common cutaneous eruptions - mississippi-academy
TRANSCRIPT
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“Dermatological Diagnoses
and Treatment for Primary
Care”
PHILIP LORIA, M.D.
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Basics
• Is it Symmetrical?
• Is it Dermatomal?
• Is it scaly?
• Is it in a “Photo Distribution”
• Does it Itch, Burn or Sting
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• If it’s Wet Dry it
• If it’s Dry Wet it
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Topical Steroids
• Class I Clobetasol, Halbetasol
• Class II Betamethasone, Mometasone
• Class IV Triamcinelone Ointment
• Class VI Desonide
• Class VII OTC Hydrocortisone
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How Long to Use
• Face, Groin, Inframammary and “Creases”
• Ears
• Scalp
• Rest of Body
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Steroid Alternatives
• Tar
• Salicylic Acid
• Calcineurin Inhibitors
• Others
• Eucrisa
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CONTACT DERMATITIS
POISON IVY TYPE
• OFTEN STREAKED VESICLES WITH SCALE
• USUALLY ASYMMETRICAL
OTHER TYPES
• LOOK FOR PATTERNS, ASYMMETRY, VESICLES AND SCALE
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HERPES ZOSTER
(SHINGLES)
• PAIN PRIOR TO ERUPTION
• FIRST A RED PLAQUE
• THEN VESICULATION AND CRUSTING
TREATMENT
• VALTREX OR ACYCLOVIR
• SYSTEMIC STEROIDS
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KENALOG
• Traimcinelone acetonide
• Safety Profile
• Patient Populations
• Duration and Cost
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TINEA VERSICOLA
TREATMENT
• KETOCONAZOLE 400 mg ONCE PER WEEK
FOR 2-3 DOSES
• VARIOUS TOPICALS
• DO NOT USE LAMASIL OR GRISEOFULVIN
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TREATMENT OF TINEA
• AVOID CLOTRIMAZOLE-BETAMETHASONE
• NEWER TOPICAL AZOLES
• ORAL KETOCONAZOLE, TERBINAFINE,
FLUCONAZOLE OR GRISEOFULVIN
• PROPYLENE GLYCOL FOR MAINTENANCE
OF CHRONIC TINEA $26 per GALLON AT
TRACTOR SUPPLY
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ONYCHOMYCOSIS
• TREATMENT OF FINGERNAILS IS 4-5
MONTHS
• TREATMENT OF TOENAILS IS 6 – 12
MONTHS
• TOENAIL RECURRENCE RATE IS 73%
AT 3 YEARS
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TREATMENT OF TINEA CAPITIS
• ORAL TREATMENT ONLY
• 6 WEEKS OF ORAL GRISEOFULVIN AT 7.5
mg/lb/day WITH FATTY FOOD
• TERBINAFINE, FLUCONAZOLE AND
KETOCONAZOLE ARE MUCH LESS
EFFECTIVE
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Onycholysis
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Granuloma Annulare
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Psoriasis
• Triggers
– Strep
– Beta Blockers
– Lithium
– Rarely ACE inhibitors, ARBs, Antimalarials
and NSAIDS
– Others
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Inverse Psoriasis
• Scalp
• Ears and Post Auricular Crease
• Belly Button
• Groin
• Palms and Soles
• Look for Candida
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TREATMENT
• Remove the trigger
• Topicals
• AVOID PREDNISONE AND DOSE
PACKS
• Kenalog is OK
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• ACITRETIN
• METHOTREXATE
• OTEZLA
• TUMOR NECROSIS BLOCKERS
• INTERLEUKIN RECEPTOR ANTIBODIES
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TREATMENT OF SEBORRHEA
• TAR, SALICYLIC ACID, SELENIUM, ZINC
AND SULFUR; OTC OR Rx
• TOPICAL ANTI YEAST AGENTS
OFF LABEL
• ELIDEL AND PROTOPIC
• EUCRISA
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TREATMENT OF SCABIES
• TOPICAL LINDANE OR ELIMITE NOT
AVAILABLE / DON’T WORK
• 10% PRECIPITATED SULFUR IN AQUAPHOR
OFF LABEL
• ORAL STROMECTOL (IVERMECTIN)
200ug/kg/dose X3 DOSES 5 DAYS APART.
AVAILABLE AS 3 mg TABLETS
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TREATMENT FAILURE
• FAILURE TO TREAT ENTIRE HOUSEHOLD
AND CLOSE CONTACTS
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Atopic Dermatitis
• Triggers
– Laundry Products
– Tinea Capitis
– Sub Umbilical Contact Dermatitis
– Other Contact Dermatitis
– Staph
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Staph
• Tetracycline or Clindamycin
• Ciprofloxin and Trimethoprim /
Sulfamethoxizole less effective
• Gentamycin
• Zyvox & Sivextro $$$$$$$$
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Carrier Eradication
• Mupirocin ointment bid x 7 days nose,
ears, umbilical, scrotal, vaginal and rectal.
• Consider treating the entire family
• Rifampin may be added to another
antibiotic 300 bid x 7 days
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