Dermatology therapy essentials - part 4 ppsx

Dryness of skin 193 D Doxycycline. Dermatologic indications and dosage Disease Adult dosage Child dosage Acne vulgaris 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice daily Anthrax 100 mg PO twice daily for 60 days in bioterrorism situation > 8 years old – 50 mg PO twice daily for 60 days in bioterrorism situation Atrophoderma of Pasini-Pierini 50–100 mg PO twice daily > 8 years old – 50 mg PO twice daily Bacillary angiomatosis 100 mg PO twice daily for 3 weeks > 8 years old – 100 mg PO twice daily for 3 weeks Bartonellosis 100 mg PO twice daily for 3 weeks > 8 years old – 50 mg PO twice daily for 3 weeks Boutonneuse fever 200 mg PO or IV immediately and at bedtime, followed by 100 mg PO twice daily for 3 days > 8 years old – 2–5 mg per kg PO daily for 7–10 days Bullous pemphigoid 50–100 mg PO twice daily > 8 years old – 50 mg PO twice daily Dermatitis herpetiformis 50–100 mg PO twice daily > 8 years old – 50 mg PO twice daily Epidemic typhus 200 mg PO or IV twice daily for 3 days, then 100 mg PO of IV daily until 48–72 hours after patient becomes afebrile > 8 years old – 200 mg PO or IV twice daily for 3 days, then maintenance dose 100 mg PO or IV twice daily until 48–72 hours after patient becomes afebrile Folliculitis 50–100 mg PO twice daily > 8 years old – 50 mg PO twice daily Leptospirosis 100 mg PO twice daily for 3 weeks > 8 years old – 50 mg PO twice daily for 3 weeks Linear IgA bullous dermatosis 50–100 mg PO twice daily > 8 years old – 50 mg PO twice daily Lyme disease 100 mg PO twice daily for 21 days; prophylaxis after tick bite – 200 mg PO for 1 dose > 8 years old – 50 mg PO twice daily for 3 weeks Lymphogranuloma venereum 100 mg PO twice daily for 3 weeks > 8 years old – 50 mg PO twice daily for 3 weeks Perioral dermatitis 100 mg PO twice daily for at least 30 days > 8 years old – 50–100 mg PO twice daily for at least 30 days Relapsing fever 100 mg PO twice daily for 7 days > 8 years old – 50 mg PO twice daily for 7 days Rickettsialpox 100 mg PO twice daily for 5 days > 8 years old – 50 mg PO twice daily for 5 days Rocky Mountain spotted fever 100 mg PO twice daily for 7–10 days > 8 years old – 2 mg per kg PO or IV loading dose, followed by 1 mg per kg PO or IV every 12 hours for 7 days and for at least 48 hours after defervescence Rosacea 100 mg PO twice daily for at least 30 days > 8 years old – 50–100 mg PO twice daily for at least 30 days PART4.MIF Page 193 Friday, October 31, 2003 9:52 AM 194 Drysol Drysol ᭤ Aluminium chloride DSAP ᭤ Porokeratosis Dühring-Bloch disease ᭤ Dermatitis herpetiformis Dühring’s disease ᭤ Dermatitis herpetiformis Dupuy's syndrome ᭤ Auriculotemporal syndrome Dupuytren’s contracture Synonym(s) Palmoplantar fibromatosis; Dupuytren's disease, palmar fasciitis; Viking disease Definition Disorder characterized by subcutaneous fascia thickening and shortening, causing the fingers to retract down towards the palm of the hand Pathogenesis Unclear; dominant genetic inheritance; often involves individuals of northern Euro- pean descent; trauma sometimes initiates or accelerates the process; associated with alcoholism, diabetes mellitus, smoking, epi- lepsy, pulmonary disease Clinical manifestation Asymptomatic, palmar skin nodule, gener- ally within the distal aspect of the palm, often with puckering of the skin above the nodularity; overlying skin sometimes adherent to the fascia, and fibrous cord sometimes extending into the finger; ring finger most commonly involved site, followed by the small finger Differential diagnosis Trigger finger Scrub typhus 100 mg PO twice daily for 7–14 days > 8 years old – 50 mg PO twice daily for 14 days Trench fever 100 mg PO twice daily for 4 weeks > 8 years old – 50 mg PO twice daily for 4 weeks Tularemia 100 