Dermatology Prescriptions

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The document discusses various dermatological conditions and their management options including skin disorders, hair disorders, and prescriptions.

Some common skin conditions discussed include eczema, psoriasis, acne, vitiligo, rosacea, and disorders of pigmentation like melasma.

Treatment options mentioned for hair loss include minoxidil, hair sprays, shampoos, and multivitamins as well as injectable and oral steroids.

Page |1

DERMATOLOGY
PRESCRIPTIONS
Page |2

INDEX

Skin Anatomy _______________________________________________________ Page 1

History Taking _______________________________________________________ Page 2

Examination _______________________________________________________ Page 3

Common Terminologies ________________________________________________ Page 4

Differentials of Itchy Eruption ___________________________________________ Page 17

Topical Vehicles _______________________________________________________ Page 18

Topical Steroids _______________________________________________________ Page 19

Anti-Histamine _______________________________________________________ Page 21

Sunscreen ____________________________________________________________ Page 22

For Hyper-Pigmentation _________________________________________________ Page 23

Multivitamins _________________________________________________________ Page 24

Emollients for Dry Skin __________________________________________________ Page 25

Shampoo _____________________________________________________________ Page 26

Common Prescriptions:

Hypersensitivity Reactions

Allergy / Pruritis _______________________________________________________ Page 28

Urticaria ______________________________________________________________ Page 30

Fixed Drug Eruption _____________________________________________________ Page 31

Steven Johnson Syndrome ________________________________________________ Page 34

Erythema Multiforme ____________________________________________________ Page 38

Erythema Nodosum ______________________________________________________ Page 38

Acne Vulgaris __________________________________________________________ Page 39


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Dark Circles & Wrinkles __________________________________________________ Page 43

Disorders Of Pigmentation

Freckles / Melasma ______________________________________________________ Page 44

Scars _________________________________________________________________ Page 48

Keloid Scar ____________________________________________________________ Page 48

Pityriasis Alba __________________________________________________________ Page 49

Vitiligo _______________________________________________________________ Page 50

Ochronosis ____________________________________________________________ Page 51

Erythema Ab IGNE _____________________________________________________ Page 52

Rosacea _______________________________________________________________ Page 53

Telangiectasia On Face ___________________________________________________ Page 54

Photosensitivity, Actinic Dermatitis, Solar Keratosis ____________________________ Page 55

Burns _________________________________________________________________ Page 57

Psoriasis _______________________________________________________________ Page 58

Erythroderma ___________________________________________________________ Page 64

Eczema / Dermatitis

Introduction ___________________________________________________________ Page 65

Atopic vs Contact Dermatitis ______________________________________________ Page 66

Pompholyx ____________________________________________________________ Page 70

Diaper Dermatitis _______________________________________________________ Page 71

Seborrheic Dermatitis / Dandruff ___________________________________________ Page 72

Numular / Discoid Eczema ________________________________________________ Page 74

Intertrigo ______________________________________________________________ Page 74

Factitious / Dermatitis Artefacta ____________________________________________ Page 75


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Lichen Simplex / Lichencification__________________________________________ Page 76

Infestations

Scabies _______________________________________________________________ Page 77

Insect Bite _____________________________________________________________ Page 80

Fungal Infections

Tinea Infection , Pityriasis Versicolor _______________________________________ Page 81

Candidiasis ____________________________________________________________ Page 85

Pityrosporum Folliculitis / Malassezia ______________________________________ Page 87

PhaeoHyphomycosis ____________________________________________________ Page 88

Viral Infections

Chicken Pox ___________________________________________________________ Page 89

Herpes Simplex ________________________________________________________ Page 92

Herpes Zoster ( Shingles )________________________________________________ Page 93

Warts ________________________________________________________________ Page 96

Bacterial Infections

Folliculitis ____________________________________________________________ Page 97

Boil / Furunculosis _____________________________________________________ Page 98

Carbuncle _____________________________________________________________ Page 99

Erysipelas _____________________________________________________________ Page 99

Impetigo ____________________________________________________________ Page 100

Cutaneous TB _________________________________________________________ Page 101

Leprosy ______________________________________________________________ Page 103

Cutaneous Leishmaniasis ________________________________________________ Page 104

Chill Blains / Perniosis __________________________________________________ Page 105


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Lichen Planus _________________________________________________________ Page 107

Disorders of Keratinization

Burning / Cracked Heels _________________________________________________ Page 109

Tylosis / Palmo-plantar Keratoderma _______________________________________ Page 110

Papillon-Lefevre Syndrome ______________________________________________ Page 111

Darier Disease ________________________________________________________ Page 111

Gunther’s Disease _____________________________________________________ Page 112

Ichthyosis, Harlequin Baby, Collodion Baby_________________________________ Page 112

Bullous Disease

Pemphigus Vulgaris, Hailey Hailey Disease, Bullous Pemphigoid _______________ Page 113

Epidermolysis Bullosa __________________________________________________ Page 115

Linear IgA Bullous Disease ______________________________________________ Page 116

Connective Tissue Disorders

Reactive Perforating Collagenosis (RPC) ___________________________________ Page 117

Systemic Lupus Erythmatosus ( SLE )______________________________________ Page 118

Lupus Profundus ______________________________________________________ Page 119

Pseudoxanthoma Elasticum ______________________________________________ Page 119

Lipoid Proteinosis ______________________________________________________ Page 120

Muco-cutaneous Ulcers

Aphtous Ulcers ________________________________________________________ Page 121

Pyoderma Gangrenosum _________________________________________________ Page 122

Behcet’s Disease _______________________________________________________ Page 123

Sweet’s Syndrome _____________________________________________________ Page 124

Sweat Gland Disorders

Hidradenitis Suppurativa _________________________________________________ Page 125


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Miliaria ___________________________________________________________ Page 126

Benign Skin Conditions

Mole _______________________________________________________________ Page 127

Milia ______________________________________________________________ Page 128

Becker’s Nevus _______________________________________________________ Page 128

Nevus Sebaceous ______________________________________________________ Page 128

Nevus Depigmentosus ___________________________________________________ Page 129

Halo Nevus ___________________________________________________________ Page 129

Keratocanthoma _______________________________________________________ Page 129

Hemangioma _________________________________________________________ Page 130

Kassabach-Merritt Syndrome _____________________________________________ Page 130

Lymphanioma Circumscriptum ___________________________________________ Page 131

Neurofibromatosis _____________________________________________________ Page 131

Bowen’s Disease ______________________________________________________ Page 132

Klippel Trenaunay Syndrome ____________________________________________ Page 133

Hair-Related Disorders

Hair loss _____________________________________________________________ Page 134

Alopecia Areata _______________________________________________________ Page 138

Hirsuitism & Hyper-Trichosis ____________________________________________ Page 140


Page |1

ANATOMY
Page |2

HISTORY TAKING
Page |3

EXAMINATION
Page |4

COMMON TERMINOLOGIES
Dermatosis: It is a broad term that refers to any disease of the skin, especially one
that is not accompanied by inflammation

Dermatitis: It is a general term that describes an inflammation of the skin


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DIFFERENTIALS OF ITCHY ERUPTION


P a g e | 18

TOPICAL VEHICLES
( Lotion, Cream, Gel , Ointment )

Absorption rate in increasing order:


Lotion < Cream < Gel < Ointments
P a g e | 19

TOPICAL STEROIDS
LOW-POTENCY ( For Face ) :
Methylprednisolone (Avate)

Mometasone (Hivate / Santomet)

HIGH-POTENCY ( For Body ) :


Fluticone (Ticovate 5g, Cutivate 15g)

Fusidic acid (Fusic, Fusac, Fucidin, Fudic 15g )

Fusidic acid with Hydrocortisone (Fusic H, Fusidin H, Fusac H, Fudic H 15g )

Fusidic acid with Betamethasone ( Fucicort 30g , Fuskin-B 15g )

Betamethasone (Valisone 45g, Provate 10g, Effidex, Betnovate, Pro-one gel)

Betamethasone with Salicylic acid (Provate-S 15g, Valisone-S, Epikilin)

Clobetasol (Clobevate 20g, Covate 30g , Clobederm 10g , Dermovate 15g )

Clobetasol with Salicylic acid ( Cortisil )

STEROID + ANTI-FUNGALS:
Hydrocortisone with Clotrimazole (Hydrozole, Clozox-H )

Diflucortone with Isoconazole (Travocort)

Triamcinolone with nystatin, neomycin, Gramcidin (Kenacomb)

OTHERS:
Flucinolone with Tretinoin, Hydroquinone (Siton-plus)
P a g e | 20
P a g e | 21

ANTI-HISTAMINE

Centrally acting Anti-Histamine:

Tab / syrup Avil (Pheniramine )

Tab Piriton (Chlorpheniramine )

half BD for 10 days

Peripherally Acting Anti-histamine:

Tab Softin, Antial (Loratidine ) 10mg

Tab Desora, Tab Selora (Desloratidine )

Tab Rigix (Cetirazine )

Tab -T day ( Levocetirizine )

Tab Evastel (Ebastine ) 20mg

OD for 10 days / 1 month

OTHERS:

Tab Atoxan ( oxatomide ) sedating 30mg

BD for 1 month

Tab Atarax / Roxyzin ( hydoxyzine ) for pruritis

BD for 1 month

Tab Gabica ( Pregabalin ) 100 mg

OD for 10 days
P a g e | 22

SUNSCREEN
Suntek-60

Suncoat-60

Sunshade-60

Deemal sunscreen

Prote’sun Lotion

 Apply before exposure to sunlight, heater, stove


 Remains effective for 3 hours only
P a g e | 23

FOR HYPER-PIGMENTATION

Tab Glutalex / Glutamax ( Glutathione) BD for 3 months

Whitrum serum BD for 2 months

Melazam/ Melacare / Melaquin / Meladerm / Mederma / Maxdiff skin brightening cream BD


for 2 months

Biofade / Beyonce cream, apply thin layer at night for 1 month

Deemal fade out cream / Mark out cream / Scar gel BD for 2-3 months

Aprica cream on post-acne scars, apply thin layer at night for 2 months
P a g e | 24

