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Facial Rashes/eruptions

Facial Rashes/eruptions. Emily McGrath Dermatology Consultant Royal Devon and Exeter Hospital. Overview. Cases Discuss differential – points in the history and examination to help Management tips. Case 1. 21 year old female 4 year history of acne Tried Panoxyl over the counter .

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Facial Rashes/eruptions

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  1. Facial Rashes/eruptions Emily McGrath Dermatology Consultant Royal Devon and Exeter Hospital

  2. Overview • Cases • Discuss differential – points in the history and examination to help • Management tips

  3. Case 1 • 21 year old female • 4 year history of acne • Tried Panoxyl over the counter

  4. Treatment • Topical • BPO • Azaleic acid • Retinoids • Antibiotics • Oral • Antibiotics • Isotretinoin

  5. Oral Antibiotics • No benefit in concomitant oral and topical antibiotics. • Intermittent benzoyl peroxide recommended during oral antibiotics to eliminate resistant strains. • Dose: evidence to support erythromycin at 1g/day rather than 500mg/day. No evidence regarding dose of other oral antibiotics. • Treatment should be at least 3 months, maximal effect by 6 months – then if relapse, change drug.

  6. Case 2 • 17 year old 6th Former • 2 year history of worsening acne. • On 250mg bd oxytetracycline.

  7. Case 3 • 6 year old girl • Itchy face, neck, arms. • Worsening over past 3 months. • Not responding to hydrocortisone. • Mum asks about allergy tests.

  8. Atopic eczema - top tips • Emollients - trial then large quanitities. • Soap substitutes - simplify • Topical steroids - appropriate to severity • Short bursts of moderate / potent steroids to achieve control • Topical tacrolimus 0.1% - equivalent strength to mod potent top steroid. Maintenance. • Allergy: consider to be relevant if • Instant urticaria/itching after eating/ contact • Severe/ resistant eczema especially if bowel sx +/- FTT

  9. Case 4 • 51 year old school teacher. • Worsening facial rash. • Uncomfotable, especially in hot weather.

  10. Rosacea • Subtypes: • Erythematotelangectatic • Papulopustular • Phymatous • Treatment • Depends on subtype • Avoid triggers • Sun protection • Topical azaleic acid/metronidazole • Oral antibiotics

  11. Rosacea Mild or moderate papulopustular rosacea • Metronidazole • Gel (Metrogel®) 0.75%......................................................................£9.95 (40g) • Cream (Rozex®) 0.75%..................................................................£15.28 (40g) • Apply twice daily for 3-4 months Moderate or severe papulopustular rosacea • Oxytetracycline • Tablets 500mg twice daily for 3-6 months.................................................£5.68 • Lymecycline (unlicensed) • Capsules 408mg once daily ………………………………..….£22.45 (3 months) • Review at 2 months and continue for a total of 3 months if responding well. • Repeat 3 monthly course when rosacea flares.

  12. Case 5 • 55 year old art teacher. • Worsening facial rash over 2 weeks. • Sore, weeping.

  13. Case 6 • 38 year old IT worker • Persistent lesion R cheek

  14. Case 7 • 35 year old nurse • Irritating rash past 2 years central face

  15. Joint Formulary For moderate and severe disease affecting the scalp • Ketoconazole shampoo............................................................£3.02 (120mL) • Use twice a week For more severe erythema and flaking on the scalp add • Betamethasone scalp application............................................£3.81 (100mL) • Apply to dry hair morning and evening and allow to dry Disease affecting face and body • Ketoconazole cream.......................................................................£3.40 (30g) • Apply once or twice a day until resolution then reduce frequency to daily or • alternate daily use. • For inflamed skin • Daktacort® cream………………..…………………………………...……….£1.83 • Apply once or twice a day until resolved.

  16. Case 8 • 75 year old man • Rough patches on forehead. • Sore in strong sunlight.

  17. Solar (actinic) keratosis: Treamtent • Treatment: • Diclofenac • 5FU • Photodynamic Therapy • Cryotherapy • Curettage

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