General DermatologyPearls

Jason M Cheyney, MPAS, PA-CDermatologic Surgery Specialists

Macon, Ga 31211

Inflammatory Diseases of the Skin

Infectious Diseases of the Skin

Atopic dermatitis

Contact Dermatitis

Unknown etiology, suspect genetics and environmental influencesIncreased permeability of the skin to environmental allergens and immunologic hypersensitivityTypically appears in infancy peaks at one year of age and resolves by 6-8 years of ageSome individuals have lifelong issuesSanitary environment may predispose to development. Immune system becomes tolerant of antigens when exposed at a young age

Restoration of skin barrier of paramount importance

Consider infection stimulating superantigen and treat with appropriate antibiotic if flaring

Topical calcineurin inhibitors

Topical corticosteroids

UV light extremely beneficial

Oral steroids as last resort

If no control refer to dermatology for more aggressive therapy.

Caused by contact with an external allergenMost common is plant typeMetals, most common nickel but gold is a rising problem and starting to see platinumTwo most common topical causes are diphenhydramine and triple antibioticDelayed hypersensitivity, rash typically appears 5-7 days after exposureIf concerned about workplace allergen refer to dermatology or allergist for patch testingMost cases resolve spontaneously in several days to weeks

AVOIDANCE

Topical corticosteroids

Oral corticosteroids

Oral antihistamines – NON-SEDATING

If no improvement within 3-4 weeks need biopsy or referral to specialist

Tinea

Folliculitis

Impetigo

Molluscum Contagiosum

Herpes Zoster

Herpes Simplex

Erythema Infectiosum

Pityriasis Rosea

Intertrigo

Verruca

Tinea (Dermatophyte)

Corporis

Cruris

Pedis

Versicolor (Yeast)

aka “Ringworm”

Dermatophyte Infection of the Trunk, Legs, Arms and/or Neck. (not feet, hands or groin)

Etiology

T. rubrum - most common

T. mentagrophytes

M. canis – from an infected animal

M. gypseum – from infected soil

Transmission:

Direct contact with another person, animal or infected soil.

Auto-innoculation possible (T. pedis, T. cruris)

Treatment:

Topical Antifungal of Choice

Oral Antifungal if Widespread or Recalcitrant

Oral Ketoconazole is Not Indicated for Dermatophyte Infection in the United States

BacterialMechanicalPityrosporumGram NegativeHot TubEosinophilicDissectingViral

Aka Malassezia Folliculitis (Yeast)Most Often Appears on Chest and BackBiopsy Often NecessaryTreatment Options:Topical anti-yeast creamsKetoconazole 200 mg x 1 and repeat in 1 weekRecurrence is Common

Deep Dermatophytic Folliculitis

Found in Any Hair-Bearing Area

Often Secondary to Steroid Use

Etiology

T. rubrum

T. tonsurans

T. mentagrophytes

Common and Contagious

Honey Colored Crusting

EtiologyStaph aureus

Strep pyogenes

Minor Skin TraumaBreak in the skin – Trauma

Atopic Dermatitis

Easily Missed

Minimal Erythema

Ruptures to form thin rim with flat center

Lesions seen in all stages

Staph aureus is primary pathogen

Reactivation of the varicella(chickenpox) virusAfter initial infection disease lies dormant in the dorsal root ganglionProdrome is typically painPost-herpetic neuralgia most common complication which can lasts months to yearsOphthalmic involvement Suppressed immune status leads to greater chance of longterm side effects and complicationsRisk increases with age 4 in 1000 will develop in lifetime, 10 in 1000 after the age of 60

Valacyclovir 1 gm tid for 7 days

Acyclovir 800 mg 5x/day for 7 days

Vaccination for pts 60 yo and older even pts who have had a zoster outbreak

HSV IPredominately around the mouth, eyes, face and throat

HSV IIPrimarily anogenital

Individuals with altered immune systems are more susceptible to severe complications

Eczema herpeticum

Approximately 80% of world population is infectedAsymptomatic carriers are common

Condom use to reduce transmission when active lesions present

Valacyclovir1st - 1 gm bid for 7 days

Recurrence - 500 mg bid for 3 days

Suppression - 1 gm qd

Acyclovir1st – 400 mg tid for 7 days

Recurrence – 400 mg tid for 5 days

Suppression – 400 mg bid

The “fifth” of the classic childhood exanthems

Etiology: HPV (Parvovirus) B19

Children between 5 – 15 years of age

Prodrome of fever, malaise and pharyngitis

Circumoral pallor and “Slapped Cheeks”

Lace-like rash on trunk and proximal limbs

Lasts up to 4 weeks but may recur with sun exposure

Transient aplastic crisis may occur

Parent Reassurance

LabsCBC

Serology

Antipyretics (acetaminophen, ibuprofen)

Systemic Corticosteroids

Rarely Blood Transfusion

Typically preceded by a “Herald Patch”

Commonly mistaken for “ringworm”

Most cases asymptomatic but can be extremely pruritic

Unknown etiology, suspect viral URI as culprit

No evidence of being contagious

Typically lasts 6-8 weeks and resolves spontaneously

None necessary if asymptomatic – self limiting

UV Light can be helpful

Erythromycin, 500 mg bid for 7 days

Topical mid-potency corticosteroid for itching

Oral antihistamines – NON-SEDATING

Inflammation in areas of skin to skin contactAxillaBreastsGroin

Multiple etiologiesBacterialFungalViral

Get comfortable with KOHBe careful not to mistake inverse psoriasis or seborrheic dermatitis for intertrigoRare cases of cancer can mimic always look at the area. Please never take the pts word and treat with out an evaluation, no matter how uncomfortable.

Targeted against cause

Oral or topical antibiotic

Oral or topical antifungal

Topical corticosteroid

Diaper rash cream is a great prevention, reduces skin surface tension

Always see pt back in two weeks or if symptoms worsen.

If no improvement or worsening – BIOPSY or refer!

Multiple types – All in Human Papilloma Virus Family

Common – 2 & 4

Flat – 3, 10 & 28

Genital – 6 & 11 most common, 16 & 18 associated with most cases of cervical and penile cancer

Periungal – 2 & 4

Plantar - 1

Virus that is transmitted from person to person, typically through broken skin

Multiple Therapies – too many to list!!

My ListLeave it alone.

Cryotherapy

Topical keratolytic

Immunotherapy

Vaccine – Giardisil

MMR

Canthardin

Surgery

QUESTIONS?