MULTIVITAMINS
(For Skin, Hair, Nails)
Cap Iberet

Tab Thera gran ultra

Tab Surbex-Z

Tab Maxidel

Tab Picno plus

Syp Mosigan

Capsule/syrup Bio-Z

Syp Zincol

Tablet Ekstra

Tablet Trihemic 600mg

Tab Perfectil

Cap Folister plus

Tab Vita-syn

Tab Cola-zinc

Tab Maxideen

OD for 3 months
P a g e | 25

EMOLLIENTS FOR DRY SKIN


Emollients:

Olive oil

White Petroleum Jelly 50g, 100g

Derma smooth lotion

Physiogel

Glycream

Deemal moisturizing milk

Dermal cream

Derma save lotion

Hydrogel 50/50

Tarcyl ointment

Mixit Ointment

Lacticare / Hydrophil 5% & 10% lotion ( Lactic acid )

Soaps:

Deemal moisturizing soap

Derma care soap

Softex Soap

Moisten soap
P a g e | 26

SHAMPOO
( Anti-Dandruff, Anti-Hair fall )

Hair-x shampoo
Deemaal anti-dandruff shampoo
Oloprox-S shampoo
Cilox-S shampoo
Stieprox shampoo
Syntar shampoo
Ketowin shampoo
Photonic-max shampoo
Biolyn shampoo

Twice a week
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COMMON
PRESCRIPTIONS
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HYPERSENITIVITY REACTIONS
1. ALLERGY / PRURITIS :
 Centrally acting Anti-Histamine
 Peripherally acting / other Anti-Histamine
 Oral Steroid ( optional )

Centrally acting Anti-Histamine:

Tab / syrup Avil (Pheniramine )

Tab Piriton (Chlorpheniramine )

half BD for 10 days

Peripherally Acting Anti-histamine:

Tab Softin, Antial (Loratidine ) 10mg

Tab Desora, Tab Selora (Desloratidine )

Tab Rigix (Cetirazine )

Tab Evastel (Ebastine ) 20mg

OD for 10 days / 1 month

OTHERS:

Tab Atoxan ( oxatomide ) sedating 30mg

BD for 1 month

Tab Atarax / Roxyzin ( hydoxyzine ) for pruritis

BD for 1 month

Tab Gabica ( Pregabalin ) 100 mg

OD for 10 days
P a g e | 29

Oral Steroids:

Tab Deltacortril ( Prednisolone ) 5 mg, after meal

3+3 OR 2 + 2 + 2 for 3 days


P a g e | 30

2. Urticaria :
Urticaria, also known as hives, is an outbreak of swollen,
pale red bumps or plaques (wheals) on the skin that appear
suddenly -- either as a result of the body's reaction to certain
allergens,drugs or for unknown reasons. Hives usually cause
itching, but may also burn or sting


Ask History
 Investigations
 Counsel
 Centrally acting Anti-Histamine
 Peripherally acting Anti-Histamine
 Oral Steroid

Ask History :

Drug intake / food intake / insect bite etc

Investigations:

Blood CP

Urine R/E

Counsel :

Beware of the causative agent or else, it will recur

Centrally acting Anti-Histamine:

Tab / Syp Avil (Pheniramine ) 10mg

1 TSF OR Half tablet BD for 10 days

Peripherally acting Anti-Histamine:

Tab Desora (Desloratidine)

OD for 1 month

Oral Steroid:

Tab Deltacortril ( Prednisolone ) 5mg, after meal

3 + 3 OR 2 +2 +2 for 3 days
P a g e | 31

3. FIXED DRUG ERUPTION:


Fixed drug eruption describes the development of one or more annular or
oval erythematous patches as a result of systemic exposure to a drug; these
reactions normally resolve with hyperpigmentation and may recur at the
same site with re-exposure to the drug.

Drugs can also cause hair and nail changes, affect the mucous membranes,
or cause itching without outward skin changes.
P a g e | 32

 Find & avoid causative Drug


 Centrally acting Anti-Histamine
 Peripherally acting Anti-Histamine
 Oral Steroid
 Topical Anti-bacterial ointment

Find & Avoid causative Drug Including :

i. NSAIDs ( Aspirin, Ibuprofen, Diclofenac, Indomethacin, Celecoxib, Diflunisal, Etodolac,


etc )
ii. Paracetamol
iii. Cetirizine
iv. Pseudo-Ephidrine
v. Co-Trimoxazole
vi. Fluoroquinolones ( Ciprofloxacin, Levofloxacin, Norfloxacin, Ofloxacin, Gemifloxacin )
vii. Clarithromycin
viii. Doxycycline
ix. Fluconazole
x. Anti-Malarials ( Quinine, Pyrimethamine, Chloroquine, Sulphonamides, Mefloquine,
Atovaquone, Proguanil, Amodiaquin )
xi. Trimethoprim
xii. Hyoscine Butyl Bromide ( Buscopan )
xiii. Phenytoin
P a g e | 33

Centrally acting Anti-Histamine:

Tab / Syp Avil (Pheniramine ) 10mg

1 TSF OR Half tablet BD for 10 days

Peripherally acting Anti-Histamine:

Tab Desora (Desloratidine)

OD for 1 Month

Oral Steroid:

Tab Deltacortril ( Prednisolone ) 5mg , after meal

3 + 3 OR 2 +2 +2 for 3 days

Topical Anti-bacterial ointment :

Mupir ointment ( Mupirocin , Mineral oil )

BD for 20 days
P a g e | 34

4. STEVEN JOHNSON SYNDROME:


Stevens-Johnson syndrome is a rare, serious disorder of your skin and mucous
membranes. It's usually a reaction to a medication or an infection. Early symptoms
of SJS include fever and flu-like symptoms. A few days later the skin begins to
blister and peel forming painful raw areas. Mucous membranes, such as the mouth,
are also typically involved. Complications include dehydration, sepsis, pneumonia,
and multiple organ failure. With a more severe drug reaction, Toxic epidermal
necrolysis (TEN) can occur which is a life-threatening mucocutaneous disease.
P a g e | 35

 Oral / IV Antibiotic
 Centrally / Peripherally acting Anti-Histamine
 Oral / IV Steroid
 Topical Anti-bacterial ointment
 Antibiotic Eye Drops

Oral / IV Antibiotic :

Tab Klaricid ( Clarithromycin ) 250 mg

BD for 5 – 7 days

Infusion Nezkil ( Linezolid ) 200mg/ 100 ml

10 mg / kg X TDS

Tab Nezkil / linzid ( Linezolid ) 600 mg

BD for 15 days

Centrally / Peripherally acting Anti-Histamine :

Tab / Syp Avil (Pheniramine ) 10mg

1 TSF OR Half tablet BD for 10 days

Tab Rigix (Cetirazine )

OD for 10 days / 1 month

Oral / IV Steroid :

Tab Deltacortril ( Prednisolone ) 5mg , after meal

3 + 3 OR 2 +2 +2 for 3 days

Injection Decadron ( Dexamethasone )

1cc X TDS for 2 days


P a g e | 36

Topical Anti-bacterial ointment :

Mupir ointment ( Mupirocin , Mineral oil )

BD for 20 days

Antibiotic Eye Drops :

Nebra eye drops ( Tobramycin )

2 drops X QID
P a g e | 37

PEDIATRIC MANAGEMENT
P a g e | 38

OTHERS :

Erythema Multiforme :

Erythema multiforme is a hypersensitivity reaction


usually triggered by infections, most commonly
herpes simplex virus (HSV). It presents with a skin
eruption characterized by a typical target lesion. There
may be mucous membrane involvement. It is acute and
self-limiting, usually resolving without complications

Erythema Nodosum :

Erythema nodosum is a type of skin inflammation that is


located in a part of the fatty layer of skin caused by a delayed
hypersensitivity reaction Erythema nodosum results in reddish,
painful, tender lumps most commonly located in the front of the
legs below the knees.

Women in early adulthood are commonly affected. Most cases


are idiopathic, but an association with a variety of diseases,
including infections and autoimmune disorders (e.g., ulcerative
colitis), is possible.
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ACNE VULGARIS
P a g e | 40

Oral Anti-Bacterial / Retinoid

Topical Anti-Bacterial / Retinoid

Face wash / Face Cleanser / Face soap

Oral Anti-Bacterial / Retinoid :


1. Oral Tetracycline for Mild Acne :

Tab Adoxa / Oracea (Doxycycline) / Tab Minogen ( Minocycline ) 100mg

OD for 1 month

2. Oral Macrolide for Moderate Acne :

Tab Azotek / Azitma (Azithromycin) 250 or


500mg

1 tablet with 1 day gap for 24 days

3. Oral Retinoid for Severe Acne :

Isotretinoin: 6-8 months course ( 120 mg /


kg )

Cap Isozam 10 mg or 20 mg

Cap Oratane/ Itonin 20 mg

Cap Resoft / Recute 20mg

Cap Atractin / Accutane / Acnoren 20mg

OD for 2 months initially then gradually increase dose till 6-8 months

Maintenance dose: 0.5 to 1 mg/kg / day orally

Maximum dose: Up to 2 mg/kg/day

Investigations :

 Serum ALT
 Serum triglyceride
P a g e | 41

Counsel Regarding Isotretinoin :

 It may cause more acne in the beginning but DONOT discontinue the use.
 It will cause dryness of lips & nose so keep White petroleum jelly in pocket and apply
around lips and nose every 2 hourly.
 DONOT wear contact lenses as it causes dryness of eyes.
 DONOT get pregnant within 6 months as it is Teratogenic.
 DONOT donate blood during its use as your donated blood can get transfused to a
pregnant women causing Teratogenicity.