mg PO twice daily for 7–14 days or until patient is afebrile for 5–7 days > 8 years old – 50 mg PO twice daily for 7–14 days or until patient is afebrile for 5–7 days Yaws 100 mg PO twice daily for 15 days > 8 years old – 2–5 mg per kg PO divided into 2 doses daily for 15 days Doxycycline. Dermatologic indications and dosage (Continued) Disease Adult dosage Child dosage PART4.MIF Page 194 Friday, October 31, 2003 9:52 AM Dyshidrotic eczema 195 D Therapy Physical therapy in early stages ଙ ; intrale- sional triamcinolone 3–5 mg per ml; partial surgical fasciectomy for a patient with sig- nificant functional disability References Saar JD, Grothaus PC (2000) Dupuytren's disease: An overview. Plastic & Reconstructive Surgery 106(1):125–134 Dupuytren's disease ᭤ Dupuytren’s contracture Dwarfism with retinal atrophy and deafness ᭤ Cockayne syndrome Dyschondrodysplasia with hemangiomas ᭤ Maffucci syndrome Dyshidrosis ᭤ Dyshidrotic eczema Dyshidrotic eczema Synonym(s) Dyshidrosis; pompholyx; vesicular palmoplantar eczema; vesicular eczema of palms and soles Definition Recurrent or chronic relapsing form of vesicular palmoplantar dermatitis Pathogenesis Occurring commonly in atopic individuals; associated with stress, infection, exogenous contactants, climate changes Clinical manifestation Symmetric crops of clear vesicles and/or bullae on the palms and lateral aspects of fingers and feet; vesicles deep seated, with a tapioca-like appearance, and sometimes becoming confluent to form bullae; may develop crusting, scaling, and fissuring after persistent scratching Differential diagnosis Contact dermatitis; vesicular tinea pedis; tinea manus; palmoplantar pustular psoria- sis; autosensitization reaction (id reaction) Therapy Corticosteroid, topical, high potency ଙ ; severe flare: prednisone; triamcinolone 40– 80 mg IM as single dose. Chronic persistent disease: azathioprine; local photochemotherapy; disulfiram 250– 500 mg PO per day in nickel-sensitive patients; aluminium acetate 5% solution soaks References Landow K (1998) Hand dermatitis. The perennial scourge. Postgraduate Medicine 103(1):141–142, 145–148, 151–152 Dyshidrotic eczema. Multiple vesicles on the hands, with concentration along the sides of the digits PART4.MIF Page 195 Friday, October 31, 2003 9:52 AM 196 Dyskeratoma, warty Dyskeratoma, warty ᭤ Warty dyskeratoma Dyskeratosis congenita Synonym(s) Zinsser-Engman-Cole syndrome; Zinsser- Cole-Engman syndrome Definition Genodermatosis characterized by reticu- lated hyperpigmentation, nail dystrophy, premalignant leukoplakia of the oral mucosa, and progressive pancytopenia Pathogenesis Mutations in DKC1 cause X-linked recessive form; involved in the regulation of the pro- liferative capacity of the cell; defect in maintenance of telomeres results in chro- mosomal instability, telomeric rearrange- ments, and cancer progression; etiology of autosomal dominant and autosomal recessive forms unknown Clinical manifestation Cutaneous manifestations developing between 5 and 15 years of age; tan-to-gray, hyperpigmented or hypopigmented mac- ules and patches in a mottled, or reticu- lated pattern, sometimes with poikilo- derma; located on the upper trunk, neck, and face, often with involvement of sun- exposed areas; scalp alopecia; mucosal leukoplakia on the buccal mucosa, tongue, oropharynx, esophagus, urethral meatus, glans penis, lacrimal duct, conjunctiva, vagina, anus; dental caries; progressive nail dystrophy; increased incidence of malignant neoplasms, particularly squamous cell carcinoma of the skin, mouth, nasophar- ynx, esophagus, rectum, vagina, and cer- vix; late bone marrow failure; pulmonary complications Differential diagnosis Graft versus host disease; Fanconi syndrome; Rothmund-Thompson syndrome; ataxia telangiectasia Therapy No