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Common Skin Problems


Atopic Dermatitis
Rx: 
1. Advice- Give patient the following handout
2. Medication-
a. Mild:
 - Soap substitutes such as aqueous cream
-  Emollients apply bd to dry skin eg. Aqueous cream, sorbolene, paraffin creams, bath oils, moisturising lotions
-  1% hydrocortisone ointment od or bd
b. Moderate:
- as for mild
- Topical steroids:  moderate strength for truck and limbs, weaker strength to face and flexures (10 days on / 4 days off in chronic cases)
- NSAID cream alternative:  pimecrolimus
- Oral anti-histamines
c. Severe:
- As for mild and moderate eczema
- Potent steroids to worse areas
- Rarely systemic steroids
- Allergy assessment if unresponsive
d. Weeping
- Soak affected areas with Burow's solution 
 

Seborrhoeic Dermatitis
1. Seborrhoeic Dermatitis of Infancy
Rx:
Scalp: 1-2% sulphur and 1-2% salicylic acid in aqueous: apply overnight to scalp, shampoo off next day with a mild shampoo.  Use 3 x per week until it clears
Egozite cradle cap lotion
Face, Flexures and trunk: Ketoconazole 2% cream bd
Napkin Area: Hydrozole (Hydrocortisone 1% + Clotrimazole1%)


2. Adult Seborrhoeic Dermatitis
Scalp
  • Medicated shampoos containing ketoconazole, ciclopirox, selenium sulfide, zinc pyrithione, coal tar, and salicylic acid, used twice weekly for at least a month and if necessary, indefinitely.
  • Steroid scalp applications reduce itching, and should be applied daily for a few days every so often.
  • Tar cream can be applied to scaling areas and removed several hours later by shampooing.

Face, ears, chest & back

3. Psoriasis
Rx:  Click Here
Patient handout:  Click Here

4. Rosacea

Clinical Features:
- 30-50 yo
- Forehead, nose and chin
- "Flushing and blushing"
- Peri-orbital and peri-oral areas 
- Can get pustules and papules

Complications:
- Blepharitis
- Conjunctivitis
- Rhinophyma

Management:
2. Systemic Antibiotics
- Minocycline or Doxycycline 50mg bd for 8 weeks
- If these fail : Metronidazole 200mg for 10 days
3. Topical Agents
Mild:  2% Suphur in Aqueous cream tds
Severe:  Clindamycin 1% solution bd
4. Laser Therapy for telangectasia, erythema and phinophymas

5. Peri-oral Dermatitis


Clinical Features:
- acne-like dermatitis of the lower face
- women 20-50
- Children and adolescents
- "muzzle area"
- nasolabial folds
- Multiple red macules and papules
- Burning and irritation
- Ass with seb derm on scalp and head

Management
1. Doxycycline or minocycline 100mg daily for 6-8 weeks 
2. DO NOT USE steroids or 'creamy' preparations including cleansers, moisturisers and make-up
3. Topical Ketoconazole cream and shampoo 10-14 days or metronidazole 0.75% gel BD