Topical Anti-Bacterial / Retinoid :


Acrid cream (Clindamycin, Adapalene retinoid)

Cleret or Acdermin gel (Clindamycin, Tretinoin)

Dermina gel ( Clindamycin, Nicotinamide )

Duac gel (Clindamycin, Benzoyl peroxide )

Clycin-T lotion / Clindamex cream ( Clindamycin)

Itonin gel ( Isotretinoin )

Oratraxin gel ( Isotretinoin, Erythromycin )

Triclosan cream ( Anti-bacterial ) apply frequently

Acne serum

Apply minute amount on acne at night for 20 days


P a g e | 42

Face wash / Face Cleanser / Face soap :


Eclear face wash for oily skin

Deemal Anti-acne face wash

Skin-pro face wash

TBS TT face wash

Alite face wash for oily skin

Airol-N cleanser

Deemal moisturizing soap

Softek / Moisten soap for Dry skin

Acne wash soap for oily skin


P a g e | 43

DARK CIRCLES & WRINKLES

 Rezulin-C cream (Glutathione, vitamin C) , Cilix cream ( Ascorbic acid )


OD at morning for 1 month

 Intensive eye orbital serum / Florence cream / Elastogen / Deemal Anti-aging cream /
Mandelac ( mandelic acid ) cream / Vivid cream
BD for 20 days
P a g e | 44

DISORDERS OF PIGMENTATION
1. FRECKLES / MELASMA

FRECKLES:

 spots of hyper-pigmentation formed by collection of 2-3 Melanocytes


 caused by sun exposure
 may occur in adults or children
 found on sun exposed areas like chin, upper arm, shoulders
 common in fair-skinned people

MELASMA:

 patches of hyper-pigmentation caused by over production of Melanin


 caused by genetic predisposition, sun exposure, hormonal changes in pregnant women or
by use of birth control pills, stress, cosmetics
 mostly found in adults
 occur in mask-like pattern on cheeks, nose bridge, above upper lip, forehead
 common in dark- skinned people
P a g e | 45

 Oral / Topical Agents For Hyper-Pigmentation


 Sunscreen
 Multivitamins

Oral / Topical Agents For Hyper-Pigmentation :


Tab Glutalex / Glutamax ( Glutathione) BD for 3 months

Whitrum serum BD for 2 months

Melazam/ Melacare / Melaquin / Meladerm / Mederma / Maxdiff skin brightening cream BD


for 2 months

Biofade / Beyonce cream, apply thin layer at night for 1 month


P a g e | 46

Sunscreen :
Suntek-60

Suncoat-60

Sunshade-60

Deemal sunscreen

Prote’sun Lotion

 Apply before exposure to sunlight, heater, stove


 Remains effective for 3 hours only

Multivitamins :

Cap Iberet

Tab Thera gran ultra

Tab Surbex-Z

Tab Maxidel

Capsule/ Syrup Bio-Z

Tablet Ekstra

Tablet Trihemic 600mg

Tab Perfectil

Cap Folister plus

Tab Vita-syn

Tab Cola-zinc

Tab Maxideen

OD for 3 months
P a g e | 47
P a g e | 48

2. SCARS :
Deemal fade out cream / Mark out cream / Scar gel BD for 2-3 months

Aprica cream for post-acne scars, apply thin layer at night for 2 months

Glyderm cream for stretch marks

3. KELOID SCAR :
 Injectable Steroids
 Scar gel
 Antibiotic
 Anti-Histamine

Injectable Steroids :
Injection Lonacort / Kenacort / Tricort ( Triamcinolone )

3 doses----1 month apart

Scar gel :
Contractubex scar gel

nocte for 3 months

Antibiotic :
Cap Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days

Anti-Histamine :
Tab Piriton ( Chlorpheniramine )

half BD for 10 days


P a g e | 49

4. PITYRIASIS ALBA
( HYPO-PIGMENTATION ):

 Dry, fine-scaled, pale patches on face


 Common in children & young adults
 May be due to zinc-deficiency
 Self-limiting
 Requires more use of moisturizers & less
use of soaps

 Topical Steroid
 Zinc Supplements

Topical Steroid :
Avate ointment ( Methylprednisolone )

Hivate / Santomet (Mometasone )


Apply BD on face for 10 days

Zinc Supplements :
Syrup / Cap Bio-Z

Tab Cola-zinc
Tab Surbex-Z

Syp Zincol

OD for 1 month
P a g e | 50

5. VITILIGO
( DE- PIGMENTATION ):
Long-term, Autoimmune disorder characterized by patches of skin losing
pigment due to destruction of Melanocytes. Affected areas have sharp
margins & may also involve hair, inside of mouth and nose.
It has a poor prognosis in old age, over bony areas such as elbows, or in
lips, finger tips and genital areas.
 Topical Immunosuppressant
 Topical Steroid
 Oral Steroid
 Zinc Supplements

Topical Immunosuppressant :
Crolimus 0.03% , 0.1 % / Eczemus ointment
0.01% , 0.03% (Tacrolimus)

OD at morning for 1 month

Topical Steroid :
Avate ointment ( Methylprednisolone ) on face

Hivate / Santomet (Mometasone ) on face

Vitix gel on face

Ticovate / Cutivate ( Fluticone ) ointment on body

Nocte for 1 month

Oral Steroid :
Syp Neupred ( Prednisolone )

2 + 2 for 3 days

1 + 1 for 3 days

1/2 + 1/2 for 3 days

Zinc Supplements : Syrup / Cap Bio-Z OD for 1 month


P a g e | 51

6. OCHRONOSIS :

 Tab Glutalex / Glutamax ( Glutathione) BD for 3 months


 Deemal Anti-Aging cream BD for 3 months
 Deemal fade out cream BD for 3 months
 Deemal sunblock before exposure to sunlight, heat
P a g e | 52

7. ERYTHEMA Ab IGNE ( EAI ) :

 Avoid risk factor


 Topical De-pigmentation agents
 Topical Steroids
 Oral Anti-Histamine

Avoid risk factor:


Pigmentation can simply be reduced by Avoiding over-exposure to heat

Topical De-pigmentation agents :


Melacare cream ( Hydroquinone, Tretinoin, Mometasone )

Apply BD for 2 months

Topical Steroids :
Cutipro + Covate ( Clobetasol ) ointment

Mix & apply BD for 15 days

Oral Anti-Histamine :
Tab Piriton (Chlorpheniramine )

half BD for 10 days


P a g e | 53

8. ROSACEA :

Rosacea (rose-AY-sha) is a
common skin disease. It often
begins with a tendency to
blush or flush more easily
than other people. The
redness can slowly spread
beyond the nose and cheeks
to the forehead and chin.
Even the ears, chest, and back
can be red all the time

 Oral Tetracycline
 Topical Agents

Oral Tetracycline :
Tab Adoxa / Oracea ( Doxycycline ) 100 mg

OD for 1 month

Topical Agents :
Rozamet ( Metronidazole ) Cream

Apply BD for 1 month


P a g e | 54

9. TELANGIECTASIA ON FACE :
They commonly occur on the nose, chin, and
cheeks, where they may cause facial redness

 Alphagan eye drops


Apply 2 drops BD for 2 months

 Maxdiff / Melacare / Melazam skin brightening cream


Apply BD for 2 months

 Suntek-60 / Suncoat-60 / Sunshade-60 / Deemal sunscreen /


Prote’sun Lotion
Apply before exposure to sunlight, heater, stove

 Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)


Half BD for 10 days
P a g e | 55

9. PHOTOSENSITIVITY / ACTINIC
DERMATITIS / SOLAR KERATOSIS :
 Oral Hydroxychloroquine
 Oral Steroids
 Topical Steroids
 Sunscreen
CHRONIC ACTINIC
 Cryotherapy DERMATITIS

Oral Hydroxychloroquine :
Tab HCQ 200 (hydroxychloroquine)

OD for 1 month

For SLE, Lichen planus, Photosensitivity

Contraindicated in Psoriasis

Oral Steroid :
Tab Deltacortril ( Prednisolone ) 5mg , after meal

3 + 3 for 3 days

2 + 2 for 3 days

1 + 1 for 3 days

Topical Steroid :
Avate ointment ( Methylprednisolone )

Hivate / Santomet (Mometasone )


Apply BD on face for 10 days
P a g e | 56

Sunscreen :
Suntek-60

Suncoat-60

Sunshade-60

Deemal sunscreen

Prote’sun Lotion

 Apply before exposure to sunlight, heater, stove


 Remains effective for 3 hours only

Cryotherapy :
For Solar Keratosis

Other Causes Of Photodermatosis :


 Drugs Including Phenytoin, Tetracyclin can cause photo-toxic reaction.
 Photodermatosis can also occur with Pellagra, a disorder of vitamin B3
( Niacin ) deficiency, causing diarrhea, dermatitis, dementia & death.
P a g e | 57

10.BURNS :

Wound Care :

 Wash with plenty of Normal Saline.