therapy for skin disease; bone marrow transplantation References Dokal I (2000) Dyskeratosis congenita in all its forms. British Journal of Haematology 110(4):768–779 Dysplasia epiphysialis punctata ᭤ Conradi disease Dysplastic mole ᭤ Atypical mole Dysplastic nevus ᭤ Atypical mole Dystrophic epidermolysis bullosa ᭤ Epidermolysis bullosa PART4.MIF Page 196 Friday, October 31, 2003 9:52 AM E Early-onset prurigo of pregnancy ᭤ Prurigo of pregnancy Eccrine acrospiroma Synonym(s) Acrospiroma ; myoepithelioma ; clear cell hidradenoma ; clear cell adenoma ; cystic hidradenoma ; sweat gland adenoma ; eccrine sweat gland adenoma Definition Tumor of eccrine sweat gland origin, with a predominance of clear cells Pathogenesis Unknown Clinical manifestation Onset after minor trauma; solitary, flesh- colored dermal papule; occurring most commonly on the scalp, face, and trunk; tendency for central ulceration; occasional malignant degeneration Differential diagnosis Basal cell carcinoma; lymphangioma; hemangioma; squamous cell carcinoma Therapy Surgical excision ଙ References Ishikawa M, Nakanishi Y, Yamazaki N, Yamamoto A (2001) Malignant eccrine spiradenoma: A case report and review of the literature. Derma- tologic Surgery 27(1):67–70 Eccrine adenocarcinoma ᭤ Eccrine carcinoma Eccrine bromhidrosis ᭤ Bromhidrosis Eccrine carcinoma Synonym(s) Eccrine adenocarcinoma ; malignant tumor with eccrine differentiation Definition Neoplasm of eccrine sweat gland with potential for destructive local tissue infil- tration and metastasis; sometimes subdi- vided into tumors arising de novo in nor- mal skin and tumors originating from preexisting, benign, sweat gland tumors PART5.MIF Page 197 Friday, October 31, 2003 10:08 AM 198 Eccrine chromhidrosis Pathogenesis Derived from any portion of the eccrine apparatus or resulting from the malignant transformation of an existing benign eccrine tumor Clinical manifestation Non-specific solitary nodule or plaque with occasional ulceration, on the head, extremi- ties, or trunk Differential diagnosis Basal cell carcinoma; squamous cell carcinoma; Merkel cell carcinoma; cutaneous metastasis; eccrine acrospiroma; micro- cystic adnexal carcinoma; eccrine porocar- cinoma; cutaneous adenoid cystic carcinoma Therapy Wide local excision; Mohs micrographic surgery; radiation therapy References Katzman BM, Caligiuri DA, Klein DM, DiMaio TM, Gorup JM (1997) Eccrine carcinoma of the hand: a case report. Journal of Hand Surgery – American Volume 22(4):737–739 Eccrine chromhidrosis ᭤ Chromhidrosis Eccrine cystadenoma ᭤ Eccrine hidrocystoma Eccrine hidradenoma Synonym(s) Clear cell hidradenoma ; clear cell myoepithelioma ; solid cystic hidradenoma Definition Skin tumor of sweat gland origin with dis- tinctive histologic appearance Pathogenesis Unknown Clinical manifestation Solitary, dome-shaped papule or nodule, often attached to the overlying epidermis; associated epidermal thickening or ulceration; most common over scalp, face, and trunk Differential diagnosis Basal cell carcinoma; squamous cell carcinoma; dermatofibroma; epidermoid cyst Therapy Surgical excision ଙ References Hernández-Perez E, Cestoni-Parducci R (1985) Nodular hidradenoma and hidradenocarcino- ma. Journal of the American Academy of Der- matology 12:15–20 Eccrine hidrocystoma Synonym(s) Eccrine cystadenoma ; eccrine syringocystadenoma ; syringectasia Definition Tumor consisting of a cystic proliferation of eccrine secretory elements Pathogenesis Possibly adenomatous cystic proliferations of the eccrine glands or retention cysts of the eccrine sweat apparatus Clinical manifestation Asymptomatic, solitary, translucent-to-blu- ish papule, with a predilection for the periorbital area PART5.MIF Page 198 Friday, October 31, 2003 10:08 AM Ecthyma 199 E Differential