Scabies

A. Scabies is an extremely pruritic eruption usually accentuated in the groin, axillae, navel, breasts and finger webs, with sparing the head.

B. Scabies is spread by skin to skin contact. The diagnosis is established by finding the mite, ova, or feces in scrapings of the skin, usually of the finger webs or genitalia.

C. Treatment of choice for nonpregnant adults and children is lindane (Kwell), applied for 8-12 hours, then washed off.

D. Elimite, a 5% permethrin cream, is more effective but more expensive than lindane (Kwell).

E. Treatment should be given to all members of an infected household simultaneously. Clothing and sheets must be washed on the day of treatment.

III. Acne Rosacea

A. This condition commonly presents in fair-skinned individuals and is characterized by papules, erythema, and telangiectasias.

B. Initial treatment consists of doxycycline or tetracycline. Once there has been some clearing, topical metronidazole gel (Metro-gel) can prevent remission. Sunblock should be used because sunlight can exacerbate the condition.

IV. Seborrheic Dermatitis

A. Seborrheic dermatitis is often called cradle cap, dandruff, or seborrhea. It has a high prevalence in infancy and then is not common until after puberty. Predilection is for the face, retroauricular region, and upper trunk.

B. Clinical findings

1. Infants present with adherent, waxy, scaly lesions on the scalp vertex also known as "cradle cap."

2. In adults, the eruption is bilaterally symmetrical, affecting the scalp with patchy or diffuse, waxy yellow, greasy scaling on the forehead, retroauricular region, auditory meatus, eyebrows, cheeks, and nasolabial folds.

3. Trunk areas affected include the presternal, interscapular regions, the umbilicus, intertriginous surfaces of the axilla, inframammary regions, groin, and anogenital crease.

4. Pruritus is mild, and bacterial infection is indicated by vesiculation and oozing.

C. Treatment

1. Scalp. Selenium sulfide or tar shampoos are useful. Topical corticosteroid lotions are used for difficult lesions.

2. Face, neck, and intertriginous regions. Hydrocortisone 1 or 2

3. Trunk. Fluorinated steroids can be used if severe lesions are present.

V. Drug Eruptions

A. Drug eruptions may be type I, type II, type III, or type IV immunologic reactions. Cutaneous drug reactions may start within 7 days of initiation of the drug or within 4-7 days after the offending drug has been stopped.

B. The cutaneous lesions usually become more severe and widespread over the following several days to 1 week and then clear over the next 7-14 days.

C. Lesions most often start first and clear first from the head and upper extremities to the trunk and lower legs. Palms, soles, and mucous membranes may be involved.

D. Most drug reactions appear as a typical maculopapular drug reaction. Tetracycline is associated with a fixed drug eruption; thiazide diuretics have a tendency for photosensitivity eruptions.

E. Treatment of drug eruptions

1. Oral antihistamines are very useful. Diphenhydramine (Benadryl), 25-50 mg q4-6h.

2. Soothing, tepid water baths in Aveeno or corn starch or cool compresses are useful.

3. Severe signs and symptoms. A 2-week course of systemic steroids (prednisone starting at 60 mg/day and then tapering) will usually stop the symptoms and prevent further progression of the eruption.

F. Erythema Multiforme

1. Erythema multiforme presents as dull red macules or papules on the back of hands, palms, wrists, feet, elbows and knees. The periphery is red and the center becomes blue or darker red, hence the characteristic target or iris lesion.

2. It is most commonly a drug reaction caused by sulfa medications or phenytoin (Dilantin). It is also seen as a reaction to herpes simplex virus infections, mycoplasma, and Hepatitis B.

3. Erythema multiforme major or Steven's Johnson syndrome is diagnosed when mucous membrane or eye involvement is present.

4. Prednisone 30-60 mg/day is often given with a 2-4 week taper.

5. For HSV-driven erythema multiforme, acyclovir may be helpful. Ophthalmologic consultation is obtained for ocular involvement.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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