Archive

Dermatophytes

1. Tinea capitis: head

    1. Tab griseofulvin 500mg qd 4-6 weeks (10-20 mg/kg, tab 125 mg), use with fatty meal

        1. or Tab itraconazole 100mg qd for 6 weeks (5mg/kg/day)

    2. Shampoo Ketoconazole 2%

        1. or shampoo selenium sulfide qod

        2. Use it for all members of the family

    3. Dis-infect personal objects

2. Tinea corporis: body

    1. Round, exfoliative patch or plaque with peripheral bulging and central hypopigmentation

    2. if limited area

        1. Cream clotrimazole 1% bid for 4 weeks

            1. or cream miconazole 2%

            2. or cream terbinafine 1%

        2. solution burrows tds

    3. if severe case all around the body

        1. Cream terbinafine 1% bid for 4 weeks

        2. Cap itraconazole 200 mg qd for 1 week

        3. solution burrows tds

3. Tinea cruris: groin

    1. if limited area

        1. erythematous lesion, pruritic, sharp border

        2. Cream clotrimazole 1% bid for 4 weeks

            1. or cream miconazole 2%

    2. if severe case

        1. Cap itraconazole 200 mg qd for 1 week

        2. solution burrows tds

4. Tinea pedis: foot

    1. more common tinea

    2. for limited lesions:

        1. Cream clotrimazole 1% bid for 2 weeks

            1. or cream terbinafine 1%

    3. for severe cases:

        1. cap itraconazole 200 mg qd for 1 week

5. Onychomycosis

    1. for 1-2 nails

        1. Cream ciclopirox 20gr bid 4weeks

            1. or cream cream clotrimazole 1% qd

            2. or cream miconazole 2% qd

    2. For >2 nails

        1. Tab terbinafine 250 mg qd (foot 12weeks, hand 6weeks)

            1. or cap itraconazole 100 mg qd

        2. check LFT before starting the treatment and monthly

        3.

1. Tinea capitis

    1. More in children

    2. Types

        1. Endotrix

            1. In hair body

            2. Black dots

            3. Trichofitun with green flurence

            4. Usually inflammation is not severe

        2. Ectrotrix

            1. Gray patch

            2. Spurs on hair

            3. Microsprum canis and odeini

            4. Exfuliative

        3. Inflammatory

            1. Kerion

                1. Zoonotic tinea

                2. A form of ectrotrix

                3. Pussy pustules

                4. Smear in negative

                5. Cervical adenopathy

                6. Fever, leukocytosis

            2. Favus

                1. T. Shoilini

                2. cup shape pit, wet wound

                3. Scarring alopecia

                4. Chronic form

                5. Green-gray flourocence

1.

Acnes

1. For non inflammatory acnes

    1. Soap glycerin PRN

    2. Cream tretinoin 0.05% for dry skins

    3. Gel tretinoin 0.05% for oily skins

    4. Lotion tretinoin 0.05% for body

2. For inflammatory acnes

    1. Gel benzoyl peroxide 5% only on acnes

    2. Topical AB therapy

        1. Alcohol 70% 100cc

        2. Tetracycline or Clindamycin or erythromycin 2 gr

    3. or Systemic AB therapy for 6 months

        1. Cap tetracycline 250 mg qid

        2. or Cap doxycycline 100 mg bid

        3. or tab erythromycin 400 mg qid

    4. Sunscreen cream SPF >30

    5. In women on OCP use Cap amoxicillin 250 mg qid

3. Do not use benzoyl with tretinoin

4. Lab data:

    1. Testosterone, DHEAS

        1. high T, NL D ⇒ T from ovaries

            1. contraceptive HD for 21 days

        2. NL T, High D ⇒ D from Adrenal

            1. Tab prednisolone 5 mg qd

        3. Both HIGH

            1. contraceptive HD for 21 days

            2. Tab prednisolone 5 mg qd

        4. other forms ⇒ refer the PT

5. For skin whitening:

    1. Cream AHA 15% My #1 QoD

    2. Cream Vit-c Medilann # bid