Speaker and paid consultant for Galderma, Novartis and Jansen No other potential conflicts to disclose Review of Relevant Physiology Discussion of Common Problems Treatment Options Counselling
Knowing what to include is the best way to convey your meaning Color Type Size Grouping Location Feel Secondary characteristics Macules/Patches Papules/Plaques Vesicles/Bullae Nodules Pustule Polyp Wheal Abcess Fissure
Flake Scale Crust Exudate Lichenification Atrophy
When did it start? Does it itch, burn, or hurt? Is this the first episode? Where on the body did it start? How has it spread (pattern of spread)? How have individual lesions changed (evolution)? Provoking/exacerbating factors? Previous treatments and response? Upper arms and legs, sandpaper feel Very common Chronic overproduction of keratin Counselling on bathing and moisturizing May still last for years Rx alpha hydroxy acid, lactic acid, salicylic acid or urea creams Gentle exfoliation once per week
Red, itchy, flaky dry patches Papules may be present Usually starts in skin creases Antecubital or popliteal fossae Spreads when scratched Counsel on bathing and moisturizing Rx topical steroid creams, antihistamine for itch, oral steroids if diffuse Check for secondary infection around excoriations Treat if present - abx
Hypopigmented patches with/without flake Usually face and neck Worse in summer Counsel on bathing and moisturizing If flake or itch Rx mild topical steroid Sunscreen to even pigment Usually outgrow once they enter puberty
Greasy scale with erythematous base Usually scalp or diaper area May extend to neck and inguinal folds Usually asymptomatic Treat with topical antifungals, zinc/sulfanomide shampoos, tacrolimus or pimecrolimus Acute flares may call for low/mid potency topical steroid Not for long term use
Irritant or Allergic Look for the pattern! Common causes are soaps, saliva, urine Erythematous, pruritic, burning Topical steroid, antipruritic Good emollients and barrier care Avoidance of the trigger is key
Sometimes diffuse. Nummular, erythematous macules with fine scale Rarely pruritic Virus? Linked to URI Self limiting usually 8-12 weeks Antihistamines and topical steroids for itch, if symptomatic If potentially sexually active, rule out secondary syphilis
High fever greater than 103F and URI Sxs Usually 3-5 days When fever subsides the rash appears Small pink macules start on the trunk and spread to the extremities asymptomatic Usually less than 3 days No longer contagious
Blisters on erythematous base progress to crusts over several days Usually course 10-14 days Pruritus and mild fever Highly contagious! Starts 1-2 days PRIOR to the rash Continues until the last blister has crusted Treat symptoms and isolate Secondary infection, pneumonia, encephalitis
Slapped cheek and lacy, reticular rash Prodrome 2-3 days Fever, coryza, sore throat, pruritis Rash 7-10 days later Phase I - Slapped cheek (2-4 days) Phase II- Reticular (1-4 days AFTER Phase I) Phase III Episodes of clearing and reoccurrence may last weeks/months Symptomatic treatment
Highly contagious 90% transmission Onset 10-12 days after exposure Prodrome lasts 4-7 days High fever (103F), malaise, anorexia Classic Triad/ 3 Cs Conjunctivitis, Cough and Choryza Koplik spots - bluish-gray specks or grains of sand on red base buccal mucosa prior to rash Exanthem lasts 5-7 days blanching erythematous macules and papules Begin at hairline, ears and spread downward Within 48 hours spread and coalesce in patches Palms and soles frequently involved Fade to hyperpigmentation and often scale
Hypo/hyper pigmented, usually asymptomatic, macules and plaques Fine scale on close examination Topical azoles for limited spread Oral antifungals for diffuse Terbinafine or griseofulvin Pigment changes may persist for months after flake/active infection disappears Barrier and skin care counselling Often reoccurs Topical anti-dandruff shampoos for prevention
Annular erythematous lesions with fine flake with central clearing Macular/ less flake - intertriginous areas Topical azoles for localized infection Oral antifungal for more diffuse infection Terbinafine or griseofulvin (fat absorbed)
Ring shaped patches of hair loss Yellow crusted cup-shaped Ecothrix Around the hair shaft or beneath the hair cuticle Destruction of the cuticle Endothrix Arthrospores present within the hair shaft Chronic infections tend to progress and may last into adult life Trichophyton and Microsporum The most common pediatric dermatophyte infection worldwide TREAT: Griseofulvin - 20-25 mg/kg/d for 6-8 weeks Terbinafine 2-4 weeks 10-20 kg - 62.5 mg/d 20-40 kg - 125 mg/d > 40 kg - 250 mg/d Follow with antimycotic shampoo 2x week for 2 months to prevent reoccurrence
Small umbilicated papules Highly contagious towels! May be confined or diffuse Pruritic? Treat- canthradin, LN2, curette, electrodessication or not at all Lasts 6-12 months May persist for several years
Making a comeback and resistant to OTC Permetherin, malathion, ivermectin Retreat after 7 days Often secondary contact dermatitis Itching may cause the patient to think they still have lice Occlussives petrolatum, mayonaise, heavy lotions Apply, blow dry outer layer, bathing cap Repeat Q7D for 3 weeks
John V. Notabartolo, MPAS, PA-C Linda Woodson Dermatology Las Vegas, NV (702) 202-2700 jnotabartolopac@lindawoodsonderm.com or jnotabartolo@dermpa.org