This table cannot be relied upon in the absence of: PA Medical Directive #16 Dermatology
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1 Title and Number f Directive: Order Table PA-16: Dermatlgy This table cannt be relied upn in the absence f: PA Medical Directive #16 Dermatlgy 1. OVERALL CONDITIONS - The PA may evaluate and prvide care fr patients presenting with the fllwing new r nging cnditins: Maculpapular and plaque disrders: Eczematus disrders: Cntact dermatitis. Atpic dermatitis. Nummular dermatitis. Sebhrreic dermatitis. Periral dermatitis. Stasis dermatitis. Dyshidrtic eczema. Diaper dermatitis. Lichen simplex chrnicus. Pityriasis rsea Psriasis. Papulpustular inflammatry lesins: Acne vulgaris. Acne rsacea. Flliculitis. Lcalized skin infectins: Furuncles and carbuncles. Cellulitis. Abscess. Impetig. 1
2 Secndary skin infectin. Candidal intertrig. Bites (insect, reptile, animal, human). Dermatphytsis. Tinea versiclr. Tinea capitis. Tinea crpris. Tinea pedis. Drug eruptins. Parasitic infectins: Scabies. Pediculsis. Viral disrders: Cndylma accuminatum. Exanthems. Herpes simplex virus. Mlluscum cntagiusum. Verrucae (HPV). Herpes zster. Varicella. Benign skin cnditins: Blister. Calluse. Skin tag. Lipma. Epidermid cyst. Actinic keratsis. Actinic cheilitis. Sebrrheic keratsis. Milia. Hemangima. Mles/nevi. Pigmentatin disrders: 2
3 Acanthsis nigricans. Melasma. Vitilig. Angiedema and urticaria. Hairs and nails: Alpecia. Parnychia. Onychmycsis. Ingrwn nail. Nail trauma. - PA will discuss patient status and care with the physician n an nging basis as identified in the Practice Outline, and as necessary. Guidelines: - Cmpendium f Pharmaceuticals and Specialties, Orders Indicatins and Cntraindicatins. 2. HISTORY AND PHYSICAL EXAMINATION - The PA may cmplete a fcused histry based n presenting cnditin. Histry f present illness. Pertinent past medical histry. - Fcused physical exam may include: Vital signs. ENT. Respiratry system. Dermatlgy. 3
4 3. COUNSELING - Lifestyle mdificatin as apprpriate. - Envirnmental factrs if cntributry. - Educatin regarding cnditin. - Cnservative treatment, e.g. emllients, Calamine. 4. LABS AND INVESTIGATIONS - The PA may rder any f the fllwing labs as necessary: CBC. Renal functin (creatinine, BUN, A:Cr). Liver functin tests (AST, ALT, alk phs, GGTT, bilirubin). Rheumatid factr. ESR hs-crp - Samples fr culture and histpathlgy. 5. IMMUNIZATIONS - In accrdance with PA Medical Directive #1 Peridic Health Exam. Guidelines: - Canadian Immunizatin Guide Seventh Editin
5 6. PROCEDURES - The PA may apply silver nitrate. Indicatins: - Antiseptic, wund cauterizatin. Cntraindicatins: - Nt fr use n brken skin, cuts r wunds. - As per CPS guidelines. - The PA may apply the fllwing keratlytic agents: Cantharidin. Pdphyllin. Salicylic acid. Trichlracetic acid. Indicatins: - Cmmn r periungal warts. - Cndylmata acuminatum. - Mlluscum cntagisum. - Palpebral warts. - Plantar warts. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - Nt fr use n brken skin, cuts r wunds. - As per CPS guidelines. - The PA may rder r perfrm crytherapy. Indicatins: - Destructin f diseased skin tissue. Cntraindicatins: - Lesins suspicius fr melanma, SCC, sclersis r recurrent BCC. - Areas f end-stage cmprmised circulatin. - Lesins in which identificatin f tissue pathlgy is required. 5
6 - The PA may rder r perfrm cllectin f skin scrapings r nail clippings. Indicatins: - Diagnse fungal infectins. - The PA may perfrm the fllwing skin bipsies: Shave bipsy. Punch bipsy. Curettage. Excisins. Incisins. Indicatins: - Obtain tissue sample fr diagnsis by histpathlgy. - Perfrm an excisin fr curative r csmetic purpses. Cntraindicatins: - Significant cagulpathy. - Preparatins, anesthetics, preservatives r ther materials t which the patient is allergic. - Partial-thickness bipsies are discuraged if nt cntraindicated if melanma is suspected. - The PA may perfrm incisin and drainage f an abscess. Indicatins: - Lcalized cllectin f pus that is tender and nt spntaneusly reslving. Cntraindicatins: - Facial lesins require cnsultatin with supervising physician. - The PA may perfrm laceratin and incisin repair using the fllwing: Sutures. Wund clsure tapes & strips. Tissue adhesive. Indicatins: - Laceratins that are pen and less than 12 hurs ld (<24 hurs ld n face). - Sme bite wunds in csmetically imprtant areas (clse fllw-up recmmended). - Repair f sites where lesin has been surgically remved. Cntraindicatins: - Wunds mre than 12 hurs hld (>24 hurs ld n face). - Animal and human bite wunds (exceptins: facial wunds, dg bite wunds). - Puncture wunds. 6
