Clin Med 1 Unit 4 All Derm Treatments

candida albicans

nystatin

azole antifungal

tinea dermatophyte

topical terbinafine or azole

oral terbinafine/griseofulvin for hair and nails

pityriasis tinea versicolor

topical ketaconazole shampoo, selenium sulfide

oral fluconazole for extensive/refractory disease

staphylococcus impetigo

topical mupirocin

W-D dressings

mild bacterial folliculitis

antibacterial wash with benzyl peroxide

topical antibiotics (mupirocin or clindamycin)

extensive/recurrent bacterial folliculitis

oral antibiotics:

• oral beta-lactam

• 1st gen cephalosporin

• tetracyclines

pseudomonal folliculitis

ciprofloxacin

recurrent staph folliculitis

mupirocin 2% ointment

mild acne vulgaris

topical retinoid + benzoyl peroxide

micronized tretinoin gel (be cautious of fish allergy)

moderate acne vulgaris

topical antibiotic with or without oral doxycycline

severe acne vulgaris

oral isotretinoin

rosacea

no cure

avoid aggravating factors

moisturize frequently

gentle skin cleansing

sun protection/avoidance

telangiectatic/flushing rosacea

topical alpha-adrenergic agonists

papular-pustular rosacea

topical metronidazole cream/gel/lotion

phymatous rosacea

surgical paring/sculpting/electrosurgery, laser

failed first line tx for rosacea

doxycycline

minocycline

hidradenitis suppurative

doxycycline x3 mo

intralesional steroids

surgery

initial tx of abscess

warm compress

I&D

initial tx of carbuncle

warm compress

I&D if fluctuant

initial tx of faruncle

I&D and antibiotics if indicated

first line antibiotics for abscess

TMP-SMX, doxycycline, minocycline (MRSA coverage)

first line antibiotics for carbuncle

TMP-SMX, doxycycline, minocycline (MRSA coverage)

first line antibiotics for faruncle

TMP-SMX, doxycycline, minocycline

IV therapy: vanomycin or daptomycin FOR SEVERE

cellulitis

oral cephalexin

dicloxacillin (adjust if MRSA risk)

IV therapy if severe

erysipelas

penicillin

clindamycin if penicillin allergic

vancomycin or dicloxacillin for face

erythema infectiosum

no specific tx

not contagious once rash appears

roseola infantum (exanthem subitum)

no specific tx

supportive care: maintain adequate hydration, antipyretics

measles

supportive

vitamin A associated with decreased morbidity and mortality

mumps

supportive

rubella (german measles) / congenital

no specific tx

immunoglobulin (IM admin) to pregnant women who have been exposed

pityriasis rosea

no definitive tx

manage pruritus with topical corticosteroids

varicella zoster (chicken pox)

supportive care for children, no school until all lesions are crusted

herpes zoster (shingles)

oral antivirals within 72 hrs of onset

acyclovir, valacyclovir, famciclovir

herpes simplex HSV

oral and topical antivirals

acyclovir, valacyclovir, famciclovir

scabies

12 hour overnight permethrin 5% cream applied to entire body

repeat 1-2 weeks later

oral ivermectin is alternative, do not give to kids under 15kg

pediculosis (lice)

topical pediculicides (OTC permethrin 1%)

re-treat in 9 days

wet combing

oral ivermectin 2 or 3rd line option

cutaneous warts

only if lesion is painful, limits fx, or cosmetic concern:

salicylic acid or cryotherapy with liquid nitrogen

molluscum contagiosum

topical liquid nitrogen

cantharidin

removal by curettage

atopic dermatitis

skin hydration by thick creams (low water content) or emollients

• vasoline, aquaphor

topical corticosteroids for acute flares and relapse prevention

topical immunomodulators

• children older than 2 years, blackbox cancer warning

• Tacrolimus, pimecrolimus

contact dermatitis

avoidance of irritant/allergen

cold compress and colloidal oatmeal bath

topical, oral, IM corticosteroids

antihistamines

seborrheic dermatitis scalp

shampoos containing zinc pyrithione or selenium

ketaconazole shampoo

seborrheic dermatitis facial

mild topical corticosteroid

ketoconazole 2% cream

seborrheic dermatitis intertriginous areas

low potency corticosteroid creams

selenium lotion, ketoconazole/clotrimazole gels/creams

seborrheic dermatitis infant scalp

mild shampoo

petroleum or baby oil to loosen scale

seborrheic dermatitis infant

ketoconazole cream 1%

low potency topical corticosteroid to suppress inflammation

psoriasis

emollients

salicylic acid/keratolytics

vitamin D

nonsteroidal topicals

moderate/severe psoriasis

TNF-a inhibitors

IL-17 inhibitors

methotrexate and other immune modulators

systemic retinoids

acute urticaria

avoidance

antihistamines

epinephrine

systemic steroids

chronic urticaria

antihistamines

antileukotrienes

omalizumab

erythema multiforme

emollients

antihistamines

topical steroids

severe erythema multiforme

systemic steroids

IV fluids

electrolyte repletion

recurrent erythema multiforme secondary to HSV

prophylactic antiviral rx

erythema nodosum

bed rest, leg elevation, compression

NSAIDs

seborrheic keratosis

no tx required

cryosurgery, curettage, shave excision, electrodessication, laser therapy (cosmetic/symptomatic reasons only)

biopsy may be required based on clinical appearance

acrochordon (skin tags)

no tx required

simple excision

aluminum chloride for hemostasis/electrodessication

cherry hemangioma

none required

infantile hemagioma

spontaneous regression

periorbital lesion: ophthalmologist

vascular lesion expert

propranolol for severe cases

letigines

cosmetic tx: cryosurgery, laser surgery, acid peel, bleaching

excision if suspicious for malignancy

melanocytic nevi

longitudinal observation

excision if suspicious/atypical/changes/repeated/trauma/cosmetic reasons

lipoma

none or excision

keratoacanthoma

wide local surgical excision

• extend into SQ fat

• recurrence <1%

actinic keratosis

surgical excision/biopsy

cryotherapy

topical 5-FU

chemical acid peel

topical imiquimod or retinoids

basal cell carcinoma

standard excision with 4-5mm margin

electrodessication/curettage

Mohs

imiquimod

5-FU

total body skin exams

squamous cell carcinoma

Mohs

standard excision 4-6mm

chemotherapy

total body skin exams

malignant melanoma

sentinel lymph node biopsy

medical oncology

immunotherapy and targeted therapy

simple drug eruption

stop offending drug

antihistamines

topical corticosteroid

steven johnson syndrome

stop drug immediately

burn unit/ICU

supportive care

SJS/TEN overlap

burn unit/ICU

supportive care

toxic epidermal necrolysis

burn unit/ICU

supportive care

staphylococcal scalded skin syndrome

IV anti-staphylococcal antibiotics

supportive care