 Apply Topical Fusic , Fusac, Fusidin, Fudic cream
( Fucidic acid )

DONOT prescribe Quench cream (Silver Sulfadiazine) for long time as it leaves
pigmentation

Oral Antibiotics:
Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days

Oral Anti-Histamine:
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 58

PSORIASIS

Inverse / Flexural Psoriasis : Inflamed, red, shiny smooth


painful lesions in skin folds
P a g e | 59

NAIL CHANGES IN PSORIASIS :

Oil Drop Oil

ACRODERMATITIS CONTINUA / ACROPUSTULOSIS :


It is a rare inflammatory disease associated with Pustular Psoriasis & is characterised
by pustular eruptions on the tips of fingers and toes.It is often triggered by localised trauma
or infection & usually involves only one digit, most commonly the thumb.
P a g e | 60

 Counselling
 Topical Steroids / Vitamin-D derivatives / Salicylic acid
 Topical Emollients
 Topical Coal Tar Preparations
 Oral Anti-Histamine
 Oral Immunosuppressants / Oral Retinoids
 Phototherapy

Counselling :
 It is not contagious
 There is no complete cure
 Avoid taking any steroid injection for this

Topical Steroids / Vitamin-D derivatives / Salicylic Acid:


Covate / Clobevate ointment ( Clobetasol ) OR Valisone-S / Provate-S ointment
(betamethasone, salicylic acid) + White Petroleum Jelly

mix & apply BD on body for 15 days

Soronil-C cream / Calpsor- C lotion ( Calcipotriol, Clobetasol )

nocte for 15 days

Topical Emollients :
Calamine Lotion / Dermal cream for body

Derma smooth lotion for scalp

BD for 15 days
P a g e | 61

Topical Coal Tar Preparations :


Tar soap / Tarcyl ointment for body

Syntar / Tarcyl shampoo

thrice a week

Oral Anti-Histamine :
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days

Tab Atarax / Roxyzin ( Hydroxyzine ) for Pruritis

BD for 10 days

Tab -T day ( Levocetirizine )

OD for 15 days

Oral Immunosuppressants / Oral Retinoids : ( For Severe Symptoms )


Tab Methotrexate 2.5 mg ( not to pregnant women )

2 tablets today, 2 tablets tomorrow

In this way, give 4 tablets a week for a total period of 3 weeks

( give 2.5 mg stat then wait for 48 hours then give 7.5 - 30 mg / week )

Investigations : RFTS, CBC

Tab Onset ( Ondansetron )

1 tablet before methotrexate

Tab Acitretin 25 mg ( 2nd generation Retinoid )

OD for 1 month

Phototherapy :
For Extensive Disease
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P a g e | 64

ERYTHRODERMA
P a g e | 65

ECZEMA / DERMATITIS

Dermatitis : Inflammation of skin


Eczema : Pruritic, papulovesicular skin
reaction to endogenous or exogenous agents
P a g e | 66

1. ATOPIC VS CONTACT DERMATITIS


P a g e | 67

TYPES OF HAND DERMATITIS :

Housewives Eczema : Vesicular eczema


With the use of soap, detergents
P a g e | 68

 Avoid Risk Factors


 Topical Steroids
 Topical Emollients
 Oral Antibiotics
 Oral Anti histamine

Avoid Risk Factors ;


 Avoid safeguard, lifebuoy, Dettol soap
 Avoid direct contact with detergents
 Wear double gloves ( cotton + rubber )
 Avoid direct body contact with woolen clothes
( wear cotton + woolen clothes )
 Ask for personal & Family history of Allergy / asthma

Topical Steroids :
Covate , Clobevate (Clobetasol) OR Effidex , Valisone , Provate
(Betamethasone) OR Ticovate ointment (Fluticasone) OR Fucicort , Fuskin-B (
Fusidic acid with Betamethasone ) ointment + White petroleum jelly

mix & apply on body, BD for 15 days

If infected..... add Mupir ointment ( Mupirocin against gram+ )

Hivate , Santomet ( Mometasone ) OR Avate (Methylprednisolone) ointment

Apply OD at night for face, 10 days

Topical Emollients :
Keep skin moist, frequently massage with olive oil

Oral Antibiotics :
Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days


P a g e | 69

Oral Anti histamine :


Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days

Tab Desora, Tab Selora (Desloratidine )

Tab Rigix (Cetirazine )

Tab Evastel (Ebastine ) 20mg

OD for 10 days / 1 month

Tab Atarax / Roxyzin ( Hydroxyzine ) for Pruritis

BD for 10 days

For Hair-Dye Allergy :


Prescribe Shine-On hair dye
P a g e | 70

2. POMPHOLYX

 Avoid Risk Factors


 Topical Steroids
 Topical Emollients

Avoid Risk Factors ;


Avoid contact with irritants & wear double gloves

Topical Steroids :
Valisone-S ointment (betamethasone, salicylic acid) + WPJ

Mix & apply BD for 15 days

Topical Emollients :
Lacticare / Hydrophil 5% & 10% lotion ( Lactic acid )

Apply nocte for 15 days


P a g e | 71

3. DIAPER DERMATITIS

Diaper Hygiene

Topical Steroids ( low-potency ) :


Cutipro cream ( Non-steroidal )

Travocort cream ( Diflucortone with Isoconazole )

Fusic , Fusac, Fusidin, Fudic cream ( Fucidic acid )

Apply BD for 10 days

Oral Anti-Fungal :
Syp Flucoval ( Fluconazole ) to prevent Candidiasis

half to 1 TSF OD for 7 days


P a g e | 72

4. SEBORRHEIC DERMATITIS / DANDRUFF :

 Topical Antifungal & Steroid agents for Scalp


 Topical Steroids for body
 Oral Antimicrobial
 Oral Anti-Histamine

Topical Antifungal & Steroid agents for Scalp :


Micosone ( Miconazole ) + Santomet ( Mometasone ) Lotion

Provate lotion ( Betamethasone ) + Liquid Paraffin

Mix & Apply on Scalp BD for 10 days

Ketowin Shampoo / Deemaal anti-dandruff shampoo / Oloprox-S


shampoo / Cilox-S shampoo

Thrice a week
P a g e | 73

Topical Steroids for body :


Clobevate ( clobetasol ) 40 g / Fudic ( Fusidic acid ) 30 g / Valisone ( Betamethasone )
ointment + WPJ

mix & apply on body BD for 10 days

Oral Antimicrobials :
Syp Duricef ( cefadroxil 1st gen cephalosporin )

BD for 7 days

Oral Anti-Histamine :
Tab T-Day ( Levo-cetirizine )

OD for 10 days
P a g e | 74

5. OTHER TYPES OF DERMATITIS

Numular / Discoid Eczema ( Coin-shaped lesions )

Intertrigo (intertriginous dermatitis)


It is an inflammatory condition of skin folds, induced or aggravated by heat, moisture,
maceration, friction, and lack of air circulation.
P a g e | 75
P a g e | 76

6. LICHEN SIMPLEX /
LICHENCIFICATION :
Lichen simplex chronicus (LSC) is a localized, well-circumscribed area of
thickened skin (lichenification) resulting from repeated rubbing, itching, and scratching of the
skin.

 Topical Steroids
 Oral Anti-Histamine
 Oral Zinc Supplements

Topical Steroids :
Valisone-S , Provate-S (betamethasone, salicylic acid) OR
Ticovate / Cutivate ( Fluticone ) ointment + White Petroleum Jelly

Mix & Apply BD on body for 15 days

Oral Anti-Histamine :
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days

Oral Zinc Supplements :


Capsule / Syrup Bio-Z

OD for 1 month
P a g e | 77

INFESTATIONS
1. SCABIES:
P a g e | 78

 Counselling
 Topical Permethrin Lotion
 Topical Steroid
 Oral Anti-Histamine
 Oral Anti-Helminthic ( If infected )

Counselling :
It is Contagious infection with severe itching so advise proper Topical application of Permethrin
Lotion to the affected person ( twice ) as well as the unaffected person ( only once ) in close
contact.
P a g e | 79

Topical Permethrin Lotion :


Scabizam lotion

Scabfree lotion

Scabiderm lotion

Scabicap lotion

Malin lotion

Lotrix lotion

Scabizine ( Lindane )

Apply on whole body except face... twice with 12


hours gap

Also advice this to the unaffected person in close


contact

Scabion ( Crotamiton, Sulphur ) lotion is less


prescribed as it is less effective

Topical Steroid :
Fusac / Fusidin cream (fusidic acid) OR Fusic H,
Fusidin H, Fusac H, Fudic H ( Fusidic acid with
Hydrocortisone ) on body

Hivate , Santomet ( Mometasone ) OR Avate


(Methylprednisolone) ointment on face

BD for 10 days

Oral Anti-Histamine :
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days

Oral Anti-Helminthic ( If infected ) :


Tab Mectis ( Ivermectin ) 6mg

1-3 tablets today, 1-3 tablets next week


P a g e | 80

2. INSECT BITE :

 Topical Steroid
 Oral Anti-microbial
 Oral Anti-Histamine

Topical Steroid :
Ticovate / Cutivate ( Fluticone ) Lotion

Fusac / Fudic ( Fusidic acid) ointment

apply BD for 20 days

Oral Anti-microbial :
Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days

Tab Dapsin ( Dapsone Anti-bacterial )

half BD for 7 days

Oral Anti-Histamine :
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 81

FUNGAL INFECTIONS
P a g e | 82

Pityriasis / Tinea Versicolor


Tinea Faciei
P a g e | 83

 Topical Anti-Fungals
 Oral Anti-Fungals
 Anti-Fungal Shampoo
 Anti-Fungal Soap
 Oral Anti-Histamine

Topical Anti-Fungals :
Hydrozole , Clozox-H (Hydrocortisone, clotrimazole) OR

Konaz, Ketowin ( Ketoconazole) OR

Lamisil , Terbiderm ( Terbinafine ) OR

Bifomyk ( Bifonazole ) OR

Travocort ( Diflucortone with Isoconazole ) cream / ointment

Apply BD on body for 1 month

Micosone ( Miconazole) OR Konaz ( Ketoconazole) Lotion

Apply BD on Scalp for 20 days

Oral Anti-Fungals :
Tab Terbisil ( Terbinafine) 125 mg Or 250 mg

OD for 1 month

Tab Micoden ( Miconazole) 250 mg

OD for 1 month

Cap Zolanix ( Fluconazole ) 150 mg For Pityriasis Versicolor

2 tablets today

2 tablets on next week


P a g e | 84

Syp Flucoval ( Fluconazole )

Half to 1 TSF OD for 7 days

Cap Rolac ( Itraconazole ) 100mg

BD for 15 days

Anti-Fungal Shampoo :
Ketowin Shampoo

Oloprox-S shampoo

Cilox-S shampoo

Stieprox shampoo

Syntar shampoo

Silkin Shampoo

Thrice a week

Anti-Fungal Soap :
S N S bar

ZN bar

Salcid bar

Oral Anti-Histamine :
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 85

2. CANDIDIASIS :

Oral Thrush
P a g e | 86

 Oral Anti-Fungal
 Topical Anti-Fungal
 Anti-Histamine

Oral Anti-Fungal :
Syp Flucoval ( Fluconazole )

