Don't Rx aspirin/NSAID/ACE inhibitor

In cases of angioedema

Case: Rash on Sweating

Often quite itchy

Miliaria

• rubra variant ('prickly heat'; 'heat rash')
• small red papules; some may appear more like vesicles
• sometimes looks like folliculitis
• but rash not related to hair follicles
• dermoscope may help distinguish
• itchy (look for scratch marks)
• ?clothing distribution/friction
• epidermal
• sweat may leak into dermis
  --> very itchy lumps
• may get secondary infection
  = miliaria pustulosa
• Rx
• reduce heat/sweating
• cold compresses
  calamine lotion
• topical c.steroid
• not antihistamine as = not related to histamine release

Cholinergic urticaria (a physical urticaria)

• Rx
• reduce heat/sweating
• antihistamine (non-sedating)
• oral c.steroid

Polymorphous Light Eruption

Often triggered by short UVB and long UVA


If by UVA

• Sun block not very effective
• Can be triggered by light through windows

Genital Ulcer

Painful
=> Herpes simplex (I or II)

Painless
=> Syphilis (primary; chancre)

Poorly-defined
=> Chancroid

Hemorrhagic
=> Granuloma inguinale (Donovanosis)

Tinea or Pityriasis?

Fungi <--> Tinea
But "tinea" generally reserved to describe circinate lesions => 'ring worm'
- in particular, those caused by a dermatophyte

So, tinea => dermatophyte
Generally followed by the region it affects e.g. tinea pedis (foot); tinea corporis (trunk) etc.


Candida albicans and Malassezia furfur
- are yeast-like and not dermatophytes

Candida --> candidiasis
Mallassezia furfur --> pityriasis versicolor (misnomer = tinea versicolor)


Important reason for understanding this

• Tinea, including onychomycosis (nails)
• responds to terbinafine (e.g. Lamisil) and griseofulvin (e.g. Grisovin)
  &
  responds to the "azoles"
• Candidiasis and pityriasis versicolor
• do not respond to terbinafine or griseofulvin
  but
  respond to the "azoles"

So 

• Tinea                                      --> terbinafine or griseofulvin or an azole
• Candidiasis                          --> an azole
• Pityriasis versicolor             --> an azole

Elidel and Protopic

PBS Listing

For eczema on face where topical c.steroids have failed to control disease or where intermittent topical c.steroids are contraindicated


Intermittent use only


Don't use for more than 2 years as no safety data yet


Children 3/12 to 2 years old

• Apply to smallest practical area
• Max 3/52 episode

Topical C.Steroid vs. Elidel or Protopic

In adults:                topical c.steroids are more effective

In children:             unknown