Master the board step 3

Dermatology
Treatment
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Preventive therapy: Keep the skin moist with emollients, avoid hot water
and drying soaps, and use only cotton clothes, because these patients are
extremely sensitive to drying.
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Active disease is managed with the following:
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Topical steroids
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Antihistamines
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Coal tars
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Phototherapy
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Antistaphylococcal antibiotics, if there is impetiginization of the skin
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Topical immunosuppressants, such as tacrolimus and pimecrolimus, can
be used to decrease dependence on steroid use.
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Every effort has to be made to avoid scratching. The topical tricyclic
doxepin can be used to help stop pruritus.
Seborrheic Dermatitis
An oversecretion of sebaceous material, as well as a hypersensitivity reaction
to a superficial fungal organism, Pityrosporum ovale, underlies seborrheic
dermatitis. These patients present with “dandruff,” which may also occur on
the face. Scaly, greasy, flaky skin is found on a red base on the scalp, around
the eyebrows, and in the nasolabial fold.
Treatment
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Low-potency topical steroids, such as hydrocortisone
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Topical antifungal, such as ketoconazole or selenium sulfide
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Zinc pyrithione used as a shampoo
Stasis Dermatitis
This is a hyperpigmentation that is built up from hemosiderin in the tissue. It
occurs over a long period from venous incompetence of the lower extremities
leading to the microscopic extravasation of blood in the dermis. There is no
way to reverse this problem.
Prevention of progression is with elevation of the legs and lower extremity
support hose.
Contact Dermatitis
This is a hypersensitivity reaction to soaps, detergents, latex, sunscreens, or
neomycin over the area of contact. Jewelry is a frequent cause, as is contact
with the metal nickel from belt buckle and wristwatches. It can present as linear
streaked vesicles, particularly when it is caused by poison ivy.
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