Half to 1 TSF OD for 7 days

Cap Rolac ( Itraconazole ) 100 mg

BD for 15 days

Topical Anti-Fungal :
Daktarin ( Miconazole) gel

Apply inside mouth BD for 10 days

Travocort cream ( Diflucortone with Isoconazole )

Apply BD for 10 days

Anti-Histamine :
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 87

3. PITYROSPORUM FOLLICULITIS /
MALASSEZIA :
Pityrosporum folliculitis is a condition in which the hair follicles of the sebaceous
areas (upper trunk, shoulders, and occasionally head and neck) are infected
with Pityrosporum (Malassezia) yeasts, resulting clinically in inflammatory
papules and pustules

 Topical Ketoconazole
 Oral Ketoconazole

( Donot Give Antibiotics )

Topical Ketoconazole :
Konaz, Ketowin ( Ketoconazole) Lotion

Apply BD on body for 20 days

Oral Ketoconazole :
Tab Ketoval ( Ketoconazole ) 200mg

OD for 5 days
P a g e | 88

4. PHAEO-HYPHOMYCOSIS :
Phaeohyphomycosis is a pigmented deep fungal infection caused by dematiaceous fungi which
usually involve the skin and subcutaneous tissue

Symptoms include papules, plaques and granulomatous changes on the skin & formation of
subcutaneous nodules. In extreme cases, it causes deep infections within the eyes, bones, heart
and central nervous system.

Treatment:

There is no standard therapy. Treatment depends on the clinical symptoms and status of the
patient and includes a combination of antifungal drugs along with surgical intervention.
P a g e | 89

VIRAL INFECTIONS
1. CHICKEN POX:
 Chickenpox ( varicella ) is a viral infection that causes an itchy rash with small, fluid-
filled blisters.
 Chickenpox is highly contagious to people who haven't had the disease or been
vaccinated against it.
 It usually lasts about 5 to 10 days.
 Signs and symptoms, which may appear one to two days before the rash,
include:

Fever

Loss of appetite

Headache

Malaise

 Chicken pox rash follows a Centripetal pattern that is, it appears on trunk region first &
then covers face, arm, legs & mucosal surfaces.
 The rash appears in crops ( Polymorphic ) & goes through three phases:

i. Raised pink or red bumps (papules), which break out over several days

ii. Small fluid-filled blisters (vesicles)

iii. Crusts and scabs, which cover the broken blisters and take several more days to heal
P a g e | 90

 Bed rest & Isolation


 Oral Anti-Viral
 Oral Anti-Bacterial
 Oral Anti-Histamine
 Topical Anti-Microbial / Steroid

Bed rest & Isolation :


Counsel to separate the things in use of the patient & advice complete bed rest for 3-5 days as
it is a highly contagious infection

Oral Anti-Viral :
Tab Viracure ( Famciclovir ) 250 mg

2 tablets TDS for 7 days

Syp / Tab Acylex (Acyclovir ) 800 mg

2 + 2 + 2 + 2 for 5 days

Oral Anti-Bacterial :
Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days

Oral Anti-Histamine ;
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 91

Topical Anti-Microbial / Steroid :


Mupir ( Mupirocin ) Ointment

Fusic , Fusac, Fusidin, Fudic ( Fucidic acid ) Ointment

Apply BD on body for 10 days


P a g e | 92

Herpes Labialis
2. HERPES SIMPLEX:
Herpes simplex is a viral infection caused by the HSV 1 & HSV 2

It has following common types:

 Herpes Labialis ( cold sore ) & Genital Herpes : with painful ulceration
 Herpetic Gingivostomatitis : painful lesions of oral &
pharyngeal mucosa
 Herpetic Whitlow : intensely painful blisters on fingers
( common on index finger & thumb )
 Eczema Herpeticum : diffuse painful erosions over head & upper body, formed on an
underlying dermatological condition

Counsel : Donot share same utensils as it is Contagious

Oral Anti-Viral :
Tab Viracure ( Famciclovir ) 250 mg
Eczema Herpeticum
2 tablets TDS for 7 days

Syp / Tab Acylex (Acyclovir ) 800 mg

2 + 2 + 2 + 2 for 5 days

Oral Anti-Bacterial :
Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg
TDS for 7 days

Oral Anti-Histamine ;
Tab / Syp Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine) BD for 10 days

Topical Anti-Microbial / Steroid :


Mupir ( Mupirocin ) Ointment / Polyfax plus Ointment Apply BD on body for 10 days

For Herpetic Whitlow :


Donot drain surgically

Besides Anti-Microbials, also give analgesics & advise cold compresses, splinting and
elevation to reduce swelling
P a g e | 93

3. HERPES ZOSTER ( SHINGLES ) :

 It is an infection caused by the varicella-zoster virus, which is the same virus


that causes chickenpox. Even after the chickenpox infection is over, the virus
may live in your nervous system for years before reactivating as shingles.
 Old & Immuno-compromised Individuals are at risk of infection
 Characteristic finding include Painful, fluid-filled Vesicles / blisters in a
Dermatomal pattern on one side of the body, typically on the trunk, neck, or
face that does not cross the midline
 Other non-specific symptoms include: Headache, fever, malaise,
Itching, hyperesthesia (oversensitivity), or Paresthesia ("pins and needles",
tingling, pricking, or numbness).
 The rash usually heals within 2-4 weeks; however, some people develop
ongoing nerve pain which can last for months or years, a condition
called Postherpetic neuralgia (PHN)
 It may results in following complications :

 Eye damage, which can occur if you have a rash or blister too close to your eye
(the cornea is particularly susceptible)
 Bacterial skin infections, which can easily occur from open blisters and can be
severe
 Ramsay Hunt syndrome, which can occur if shingles affects the nerves in your
head and can result in partial facial paralysis or hearing loss if left untreated (if
treated early, most patients make a full recovery)
 Pneumonia
 Encephalitis or Meningitis, which is serious and life-threatening
P a g e | 94
P a g e | 95

 Oral Anti-Viral
 Oral Analgesic, Anti-Inflammatory, Anti-Histamine
 Anti-Convulsant / Tricyclic Anti-Depressant for Nerve pain
 Topical Anti-microbial, Numbing agent

Oral Anti-Viral :
Tab Viracure ( Famciclovir ) 250 mg

2 tablets TDS for 7 days

Syp / Tab Acylex (Acyclovir ) 800 mg

2 + 2 + 2 + 2 for 5 days

Oral Analgesic, Anti-Inflammatory , Anti-Histamine


Tab Wilgesic ( Paracetamol, Orphenadrine )

2 + 2 + 2 for 10 days

Anti-Convulsant / Tricyclic Anti-Depressant for Nerve pain :


Tab Gabica ( Pregabalin ) 1o0 mg

OD for 10 days

Tab Amyline ( Amytriptylline ) 150mg

Half BD for 10 days

Topical Anti-microbial, Numbing agent :


Polyfax plus Ointment ( Bacitracin, Lignocaine, Polymyxin B )

Apply BD on body for 10 days


P a g e | 96

4. WARTS :
Viral Warts are typically small, rough, and benign hard growths on skin caused by infection with
human papilloma virus (HPV ). They are contagious, usually occur on the hands and feet but
can also affect other locations. They typically do not result in other symptoms, except when on
the bottom of the feet where they may be painful.

Treatment:
 Avoid scratching as these are contagious

 Keep hands/ feet in warm water for 10 minutes 2-3 times daily so that warts can get

soften & then rub with towel to remove

 Duofilm lotion (salicylic acid, lactic acid)

Apply nocte for 1 - 3 months

 Cryotherapy
P a g e | 97

BACTERIAL / PYOGENIC INFECTIONS


( PYODERMA )
1. FOLLICULITIS :
Folliculitis is the inflammation of hair follicles due to an
infection, injury, or irritation. It can occur anywhere on the skin
except palms & soles.

 Oral Anti-Bacterial
 Topical Anti-Bacterial
 Oral Anti-Histamine

Oral Anti-Bacterial :
Tab Adoxa / Oracea ( Doxycycline ) 100 mg

BD for 15 days

Then OD for 15 days

Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days

Topical Anti-Bacterial :
Clycin-T lotion ( Clindamycin)

Apply BD for 15 days

Oral Anti-Histamine :
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 98

2. BOIL ( FURUNCULOSIS ) :
A boil, also called a furuncle, is a deep folliculitis that is, infection of the
hair follicle along with surrounding skin, It is most commonly caused by
bacterium Staphylococcus Aureus, resulting in a painful swollen area on
the skin ( accumulation of pus and dead tissue )

 Double Anti-Bacterial cover


 Topical Anti-Bacterial & Steroid
 Oral Anti-Histamine

Double Anti-Bacterial Cover :


Tab Adoxa / Oracea ( Doxycycline ) 100 mg

BD for 15 days

Then OD for 15 days

Cap / Syrup Flustal ( Amoxicillin ) OR Cap Bactoxyl ( Amoxicillin, Floxacilin ) 500 mg

TDS for 7 days

AND

Tab Rifampicin 600 mg

OD for 15 – 20 days before breakfast

Topical Anti-Bacterial & Steroid :


Fusic , Fusac, Fusidin , Fudic ( Fucidic acid ) cream

Apply BD on body for 10 days

Mupir Ointment ( Mupirocin )

Apply BD for 20 days

Oral Anti-Histamine :
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days


P a g e | 99

3. CARBUNCLE :
A carbuncle is a red, swollen, and painful cluster of boils that are connected to each
other under the skin.

MANAGENENT :

 Tab Nezkil / Linzid (Linezolid) 600 mg

BD for 15 days

 Drain the carbuncle


 Apply Oxoferin solution ( Tetrachlorodecaoxide ) TDS on affected area

4. ERYSIPELAS :
Erysipelas is a superficial form of cellulitis, affecting the
upper dermis and extending into the superficial cutaneous
lymphatics. It is caused by Group A Streptcoccus. It is a
tender, intensely erythematous, indurated plaque with a
sharply demarcated border, commomly affects face, arms &
legs.