diagnosis Apocrine hidrocystoma; basal cell carcinoma; epidermoid cyst; mucous cyst; syrin- goma; milium; steatocystoma multiplex Therapy Incision and drainage, followed by surgical destruction of the cyst wall by light electro- desiccation and curettage; punch, shave, or elliptical excision References Alfadley A, Al Aboud K, Tulba A, Mourad MM (2001) Multiple eccrine hidrocystomas of the face. International Journal of Dermatology 40(2):125–129 Eccrine poroma ᭤ Poroma Eccrine spiradenoma ᭤ Spiradenoma Eccrine sweat gland adenoma ᭤ Eccrine acrospiroma Eccrine syringocystadenoma ᭤ Eccrine hidrocystoma Echovirus 16 infection ᭤ Boston exanthem Econazole ᭤ Azole antifungal agents Ecthyma Synonym(s) Pyoderma Definition Skin infection that invades into the dermis, most often caused by organism Streptococ- cus Pathogenesis Caused by bacterial infection, usually Strep- tococcus but sometimes Staphylococcus; predisposing factors: previous tissue injury, immunocompromised state; environmental factors: high temperature and humidity, crowded living conditions, poor hygiene Clinical manifestation Begins as a vesicle or pustule, ulcerating and producing a yellowish crust with erythematous, indurated borders Differential diagnosis Herpes simplex virus infection; atypical mycobacterial infection; nocardia infection; sporotrichosis; trauma; insect or spi- der bite reaction; pyoderma gangrenosum Therapy Mupirocin ointment applied 3 times daily for 7–10 days; dicloxacillin; cephalexin; known Streptococcal infection: penicillin ଙ PART5.MIF Page 199 Friday, October 31, 2003 10:08 AM 200 Ecthyma contagiosum References Mancini AJ (2000) Bacterial skin infections in children: the common and the not so common. Pediatric Annals 29(1):26–35 Ecthyma contagiosum ᭤ Orf Ecthyma gangrenosum Synonym(s) None Definition Cutaneous manifestation of Pseudomonas aeruginosa bacteremia, usually occurring in patients who are critically ill and/or immunocompromised Pathogenesis Caused by Pseudomonas aeruginosa, a gram negative bacterial pathogen which disseminates in patients with impaired cel- lular or humoral immunity or those with severe underlying illnesses such as severe burns, malnutrition, recent chemotherapy, immunosuppressive therapy, or diabetes mellitus Clinical manifestation Appears as edematous, well-circumscribed plaques, rapidly evolving into hemorrhagic bullae, spreading peripherally, and eventu- ally turning into a black necrotic ulcer with an erythematous rim; commonly occurs in the gluteal or perineal region or extremi- ties; sign of widespread dissemination of infection Differential diagnosis Ecthyma; herpes simplex virus infection; atypical tuberculosis; nocardiosis; sporotrichosis; trauma; gram negative folliculitis; pyoderma gangrenosum; septicemia from other infectious agents; cryoglobulinemia; polyarteritis nodosa; necrotizing fasciitis; vasculitis Therapy Initial therapy: antipseudomonal penicillin (piperacillin) with an aminoglycoside (gen- tamicin). Subsequent therapy based on culture sensi- tivity References Khan MO, Montecalvo MA, Davis I, Wormser GP (2000) Ecthyma gangrenosum in patients with acquired immunodeficiency syndrome. Cutis 66(2):121–123 Ecthyma infectiosum ᭤ Orf Ectodermal dysplasia absent dermatoglyphics ᭤ Basan syndrome Ectodermal dysplasia, anhidrotic ᭤ Anhidrotic ectodermal dysplasia Ectodermal dysplasia, hidrotic ᭤ Hidrotic ectodermal dysplasia PART5.MIF Page 200 Friday, October 31, 2003 10:08 AM Eczematidlike purpura of Doucas and Kapetanakis 201 E Ectodermal dysplasia, hypohidrotic ᭤ Anhidrotic ectodermal dysplasia Eczema craquelatum ᭤ Asteatotic eczema Eczema craquelé ᭤ Asteatotic eczema Eczema fendille ᭤ Asteatotic eczema Eczema herpeticum Synonym(s) Kaposi varicelliform eruption ; eczema vaccinatum Definition Eruption caused by