1 / 76

Common Dermatologic Conditions

Common Dermatologic Conditions . Toby Maurer, MD University of California, San Francisco. Topicals. BP 5% gel (10% - more drying) BP 5% wash-great for comedones back/chest Retin A 0.025% - 0.1% ( vehicle determines strength - start with crème) Cleocin T or erythromycin topically

Lucy
Download Presentation

Common Dermatologic Conditions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Common Dermatologic Conditions Toby Maurer, MD University of California, San Francisco

  2. Topicals • BP 5% gel (10% - more drying) • BP 5% wash-great for comedones back/chest • Retin A 0.025% - 0.1% ( vehicle determines strength - start with crème) • Cleocin T or erythromycin topically • Combination topicals good –use qd • Use 1 qam and 1qhs ?Not improving after 8 weeks?

  3. P.O. Antibiotics • TCN - 500 bid x 8 weeks • Doxycycline - 100 bid x 8 weeks • Minocycline - 100 bid x 8 weeks-too many side effects and high cost • Taper - Do NOT STOP ABRUPTLY

  4. Alternatives • Erythromycin - 500 bid • Septra - check WBC’s • Keflex-500 tid

  5. Spiranolactone • Diuretic used in cirrhosis of liver • Also an anti-androgen • Useful in females who have cysts around menstruation • 50-100 mg qday continuously

  6. Laser treatment for acne • Placebo effect is strong so controlled studies are essential but lacking • INFRARED-1320 and 1450nm wavelength-light absorbed by sebaceous glands-results very poor • INTENSE PULSE LASER (585 nm)-decreased comedones but not inflammatory papules • BLUE LIGHT (415nm)- decreased inflammatorypapules • Yeung CK et al Lasers Surg Med 2007 Jan

  7. Accutane • Document failure of antibiotics • Baseline CBC, LFT’s ,TG and cholesterol • Two forms of birth control, negative pregnancy tests • MD’s will need to be registered as will patients • Counseling on depression

  8. Acne Rosacea • Common in over 40group • Often seen in persons of Irish decent • Associated with seborrheic dermatitis

  9. Acne Rosacea • Oral antibiotics for 6-8 weeks clears skin for some amount of time • Topicals work less frequently-Metrocreme

  10. Perioral Dermatitis TREATMENT Topicals: Cleocin T Gel bid Erythromycin bid p.o. antibiotics –TCN Doxycycline Minocycline - bid x 8 wks Keeps pts in remission x 2 yrs.

  11. Acne Keloidalis • Not acne, not keloid • Hard to treat-IL kenalog/surgical excision • Don’t crop hair at back of head!!!!

  12. Hair Loss • Scarring-refer • Non-scarring-work up

  13. Non-scarring Hair Loss • Check recent surgeries/illness, nutrition, anemia, TSH, estrogen replacement, medication history, VDRL. • If hirsute with scalp hair loss-DHEAS and free testosterone • If lactating- check prolactin

  14. If all negative • Androgenetic Alopecia- Minoxidil 5% bid topically (even in women) Minoxidil 5% foam-use once/day What about finasteride (propecia)?-equal to minoxidil in men. Does not work in women.

  15. Too Much Hair • Vaniqa • topical cream that breaks the chemical bond of hair • apply 2x’s/day forever • 30% effective • $30/month

  16. Hair Removal • pigment of hair absorbs the light and is destroyed • dark hair responds best • hair is always in different growth phases, so treatment has to be repeated several times to catch the phase= EXPENSIVE • Side effects: pigment changes of surrounding skin and scarring

  17. Psoriasis • What is it? • How did I get it? • Can I give it to someone else? • Is it associated with anything? • How can I get rid of it?

  18. Decrease the MITOTIC RATE of skin Tar (LCD 5% in TAC 0.1% oint) ( Tar emulsions) topical retinoids (Tazarac) Decrease the INFLAMMATORY RATE of the skin Steroid Ointment (mid-potency-1st line) Calcipotriene (Dovonex Creme)-not on face or groin Clobetasol/Dovonex combination Ultraviolet light Psoriasis-Tx:

  19. NO PREDNISONE

  20. NEXT STEP • Time for referral • Methotrexate • Oral retinoids (Acitretin) • Cyclosporine • Biologics (Enbrel, Remicade, Humira)-most benefit in psoriatic arthritis and quick reversal of pustular psoriasis

  21. Eczema • Dry, inflamed skin that becomes “weepy” • Not bilateral and symmetric • No thick scale • No scalp/nail involvement • Topical steroids first line of treatment • Oral cyclosporine was known to turn off inflammation • Now: topical formulation of Cyclosporine

  22. Eczema • Tacrolimus (Protopic) and Pimecrolimus (Elidel), newer kids on the block • Great for facial eczema/eyelid eczema • Expensive • Efficacy-???better than steroids • Black box warning-do not use in children under 2, in sunexposed areas for long periods of time

  23. Buttock Folliculitis • Mechanical from clothing • Ban roll-on good • Topical antibx qd • Cleocin/Erythro

  24. Keratosis Pilaris • Thickening of hair follicles on the out arms and upper legs • Associated with dry skin • Lubrication • Lachydrin 12% lotion bid

  25. Intertrigo • Pendulous breasts or pannus • Always component of candida • Blow dry area • Apply topical antifungals • Tucks pads

  26. Herpes Zoster • Zoster vaccine available • Study done on 38,000 persons 60 yrs and older (Kimberlin et al NEJM March 2007) • INCIDENCE was 51% lower in those that received vaccine vs placebo • POST HERPETIC NEURALGIA was 67% lower in vaccinated group • Worked best in 60-69 yr olds • COST?

More Related