MANAGENENT :

 Oral / IV Penicillin for 10 -14 days

 Analgesics

 Oral Anti-Fungals to control any super-imposed fungal infection

 Keep affected limb elevated to reduce swelling

 Keep the affected area clean

 Adequate diet & activity


P a g e | 100

5. IMPETIGO:
Impetigo is a bacterial infection that involves the
superficial skin, commonly found in infants &
children. It is caused by bacterium Staphylococcus
Aureus or group A Sttreptococcus. The most
common presentation is yellowish ( honey-
colored ) crusts on the face, arms, or legs. Less
commonly there may be large blisters which affect
the groin or armpits. The lesions may be painful
or itchy. It is Contagious

Advice :
Avoid scratching. Take bed rest for 2-3 days as it is contagious

Oral Anti-Bacterial :
Syrup Amoxil, Flustal ( Amoxicillin ) OR Syp Bactoxyl ( Amoxicillin, Floxacilin )

TDS for 7 days

Topical Anti-Bacterial :
Fusic , Fusac, Fusidin , Fudic ( Fucidic acid ) cream

Apply BD on body for 10 days

Mupir Ointment ( Mupirocin )

Apply BD for 20 days

Oral Anti-Histamine :
Syp Avil ( pheniramine)

1 TSF BD for 10 days

Syp Tempramine ( Paracetamol, Chlorpheniramine )

TDS for 7 days


P a g e | 101

6. CUTANEOUS TB :
P a g e | 102

MANAGEMENT :

 Oral ATT
 Topical Anti-Bacterial Ointment
 Anti-Histamine
P a g e | 103

7. LEPROSY:

Leprosy, also known as Hansen's disease (HD), is a contagious long-lasting


disease caused by Mycobacterium leprae or Mycobacterium lepromatosis that
affects the skin, mucous membranes, and nerves.

Symptoms: Initially, infection is without symptoms and typically remains this way
for 5 to 20 years. It then causes decreased ability to feel pain leading to
discoloration and lumps on the skin and, in severe cases, disfigurement and
deformities.

Treatment: includes Multi-drug therapy including Rifampicin, Dapsone,


Clofazimine.
P a g e | 104

CUTANEOUS LEISHMANIASIS:
It is the tropical and subtropical Skin disease caused by Leishmania and transmitted by the bite
of sandflies. The clinical spectrum of Leishmaniasis ranges from a self-resolving cutaneous
ulcer to a mutilating mucocutaneous disease and even to a
lethal systemic illness.

MANAGEMENT :
 Injection Glucantime /
Sodium Stibogluconate
 Oral Anti-Microbials
 Topical Anti-Microbials

Injection Glucantime / Sodium Stibogluconate :


2 cc SC around the ulcer ( 5 doses 5 days apart )

3 cc ( or 20 mg / kg ) IM dose ( If the lesion needs systemic therapy)

Oral Anti-Microbials :
Tab Terbisil ( Terbinafine ) 250 mg

OD for 1 month

Tab Nezkil / Linzid ( Linezolid ) 600 mg

BD for 15 days

Topical Anti-Microbials :
Mupir ( Mupirocin ) cream

Terbiderm ( Terbinafine ) cream

Travocort ( Diflucortone with Isoconazole ) cream

Apply BD for 20 days


P a g e | 105

CHILL BLAINS ( PERNIOSIS ) :

Chill Blains / Perniosis is an inflammatory disorder


that is triggered by prolonged exposure to cold and
damp (humid) conditions. It is a form of
inflammation of the small blood vessels (vasculitis)
and is characterized by painful, itchy, tender, skin
lesions on the lower legs, hands, toes, feet, ears
and face

 Advice
 Topical Steroids
 Oral Vasodilators
 Oral Anti-Histamine
 Oral Anti-Inflammatory drugs

Advice :
Keep the affected area warm & avoid sudden exposure to extreme temperature changes

Topical Steroids ;
Valisone . Provate ( Betamethasone ) OR Clobederam ( Clobetasol ) OR Fusic , Fusac,
Fusidin , Fudic ( Fucidic acid ) ointment + White petroleum Jelly

Mix & apply for 15 days

Oral Vasodilators :
Tab Nifedil / Adalat ( Nifedipine ) 10mg

BD for 10 days

Syrup Ginbex ( gingko leaf extract )

BD for 10 days
P a g e | 106

Oral Anti-Histamine
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days

Oral Anti-Inflammatory drugs: ( For Swelling )


Tab Deltacortril ( Prednisolone ) 5 mg, after meal

3+3 OR 2 + 2 + 2 for 3 days

Tab Danzen-DS ( Serratiopeptidase )

BD for 10 days
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LICHEN PLANUS:
Lichen planus (LP) is a chronic inflammatory
Autoimmune disease of the skin, mucous
membranes and nails. It is characterized by recurrent,
pruritic papules that are polygonal, flat-topped,
purple in color and can coalesce into plaques.
P a g e | 108

 Steroids ( Topical , Oral, Injectable )


 Oral Anti-Histamine

Steroids ( Topical , Oral, Injectable ) :


Hivate , Santomet ( Mometasone ) OR Fudic , Fusic, Fusac, Fusidin ( Fusidic acid ) OR
Valisone , Provate ( Betamethasone ) OR Clobevate ( Clobetasol ) + White Petroleum
Jelly

Mix & apply BD for 10 days

Tab Deltacortril ( Prednisolone ) 5mg after meal

3 + 3 for 3 days

2 + 2 for 3 days

1 + 1 for 3 days

Syp Neupred ( Prednisolone )

1 + 1 for 3 days

1/2 + 1/2 for 3 days

1/4 + 1/4 for 3 days

Injection Lonacort / Kenacort / Tricort ( Triamcinolone )

3 doses----1 month apart

Oral Anti-Histamine :
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine)

half BD for 10 days

Tab Evastel ( Ebastine ) non-sedating

OD for 1 month
P a g e | 109

DISORDERS OF KERATINIZATION :
1. BURNING / CRACKED HEELS :

Topical Steroids / Emollients :


Glycream ( glycerine )

Apply BD for 1 month

Valisone-S ( Bethmethasone , Salicylic acid ) ointment + WPJ

Provate-S lotion ( Bethmethasone , Salicylic acid ) + Capcidol-F lotion ( Capsicum extract,


epsom salt, Mentholum )

Mix & apply BD for 15 days

Multi-Vitamins :
Tab Cecon ( ascorbic acid ) OD for 1 month

Tab Bio-Z ( zinc supplement ) OD for 1 month

Tab Calcipan-T ( Calcium Pantothenate ) TDS for 10 days

Others :
Tab Gabica ( Pregabalin ) 100 mg

OD for 10 days
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2. TYLOSIS
( PalmoPlantar Keratoderma ) :

Tylosis is a rare genetic disorder


characterized by hyperkeratosis
( overgrowth of the outer skin layer
Epidermis ) of the palms of the hands
and soles of the feet.

Topical Emollients / Salicylic Acid :


Glycream

Deemal moisturizing milk

Dermal cream

Hydrogel 50/50

Tarcyl ointment

Lacticare / Hydrophil 5% & 10% lotion ( Lactic acid )

Salicylic Acid Ointment

QID daily

Others :
Topical or Oral Retinoids can also be prescribed if indicated
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OTHER DISORDERS :
PAPILLON-LEFEVRE SYNDROME:
Papillon–Lefèvre syndrome (PLS) is a rare autosomal
recessive disorder, characterized by diffuse
palmoplantar keratoderma and precocious
aggressive periodontitis, leading to premature loss of
deciduous and permanent dentition at a very young age.

DARIERS DISEASE:
Keratosis follicularis, also known as Darier disease (DD) or Darier-White disease, is an autosomal
dominantly inherited disorder characterized by greasy foul-smelling hyperkeratotic plaques / pustules
in seborrheic regions ( Including scalp, forehead, upper arms, chest, back, knees, elbows, and behind
the ear ) , nail abnormalities such as red and white streaks in the nails with an irregular texture, and
small pits in the palms of the hands and soles of the feet , and mucous membrane changes.
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GUNTHER’S DISEASE :

ICHTHYOSIS: ( ik-thee-O-sis )
A genetic disorder of skin, may be congenital or acquired, which causes the epidermis to
become dry and horny like fish scales.
Ichthyosis vulgaris occurs when your skin doesn't shed its dead skin cells.
Treatment: Exfoliating creams and ointments, containing lactic acid and
glycolic acid, help control scaling and increase skin moisture. Oral Retinoids
to reduce the production of skin cells

Harlequin ichthyosis is a severe genetic disorder. Infants with this condition are
born with very hard, thick skin covering most of their bodies. The skin forms large,
diamond-shaped plates that are separated by deep cracks (fissures).

Treatment; Infants will need one-on-one nursing care along with Oral Antibiotics &
Retinoids.

The Collodion baby is another form of Ichthyosis in which the infant born is encased
in a tight shiny Collodion membrane that resembles plastic wrap.

Treatment : The collodion membrane should not be debrided. Give regular emollients
such as petroleum jelly to keep the skin moist. For Pain relief give paracetamol.
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BULLOUS DISEASE:
1. PEMPHIGUS VULGARIS & BULLOUS
PEMPHIGOID :
Pemphigus was derived from the Greek word pemphix, meaning blister.

Pemphigus vulgaris is a rare autoimmune disease that causes painful Intraepidermal


blistering on the skin and mucous membranes. It is mediated by circulating autoantibodies
directed against keratinocyte cell surfaces ( Desmoglein ) . A potentially life-threatening
disease, it has a mortality rate of approximately 5-15%.

Hailey-Hailey disease , also called familial benign chronic pemphigus is a disease that causes
painful rash and blistering in skin folds, such as the armpits, groin, neck, under the breasts, and
between the buttocks.

