s recommendations and avoid applying products that have not been prescribed by him.
Using an unknown cream – even if it is recommended by a friend or family member you trust a lot – can be dangerous, as the product may have components that worsen your allergic process.
Always try to follow the doctor’s instructions and pay attention to the label of other products that you may apply to the skin.
Apply cold compresses
The contact of cold compresses with the skin affected by dermatitis causes the blood vessels in the region to contract, reducing swelling and relieving itching. So it can be a good tactic to deal with the symptoms of the disease.
To make a cold water compress, just follow a few simple steps:
- Moisten a cotton towel with cold water and place it in a plastic bag;
- Place the plastic bag with the towel inside the freezer for about 15 minutes;
- Apply directly to the dermatitis site until warm;
- Try to apply the compress at least three times a day, with intervals of at least two hours between them.
Avoid scratching
Scratching your dermatitis – especially using your nails – can weaken and hurt your skin, causing pain and making the region more susceptible to the entry of bacteria and other microorganisms.
If the itching is unbearable, try to use the palms of your hands, scratching gently, attacking the skin as little as possible.
Prognosis
The evolution of contact dermatitis is directly related to the type of substance that caused the problem, in addition to the speed of response of the affected person’s immune system.
Therefore, the prognosis is relative. Some milder dermatitis (usually an allergic type) can appear and disappear overnight, very quickly. Others, however, can lead to intense and persistent inflammatory conditions.
Generally, the first stage of developing contact dermatitis is redness and itching.
If it is not treated at this early stage, the tendency is for the condition to evolve with the appearance of blisters, which will leave the skin dry (to the point of developing cracks) and scaly.
If the patient scratches the area using the tips of the nails, the skin is likely to be sensitive and painful on contact, in addition to becoming more sensitive to bacterial infections.
The signs that contact dermatitis has become a bacterial infection vary according to the microorganism that infected the region. The symptom that usually precedes the complication is the appearance of wounds and / or ulcerations in the affected area.
In addition, an infection caused by bacteria can cause symptoms such as:
- Swelling;
- Pain (mainly throbbing);
- Intense redness;
- Sudden heat sensation in the affected region;
- Wounds with pus and other types of secretion;
- Fever.
Bacterial infections are the most serious complication of contact dermatitis. If the patient has any of the symptoms described above, it is important to seek medical help as soon as possible.
In general, contact dermatitis does not progress to more severe conditions, is easily treatable and does not cause a risk of death.
Complications
When contact dermatitis is not properly treated, some health complications can affect the patient, especially in those who are undiagnosed or have itching and severe irritation. If persistent and untreated, the following complications can occur:
Bacterial infections
Bacterial infections are serious complications that require immediate medical treatment and administration of antibiotics. Depending on the severity of the situation, they can lead to death.
In cases of contact dermatitis, they are usually caused by contact of skin lesions – usually caused by itching – with microorganisms.
In most cases, the bacteria that infect the skin after contact dermatitis belong to the staphylococcus and streptococcal families.
The symptoms of a bacterial infection can vary according to the type of microorganism that has infiltrated the region. In general, it is important to pay attention to:
- Sensation of heat in the dermatitis region, which can indicate the progress of a bacterial infection;
- Pains of any kind, with special attention to throbbing pains, with stinging or pricking;
- Swelling, especially if it is painful when squeezing;
- Fever, especially above 38ºC.
If a patient with contact dermatitis has symptoms of bacterial infections, it is very important to see a doctor as soon as possible.
Infections caused by bacteria can spread quickly and / or fall into the bloodstream, leading to serious complications.
Infectious cellulitis
Quite different from cellulite common infectious cellulite is a problem caused by a bacterial infection. It is characterized by the formation of large red plaques on the skin, which usually cause severe pain.
It is a relatively common complication in people with skin wounds and untreated dermatitis, which become entry points for microorganisms.
The main symptoms of infectious cellulitis are:
- Intensely reddish skin;
- Pain in the affected region;
- Emergence of waters in the affected region;
- Headache;
- Fever;
- Chills;
- Vomiting, in some cases.
Infectious cellulitis is considered a medical emergency, which needs immediate treatment. If left untreated, it can cause a generalized infection and even lead to death.
Neurodermatite
Despite its name, neurodermatitis is not a problem that affects the neurological area, but rather, a skin disease caused by excessive itching.
Also called chronic simple lichen, the disease causes irritation, itching, the appearance of blisters and wounds and the peeling of the skin, which is also extremely dry and sensitive. It is usually an evolution of dermatitis that is not adequately treated.
Despite the discomfort caused by the problem, the treatment is simple and consists of the application of ointments and creams with corticosteroids. Once treated, neurodermatitis usually disappears within 5 days.
How to prevent contact dermatitis?
There are some measures that can be taken on a daily basis that help prevent contact dermatitis. The main one is certainly to avoid the causative agent of dermatitis. Other basic hygiene and health habits are also part of it. Check out the main recommendations:
Avoid acidic and allergenic substances
The best way to prevent the development of contact dermatitis is to stay away from potential substances that may cause the problem. (For more information, read the section “Causes of contact dermatitis”).
So, to prevent it, it is worth staying as far away as possible from acidic, corrosive substances or to which you know you are allergic.
If it is not possible to avoid products that are bad for the health of your skin, it is important to use some safety equipment – such as gloves and rubber boots, for example – to protect yourself.
It can also be useful to study the possibility of exchanging products to which you are allergic for variables without the components that make you sick. Today, numerous brands have hypoallergenic (non-allergenic) versions of their products – including things like condoms and cleaning products.
Wash your skin regularly
Cleaning your skin properly is an excellent way to remove residues that may cause contact dermatitis and other types of allergy.
In addition to scrubbing the whole body thoroughly with soap and running water while bathing, it is also important to dry well and have additional care, such as applying skin cleansing lotions at least once a week, for example.
Keep your skin hydrated
Moisturizing the skin is also a way of preventing dermatitis, allergies and diseases that affect the region in general.
To keep your skin hydrated, it is worth following some tips:
- Invest in a good moisturizer (preferably without perfume or dyes, to avoid allergies). Apply twice a day, once in the morning and once in the evening, before bedtime. Pass over the entire body, always in circular movements to increase absorption;
- If possible, invest in a shower gel . The product is sold in cosmetic stores and helps to moisturize and cleanse the skin, in addition to leaving it well scented;
- Avoid hot baths, which speed up the dehydration process;
- Drink plenty of fluids.
Drink water
Drinking water is an inexpensive, effective and natural way to moisturize your skin and prevent contact dermatitis.
So it is important to try to drink as much natural fluids as possible (such as water, juices and coconut water, for example) to stay hydrated during the day.
Beware of plants
Some plants can cause irritant contact dermatitis. Therefore, if you do not know a certain vegetation, it is best to avoid handling its foliage.
Contact dermatitis is an extremely uncomfortable problem and, as if that were not enough, it also directly affects the individual’s self – esteem . But it is important to keep in mind that the disease is curable and easily treatable. Get a doctor as soon as possible!
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