herpes simplex virus (HSV)-1, herpes simplex virus (HSV)-2, Coxsackie A16 virus, or vaccinia virus that infects a preexisting dermatosis, most commonly atopic dermatitis Pathogenesis Caused by herpes simplex virus (HSV)-1, herpes simplex virus (HSV)-2, Coxsackie A16 virus, or vaccinia virus infecting a preexisting dermatosis; possibly associated with local T-cell immune defect, low NK cells, and/or a low antibody titer against the infective organism Clinical manifestation Presents as clusters of umbilicated vesiculopustules in areas where the skin has been affected by a preexistent dermatitis; umbilicated vesiculopustules progress to ero- sions, usually over the upper trunk and head; vesicles often become hemorrhagic and crusted, coalescing to form large, denuded plaques that bleed and sometimes become secondarily infected with bacteria Differential diagnosis Impetigo; varicella; contact dermatitis; bullous pemphigoid; dermatitis herpetiformis; erythema multiforme; pemphigus Therapy Acyclovir; valacyclovir References Mooney MA, Janniger CK, Schwartz RA (1994) Kaposi's varicelliform eruption. Cutis 53(5):243–245 Eczema hiemalis ᭤ Asteatotic eczema Eczema marginatum ᭤ Tinea cruris Eczema vaccinatum ᭤ Eczema herpeticum Eczematidlike purpura of Doucas and Kapetanakis ᭤ Benign pigmented purpura PART5.MIF Page 201 Friday, October 31, 2003 10:08 AM 202 Eczematoid epitheliomatous dermatosis Eczematoid epitheliomatous dermatosis ᭤ Paget’s disease Effluvium, anagen ᭤ Anagen effluvium Effluvium, telogen ᭤ Telogen effluvium Eflornithine Trade name(s) Va n i q a Generic available No Drug class Ornithine decarboxylase inhibitor Mechanism of action Possibly related to ornithine decarboxylase inhibition, which decreases hair growth Dosage form 13.9% cream Dermatologic indications and dosage See table Common side effects Cutaneous: stinging; burning sensation, irritant contact dermatitis, acneform eruption, pseudofolliculitis barbae Serious side effects None Drug interactions None Contraindications/precautions Hypersensitivity to drug class or compo- nent References Hickman JG, Huber F, Palmisano M (2001) Hu- man dermal safety studies with eflornithine HCl 13.9% cream (Vaniqa), a novel treatment for excessive facial hair. Current Medical Re- search & Opinion 16(4):235–244 Ehlers Danlos syndrome Synonym(s) Cutis hyperelastica Definition Heterogeneous group of inherited connec- tive tissue disorders characterized by joint hypermobility, skin fragility, and hyperex- tensibility Pathogenesis Specific collagen defect has been identified in 6 of the 11 types: Type IV – decreased Eflornithine. Dermatologic indications and dosage Disease Adult dosage Child dosage Hypertrichosis Apply twice daily Apply twice daily PART5.MIF Page 202 Friday, October 31, 2003 10:08 AM [...]... literature Pediatric Dermatology 12 (4) :351–3 54 Erythrokeratolysis hiemalis ᭤ Keratolytic winter erythema Therapy Cooling or elevating extremity to relieve symptoms of an attackଙ; aspirin 500 mg PO as needed; chemotherapy for myeloproliferative disorder References Cohen JS (2000) Erythromelalgia: new theories and new therapies Journal of the American Academy of Dermatology 43 (5 Pt 1): 841 – 847 E 226 Erythromycin,... Syphilis 500 mg PO 4 times daily for 7 days 250–500 mg PO twice daily for at least 30 days 500 mg PO 4 times daily for 7–10 days 500 mg PO 4 times daily for 2 4 weeks Child dosage 250–500 mg PO daily 30–50 mg per kg daily divided into 4 doses for 10 days 30–50 mg per kg daily divided into 4 doses for 4 weeks 30–50 mg per kg daily divided into 4 doses for 10 days 8 mg per kg daily divided into 4 doses for... manifestation 4 14 day incubation period; virus spreads primarily via aerosolized respiratory droplets Mild prodromal phase, including headache, coryza, low-grade fever, pharyngitis, and malaise First stage: erythema of the cheeks, with nasal, perioral, and periorbital sparing (slapped-cheek appearance) and fades over 2 4 days Second stage: within 1 4 days of the facial rash, erythematous macular-to-morbilliform... 