Bullous pemphigoid is a more common disease than pemphigus that is less aggressive and,
generally, not considered life-threatening. Autoantibodies against hemidesmosomes are the
reason for the subepidermal blistering seen in pemphigoid
P a g e | 114

Counselling :
Counsel the patient that it is a life-threatening disease with no
complete cure

Oral Immunosuppressants :
Tab Imuran ( Azathioprine ) 50 mg

BD……continue use

Oral Steroids :
Tab Deltacortril ( Prednisolone )

Adjust dose according to symptoms

Oral Anti-Microbial :
Tab Nezkil / Linzid ( Linezolid ) 600 mg

BD for 15 days

Oral Anti-Histamine :
Tab Atarax / Roxyzin ( hydoxyzine )

BD for 1 month

Topical Emollients & Steroid :


Provate ( Betamethasone ) + Derma save Lotion

Mix & apply BD for 10 days


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2. EPIDERMOLYSIS BULLOSA:
Epidermolysis bullosa is a group of genetic conditions that cause
the skin to be very fragile and to blister easily. Blisters and skin
erosions form in response to minor injury or friction, such as
rubbing or scratching.
Dystrophic epidermolysis bullosa (DEB) is one of the major
forms of epidermolysis bullosa in which contractures & hand
deformities also occur with a poor life expectancy.

 Counsel the patient that there is no complete cure of the disease

 Counsel the patient to take care of the skin & protect it from trauma

 Apply Topical Anti-Microbial Ointment to affected area :

Mupir ointment ( Mupirocin , Mineral oil )

BD for 20 days
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3.LINEAR IgA BULLOUS DERMATOSIS ( LABD ) :


Linear IgA bullous dermatosis is an autoimmune skin disorder in which IgA antibodies are
formed against basement membrane proteins such as the lamina lucida and sublamina densa &
can be found in a linear pattern just below the epidermis on skin biopsy.

Causes: It is mostly idiopathic & self-limiting in children. In Adults, it tends to occur with an
internal malignancy, infection, and other autoimmune diseases like rheumatoid arthritis. Other
cases of LABD are drug-induced often due to Vancomycin.

Symptoms: Blisters are formed on the base of red or normal-appearing skin with mild itching to
a severe burning sensation. Blisters may appear as a "cluster of jewels” or "string of beads”.
Patient may also experience mucous membrane and ocular involvement including burning and
discharge from the eyes.

Treatment: Idiopathic cases of LABD have been successfully treated with dapsone,
mycophenolate mofetil, colchicine, intravenous immunoglobulin, and Dicloxacillin. A short
course of corticosteroids may also be given to decrease inflammation. Infected lesions may be
treated with topical mupirocin and sterile dressing changes twice daily. For drug-induced cases,
the treatment involves removing the offending drug from one’s drug regimen.
P a g e | 117

CONNECTIVE TISSUE DISORDERS :


1. REACTIVE PERFORATING COLLAGENOSIS
( RPC ) :
Reactive perforating collagenosis (RPC) is
commonly recognized as an unusual skin
reaction to superficial trauma resulting in
transepidermal elimination of altered collagen
through the epidermis. It is observed in patients
with a certain genetic predisposition or
underlying diseases, such as diabetes mellitus or
renal diseases.

 Lesions are self-healing, but usually Recurrent

 Management protocol includes Therapy with Retinoids, Allopurinol, Doxycycline, and


Phototherapy.

 Topical Steroids :
Provate , Valisone Ointment ( Betamethasone ) + WPJ
BD for 20 days on body
Avate Ointment ( Methylprednisolone )
BD For 10 days on face

 Topical Anti-Histamine :
Tab Avil ( pheniramine) or Tab Piriton ( Chlorpheniramine )
Half BD for 10 days
Tab Softin, Antial (Loratidine ) 10mg
OD for 10 days
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2.SYSTEMIC LUPUS ERYTHMATOSUS ( SLE ) :


Systemic lupus erythematosus (SLE) is a chronic auto-immune
disease that causes inflammation in connective tissues, such as
cartilage and the lining of blood vessels. The signs and symptoms of
SLE vary among affected individuals, and can involve many organs
and systems, including the skin, joints, kidneys, lungs, central
nervous system, and blood-forming (hematopoietic) system
P a g e | 119

3.LUPUS PROFUNDUS:
Lupus profundus is a chronic form of cutaneous lupus erythematosus characterized by the
presence of discoid skin plaques with varying degrees of swelling, redness, scaliness, and skin
atrophy. This co-occurs with panniculitis; the inflammation of the fat under the skin. It involves
the arms, face, buttocks, chest, and, less frequently, the abdomen, back, and neck

Treatment options include Intralesional and systemic steroids, antimalarials, mycophenolate


mofetil, dapsone, cyclosporine, and thalidomide.

4. PSEUDOXANTHOMA ELASTICUM ( PXE )


Pseudoxanthoma elasticum (PXE), also known as Grönblad–Strandberg syndrome, is the name
given to a group of connective tissue disorders that causes mineralization and fragmentation of
elastic fibers in the skin, blood vessels, and the eyes

Symptoms: growth of yellowish bumps on the skin of the neck, Laxity and redundant
(excessive) skin folds under the arms, or in the groin area; reduced vision; periodic weakness in
the legs (claudication); or bleeding in the gastrointestinal tract, particularly the stomach.

Treatment: No specific or effective treatment is currently available


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5.LIPOID PROTEINOSIS :
Lipoid proteinosis is a rare autosomal recessive disorder characterized by the deposition of an
amorphous hyaline material in the skin, mucosa, and viscera.

Symptoms include Dry scarred skin, peculiar eyelid papules, abnormality of gums, hoarse cry,
upper respiratory infections and neurological complications including seizures & intellectual
disability.

Treatment: Treatment is based on the signs and symptoms present in each person. The skin
abnormalities may be treated with certain medications, including corticosteriods, dimethyl
sulfoxide, Retinoids, d-penicillamine. Carbon dioxide laser surgery may play a role to cure
growths over vocal cord & eyelids. Anticonvulsant medications are prescribed to people
with seizures.
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MUCOCUTANEOUS ULCERS
APHTHOUS ULCERS ;

Canker sores, also called Aphthous ulcers, are small, shallow round or oval
lesions with a white or yellow center and a red border that develop on or under the
tongue, inside the cheeks or lips, at the base of gums, or on soft palate , can also
occur on genital region. Unlike cold sores, canker sores don't occur on the surface
of your lips and they aren't contagious. They can be painful.

Causes : The cause of canker sores is not known, but most theories involve an
immune abnormality. Certain blood diseases, vitamin and mineral deficiencies,
allergies, trauma and Crohn's disease
cause similar ulcers.

Treatment : Most canker sores go


away on their own in a week or two.
Underlying factors should be treated.
Treatment includes use of topical
barriers, analgesics, anesthetics, anti-
inflammatory & mild to moderate
potency steroids.
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2. PYODERMA GANGRENOSUM :
Pyoderma gangrenosum is a condition that causes tissue to become necrotic, causing deep
ulcers that usually occur on the legs. When they occur, they can lead to chronic wounds.
Ulcers usually initially look like small bug bites or papules, and they progress to larger
ulcers.

CAUSES : It's often associated with autoimmune diseases such as ulcerative colitis,
Crohn's disease and arthritis. And it may have a genetic component. If you have
pyoderma gangrenosum, new skin trauma, such as a cut or puncture wound, may trigger
new ulcers

TREATMENT :
Treatment of pyoderma
gangrenosum is aimed
at reducing
inflammation,
controlling pain,
promoting wound
healing and controlling
any underlying disease.
Give Steroids &
Immunosuppressant
including
Cyclosporin,Infliximab,
Canakinmab
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3. BEHCET’S DISEASE:

Behcet's (beh-CHETS) disease, also called Behcet's syndrome, is a rare


Autoimmune disorder that causes blood vessel inflammation throughout
your body. The disease can lead to numerous signs and symptoms that may
seem unrelated at first. They may include mouth sores, eye inflammation,
skin rashes and lesions, and genital sores

TREATMENT : Immunosuppressive agents used in the treatment of


Behcet's include azathioprine, cyclosporine, cyclophosphamide, and TNF-
alpha inhibitors (infliximab, adaliumuab). With organ- or life-threatening
disease, the combination of prednisone and cyclophosphamide is the
preferred therapy.
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4. Sweet’s Syndrome :
Sweet’s syndrome, also known as acute febrile neutrophilic
dermatosis, is a very rare inflammatory skin condition
characterized by a sudden onset of fever and painful rash on
the arms, legs, trunk, face, or neck.

Causes : It is triggered by an infection, illness or certain medications. Sweet's


syndrome can also occur with some types of cancer

Treatment : The most common treatment for Sweet's syndrome is corticosteroid


pills, such as prednisone. Signs and symptoms often disappear just a few days after
treatment begins, but recurrence is common
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SWEAT GLAND DISORDERS:

1. Hidradenitis Suppurativa (HS)


Hidradenitis suppurativa (HS) is a painful, long-term skin condition that
causes abscesses and scarring on the skin. The exact cause of hidradenitis
suppurativa is unknown, but it occurs near hair follicles where there are sweat
glands, usually around the groin, buttocks, breasts and armpits.
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5. MILIARIA
( Sweat Rash in Hot, Humid conditions ) :

Miliaria Crystilline Miliaria Rubra (Prickly heat rash) Miliaria Pustulosa Miliaria Profunda

Treatment of Miliaria may include:


1. Cool water compresses.
2. Calamine lotion / Emollients to relieve discomfort
3. Treatment of fever with antipyretic such as acetaminophen / paracetamol.
4. Mild topical steroids.
5. Antiseptics and anti-staphylococcal antibiotics for secondary infection.
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BENIGN SKIN CONDITIONS:


MOLE :
Moles are the pigmented growth on skin formed when melanocytes grow in a cluster instead of
being spread throughout the skin. Moles may darken after exposure to the sun, during the teen
years, and during pregnancy.