7 7. THERAPEUTICS Burrw s slutin Indicatins: - Cntact dermatitis. - Stasis dermatitis. Cntraindicatins: - As per individual medicatin guidelines in CPS. Tpical crticsterids - The PA may recmmend the fllwing tpical crticsterids: Amcinnide. Betamethasne. Clbetasl. Clbetasne. Desnide. Desximetasne. Diflucrtlne. Flucinlne. Flucinnide. Halcinnide. Halbetasle Mmetasne. Triamcinlne. Indicatins: - Crticsterid-respnsive dermatses. - Cntact dermatitis. - Atpic dermatitis. - Nummular eczema. - Diaper dermatitis. - Lichen simplex chrnicus. - Sebrrheic dermatitis. - Scalp psriasis. - Sebrrheic dermatitis. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - As per individual medicatin guidelines in CPS. Tpical anti-fungals - The PA may recmmend the fllwing tpical anti-fungals: Ciclpirx. Cltrimazle. Indicatins: - Diaper dermatitis. - Sebrrheic dermatitis. - Tinea versiclr 7
8 Ketcnazle. Micnazle. Nystatin. Terbinafine. Tlnaftate. - Tinea crpris. - Tinea pedis. - Candidal intertrig * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - As per individual medicatin guidelines in CPS. Tpical skin prducts - Selenium sulfide. - Cal tar shamp. Indicatins: - Tinea versiclr - Sebrrheic dermatitis - Psriasis - Dandruff Cntraindicatins: - As per individual medicatin guidelines in CPS. Oral anti-fungals - The PA may recmmend the fllwing ral anti-fungals: Flucnazle. Itracnzle. Ketcnazle. Terbinafine. Indicatins: - Onychmycsis. - Tinea capitis. - Tinea versiclr. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - As per individual medicatin guidelines in CPS. 8
9 Tpical antibitics - The PA may prescribe the fllwing tpical antibitics: Fusidic acid. Mupircin. Indicatins: - Mild secndary skin infectins. - Mild impetig. - Flliulitis & furuncles. - Periral dermatitis. - Dyshidrtic eczema. Cntraindicatins: - As per individual medicatin guidelines in CPS. Oral antibitics - The PA may prescribe the fllwing ral antibitics: Amxicillin/clavulanate. Azithrmycin. Cephalexin. Ciprflxacin. Clarithrmycin. Clindamycin. Clxacillin. Dxycycline. Erythrmycin. Metrnidazle. TMP/SMX. Indicatins: - Mderate-severe secndary skin infectins. - Mderate-severe impetig. - Ht tub flliculitis. - Carbuncles. - Cellulitis. - Animal bites. - Periral dermatitis. - Diabetic ulcers. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - As per individual medicatin guidelines in CPS. Antihistamines - The PA may prescribe the fllwing antihistamines: First generatin: Hydrxyzine. Indicatins: - Pruritus assciated with skin cnditins. - Urticaria. Cntraindicatins: 9
10 Diphenhydramine. Secnd generatin: Cetirizine. Deslratadine. Fexfenadine. Levcetirizine. Lratadine. - As per individual medicatin guidelines in CPS. Acne prducts - The PA may prescribe the fllwing acne prducts: Tpical: Adapalene. Azelaic acid. Benzyl perxide. Clindamycin. Dapsne. Erythrmycin. Salicyclic acid. Sulfacetamide. Tazartene. Tretinin. Oral antibitics: Dxycycline. Erythrmycin. Mincycline. Tetracycline. Trimethprim. Oral cntraceptives: Tri-Cyclen. Alesse. Diane 35. Indicatins: - Acne vulgaris*. - Acne rsacea*. - Psriasis**. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. **Tazartene nly. Cntraindicatins: - As per individual medicatin guidelines in CPS. 10
11 Yasmin. Yaz. Pediculcides - The PA may prescribe the fllwing pediculcides: Permethrin. Pyrethrins and pipernyl butxide. Indicatins: - Pediculsis. - Scabies. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - As per individual medicatin guidelines in CPS. Tpical skin prducts - The PA may prescribe the fllwing tpical skin pruducts: Imiquimd. Pdfilx Indicatins: - Actinic keratsis. - Cndylma acuminata. - Mlluscum cntagisum - Superficial basal cell carcinma (in cnsultatin with supervising physician). * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. Cntraindicatins: - As per individual medicatin guidelines in CPS. Antivirals - The PA may prescribe the fllwing antivirals: Acyclvir. Famciclvir. Penciclvir. Valacylcvir. Indicatins: - Herpes simplex virus. - Herpes zster. - Varicella zster. * Nt all medicatins apply t all cnditins, apprpriate guidelines shall be utilized. 11
12 Cntraindicatins: - As per individual medicatin guidelines in CPS. 8. REFERRALS - The PA may make a OTN Telederm referral as apprpriate. - The PA may make referrals t dermatlgist in cnsultatin with supervising physician. 9. ABSENTEE NOTES The PA may write absentee ntes as apprpriate. 12
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