What does Tinea look like?
Annular or arcuate scaly and itchy rash with a definite edge and central clearing as it expands. Tinea pedis occurs on the feet and tinea cruris on the groin
What is the treatment of Tinea?
Imidazole topical preparation • Terbinafine (Lamisil) • Bifonazole (Sporanox) • Miconazole (Monistat) • Clotrimazole (Canesten) Lamisil PO required if nails involved (as shown by yellow discolouration). 2° nail infection with candida can occur.
What is the pathogenesis of acne?
- Increased sebum production
- Outflow obstruction
Stasis of sebum leads to infection & subsequent immune reaction:
- ‘White-head’ (inflammatory) if comedo is closed
- ‘Black-head’ (non-inflammatory) if comedo is open
- Cystic acne occurs if the comedo becomes encircled
What are the topial agents used to treat acne?
- Benzyl peroxide (OTC)
- Used at night for 15mins, then 30mins, etc. until overnight
- Bleaching agent (beware of clothing)
- Tertinoin / Retinoic acid
- Vitamin A derivative (not Abx)
- Excellent for blackheads (non-inflammatory acne)
- Cream applied to whole face, even when no acne
- More effective than benzyl but hphotosensitivity & irritation
- Erythromycin (Eryacne) and Clindamycin (ClindaTech)
- Topical Abx
- Good for whiteheads (inflammatory)
- Used as cream on whole face
What are the systemic Rx for acne?
- ABx
- Tetracycline, Doxycycline, Minocycline, Erythromycin, Trimethoprim
- Minocycline used when no response to above two agents or poor SE profile
- OCP
- Combined oral contraceptives that are likely to improve acne include those containing cyproterone, desogestrel, drospirenone or gestodene as the progestin.
- Cyproterone acetate in OCP formulations (2mg)
- Extra cytoproteroe acetate can be added
1. Isotretinoin (Roaccutane) - Vitamin A derivative
- Extremely high efficacy typically within 4-6months
- Last line therapy; also used for cystic cases
- SE’s: hLipids, photosensitivity, drying of mucous membranes, depression
How is pityriasis rosea commonly described?
In young adults. Starts with one “herald patch” (a red, macular patch / plaque) and then spreads 1-20 days later in the T-shirt and shorts region.
What is the prognosis of pityriasis rosea?
Pityriasis rosea clears up in about six to twelve weeks.
What is the typical patient and where is the typical distribution of a rash from a fungal infection?
In diabetics. In creases (warm, moist areas) eg. under breasts, in groin.