Treatment: Usually needs no Treatment. Treatment is indicated for cosmetic reasons only &
includes Laser therapy

Attention should be paid to the following of Melanoma :


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MILIA:
Milia are small, bump-like cysts found under the skin. They are
usually 1 to 2 millimeters (mm) in size. They form when skin flakes
or keratin become trapped under the skin. Milia most often appear on
the face, commonly around the eyelids and cheeks, though they can
occur anywhere.

Treatment :

 Topical Retinoid including Adapco gel ( Adapalene )


 Curretage or Crytotherapy.

BECKER'S NEVUS ( Pigmented Hairy Birth Mark ) :


Becker's nevus is a cutaneous hamartoma characterized by an
overgrowth of the epidermis, pigment cells (melanocytes), and
hair follicles resulting in circumscribed hyperpigmentation with
hypertrichosis, may also develop acne.

It can be present at birth, but is usually first noticed around


puberty. It pre-dominantly affects males and typically occurs on
one shoulder and upper trunk but occasionally occurs elsewhere
on the body

Treatment ;

Treatment is indicated for cosmetic reasons only & includes Laser therapy

NEVUS SEBACEOUS ( Hair-Less Birth Mark ):


A nevus sebaceous is the congenital hair-less plaque that can be found
on the scalp ( most common ) , neck, forehead, or face.

Can turn to malignant after 4th decade

Treatment ;

They can be removed by surgical excision for cosmetic reasons, but


scarring is unavoidable and will be permanent after removal.

( No role of Steroids )
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NEVUS DEPIGMENTOSUS ;
Nevus depigmentosus or nevus achromicus is a loss of pigment in
the skin which can be easily differentiated from vitiligo. It is an
uncommon birthmark (naevus) characterised by a well-
defined pale patch. Shape and size varies. Often,
smaller hypopigmented macules arise around the edges, resembling a
splash of paint.

Treatment ;

Most patients with nevus depigmentosus do not pursue treatment for their lesion. There is no
way to repigment the skin. If, however, the lesion is of cosmetic concern, camouflage makeup is
effective. If the lesion is small one could also consider excision & grafting .

HALO NEVUS :
A halo nevus is a mole surrounded by a white ring or halo.
These moles are almost always benign, meaning they aren't
cancerous. Halo nevi (the plural of nevus) are sometimes called
Sutton nevi or leukoderma acquisitum centrifugum. They're
fairly common in both children and young adults.

They usually regress within few years.

KERATOCANTHOMA:
Keratoacanthoma (KA) is a common low-grade rapidly-growing skin tumor that is
believed to originate from the hair follicle ( pilosebaceous unit ) and can
resemble squamous cell carcinoma. It is a dome-shaped lesion filled with keratinous
material that usually occurs on sun-exposed areas of the body, especially around the
head and neck.

Treatment : Curretage or Crytotherapy

 Surgical removal
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HEMANGIOMA:
Hemangioma is a benign blood vessel tumor, commonly found in infants as strawberry like birth marks
on skin. Treatment :

 May take years to regress


 Propranolol
 Oral Steroid ( 1-2 mg / kg for 4 – 6 weeks )

KASSABACH-MERRITT SYNDROME ( KMS )


( Hemangioma with thrombocytopenia ) :
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LYMPHANGIOMA CICRCUMSCRIPTUM:
Lymphangioma circumscriptum is a congenital benign 'microcytic' lymphatic
malformation which appears as a cluster of small firm blisters filled with
lymph fluid.

Treatment :

Surgical excision,cryotherapy, electrocoagulation and laser treatments for


this pathology have all been reported, but surgical excision remains the
mainstay of treatment.

NEUROFIBROMATOSIS :
Neurofibromatosis is a genetic disorder of the
nervous system which causes tumors to grow on
nerves & affects how nerve cells form and
grow. It has following main symptoms :

 Flat, light brown spots on the skin (cafe au lait


spots).
 Freckling in the armpits or groin area.
 Tiny bumps on the iris of the eye (Lisch
nodules).
 Soft, pea-sized bumps on or under the skin
(neurofibromas).
 Bone deformities.
 Tumor on the optic nerve (optic glioma).
 Learning disabilities.

Treatment :
There is no known treatment or cure for neurofibromatosis. In some cases, growths may be
removed surgically or reduced with radiation therapy.
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BOWEN’S DISEASE :
Bowen’s disease, also known as squamous cell carcinoma in situ, is a pre-cancerous skin
condition affecting the epidermal layer of the skin.

Causes: Prolonged sun-exposure & aging are the two main factors. Others include
immunosuppression, a pre-existing HPV cutaneous infection & chronic exposure to arsenic.

Symptoms: Mostly affects the sun-exposed areas of the body but may also affect other regions
including head, neck, palms, soles, lower legs and genitals.

It appears as a slow-growing, persistent reddish-brown patches of dry, scaly skin which may
become warty, fissured, darkly pigmented & crusted. Other symptoms that may develop are
itching, oozing pus & bleeding.

Treatment:

A wide variety of treatment options exist for individuals with Bowen disease including topical
chemotherapy ( with 5-fluorouracil and imiquimod 5% ) , cryotherapy, curettage, photodynamic
therapy and surgery.
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KLIPPEL TRENAUNAY SYNDROME ( KTS ) :


Klippel-Trenaunay syndrome is a rare congenital condition that affects the development of
blood vessels, soft tissue and bones & is characterized by a triad of cutaneous capillary
malformation ("port-wine stain"), lymphatic anomalies, and varicose veins in association with
variable overgrowth of soft tissue and bone. It is caused by the somatic mutation in the
gene PIK3CA.

Treatment:
Capillary Malformation: It can be improved by laser therapy, sclerotherapy
or sometimes resection and closure of the skin or replacement with a split-
thickness skin graft.
PORT-WINE STAIN
Lymphatic Malformation: Macrocystic malformations can be deflated by sclerotherapy (injection
of irritating solutions), whereas, microcystic malformations may require resection.
Venous Malformation: Blood stagnates in large dilated veins, and thus there is a risk for
initiating a clotting disorder or thrombosis and pulmonary embolism.
Anticoagulation with heparin is often necessary prior to radiologic or surgical
intervention. Large venous channels can be obliterated by sclerotherapy or
endovascular laser. Chronic bleeding from the colon may require surgical
resection. Bleeding lesions in the bladder can be controlled by laser through a
cystoscope. An elastic compressive stocking is often useful to minimize
discomfort and swelling due to venous distension in the limb.
Overgrowth: Enlarged toes may require amputation to narrow the foot and
permit footwear. Discrepancy in leg length can be corrected by inserting a lift
in the shoe on the normal foot to prevent compensatory curvature of the spine
(scoliosis). Surgical closure of the growth plate at the knee (epiphysiodesis) is
often needed to equalize leg length.
.
P a g e | 134

HAIR RELATED DISORDERS :


1. ALOPECIA ( HAIR-LOSS ) :
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 Trichotillomania (trik-o-til-o-MAY-nee-uh)
Also called hair-pulling disorder, is a mental disorder that
involves recurrent, irresistible urges to pull out hair from your
scalp, eyebrows or other areas of your body, despite trying
to stop.
P a g e | 136

MANAGEMENT ( atleast 4 months ) :

 Hair Tonic
 Minoxidil Hair Spray
 Shampoo
 Multi-vitamins
Hair Tonic :

Deemal hair tonic

Repair energy serum

Apply before washing hair

Minoxidil Hair Spray :

Hair max spray ( with 5 % Minoxidil )

Hairgen spray / Pilus hair spray ( without Minoxidil )

Apply to hair-root with a cotton bud

Twice daily

Shampoo :

Hair-x shampoo

Photonic-max shampoo

Biolyn shampoo

Twice a week
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Multi-vitamins :

Tab Thera gran ultra

Tab Surbex-Z

Tab Maxidel

Tab Picno plus

Capsule/syrup Bio-Z

Tablet Ekstra

Tablet Trihemic 600mg

Tab Perfectil

Cap Folister plus

Tab Vita-syn

Tab Cola-zinc

Tab Maxideen

OD for 3 months
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P a g e | 139

MANAGEMENT :

 Topical Minoxidil lotion


 Injectable Steroid
 Oral Steroid

Topical Minoxidil lotion :


Minoxidil lotion 5%

Gromaxx 5F lotion

BD for 2 months

Injectable Steroid :
Lonacort , Kenacort,, Tricort ( Triamcinolone ) injection

Depo-medrol ( Methyl prednisolone ) injection

3 doses----1 month apart

Oral Steroid :
Syrup Neupred ( prednisolone, prednisone )

1 + 1 for 3 days

Then ½ + ½ for 3 days

then ¼ + ¼ for 3 days

Tab Deltacortril ( prednisolone, prednisone ) 5 mg

3 + 3 for 3 days

then 2 + 2 for 3 days

then 1 + 1 for 3 days

with

Cap Omega ( omeprazole ) 20 mg

OD before breakfast
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2. HIRSUITISM & HYPER-TRICHOSIS:


HIRSUITISM:
Presence of excessive terminal hair in Androgen- dependent areas of a
woman’s body like face, chest, areola, lower back, buttock, inner
thigh & external genitalia.

It is caused by PCOs, Hyperprolactinemia , Ovarian & adrenal


tumors, use of drugs like systemic steroids, OCPs, isotretinoin,
carbamazepine or it may be Idiopathic.

HYPER-TRICHOSIS :
Excessive hair growth among both males & females that appear in Non-Androgen dependent
areas of body like forehead, forearm, hands.

It is caused by malnutrition, hypothyroidism or other endocrine disorders & can also occur by the
use of systemic steroids, minoxidil, etc

Management :
 Treat the underlying cause

 Hair removal through waxing, trimming, laser therapy

 Hair retardation using :

Epila cream ( Eflornithine )

Apply after removing hair

Tab Aldactone-A ( spironolactone ) 25 mg….for androgen-dependent hair growth

BD for 1 month
P a g e | 141

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