250–500 mg PO 4 times daily for 10 days 250–500 mg PO 4 times daily for 3 weeks 500 mg PO 4 times daily for 3 weeks 500 mg PO 4 times daily for 3 weeks 250–500 mg PO twice daily for at least 30 days 500 mg PO 4 times daily for 15 days Pityriasis lichenoides 250–500 mg PO 4 times daily for 10 days 500 mg PO twice daily Pityriasis rosea 500 mg PO 4 times daily for 2 weeks Relapsing fever (louse-borne) Relapsing... superficial thrombophle- bitis; Weber-Christian disease; pancreatic panniculitis; lupus profundus; traumatic panniculitis; polyarteritis nodosa; rheumatoid nodules Therapy Non-steroidal anti-inflammatory agents; bed rest; leg elevation; prednisone References Requena L, Requena C (2002) Erythema nodosum Dermatology Online Journal 8(1) :4 Erythema nodosum migrans ᭤ Subacute nodular migratory panniculitis Erythema... 4 doses for 15 days 30–50 mg per kg daily divided into 4 doses for 10 days 30–50 mg per kg daily divided into 2 doses 30–50 mg per kg daily divided into 4 doses for 2 weeks 250 mg PO for 1 dose 30–50 mg per kg daily divided into 4 doses for 7days 125–250 mg PO 4 times daily for at least 30 days 30–50 mg per kg daily divided into 4 doses for 10 days 30–50 mg per kg daily divided into 4 doses for 2 4. .. and case report Annals of Plastic Surgery 43 (2):21 1-2 14 Epidermodysplasia verruciformis 211 Therapy Cryotherapy; electrodessication and curettage; sun avoidance References Majewski S, Jablonska S, Orth G (1997) Epidermodysplasia verruciformis Immunological and nonimmunological surveillance mechanisms: role in tumor progression Clinics in Dermatology 15(3):321–3 34 Epidermoid carcinoma ᭤ Squamous cell carcinoma... per kg daily divided into 4 doses for 10 days 30–50 mg per kg daily divided into 4 doses for 7–10 days 30–50 mg per kg daily divided into 2 doses 30–50 mg per kg daily divided into 4 doses for 10 days 30–50 mg per kg daily divided into 4 doses for 3 weeks 30–50 mg per kg daily divided into 4 doses for 10 days 30–50 mg per kg daily divided into 4 doses for 3 weeks 125–250 mg PO 4 times daily for at least... arthri- E 218 Erythema areata migrans tis; lupus erythematosus; Reiter syndrome; gonococcal arthritis Therapy Prednisone; high potency topical corticosteroids References Tyring SK (1993) Reactive erythemas: erythema annulare centrifugum and erythema gyratum repens Clinics in Dermatology 11(1):135–139 References Beacham BE (1993) Common dermatoses in the elderly American Family Physician 47 (6): 144 5– 145 0... Disease Adult dosage Acne vulgaris 250–1000 mg PO daily Acute necrotizing 500 mg PO 4 times daily for 10 days gingivitis Bacillary angiomatosis 500 mg PO 4 times daily for 3 weeks Bartonellosis 500 mg PO 4 times daily for 3 weeks Bejel 500 mg PO 4 times daily for 15 days Ecthyma 250–500 mg PO 4 times daily for 10 days 500 mg PO 4 times daily for 7–10 days 500 mg PO twice daily Erythrasma Hidradenitis suppurativa . Child dosage PART4 .MIF Page 1 94 Friday, October 31, 2003 9:52 AM Dyshidrotic eczema 195 D Therapy Physical therapy in early stages ଙ ; intrale- sional triamcinolone 3–5 mg per ml; partial surgical. tumor: a thirty-year retrospect. Der- matology 201(1):1–5 Enlarged solitary comedone ᭤ Dilated pore Eosinophilia-myalgia syndrome Synonym(s) L-tryptophan-induced eosinophilia-myalgia syndrome;. dis- eases such as Down syndrome, Ehlers-Dan- los syndrome, Marfan syndrome, osteogen- esis imperfecta, scleroderma, acrogeria, pseudoxanthoma elasticum Drug-induced form: associated with peni- cillamine

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