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TABLE I6.3 Summary of treatment for skin disorders

Condition

Treatment

Remarks

Acne Alopecia

(1) male pattern baldness

(2) alopecia areata

Dermatitis herpetiformis

Eczema

Acute weeping

Subacute

Chronic, with dry scaly lesions

Exfoliative dermatitis

Hirsutism in women

Hyperhidrosis

Ichthyosis vulgaris see p. 31 3

(I)Topical minoxidil is worth trying if the patient is embarrassed by baldness. Some hair regrowth can be detected in up to 50% but it is rarely cosmetically significant.

(2) Finasteride by mouth. (2) Although distressing, the condition is often self-limiting. A few individuals have responded to PUVA or contact sensitistion induced by diphencyprone.

Dapsone is typically effective in 24 h, or suifapyridine. Prolonged therapy necessary, a gluten-free diet can help.

Most patients who take minoxidil orally for hypertension experience some increased hair growth. It may act by a mitogen it effect on hair follicles. The response occurs in 4-12 months: stop treatment if no result in I year.

Antipruritics locally as required. Not other sulphonamides: beneficial effect noi due to antimicrobial action. Methaemoglobinaemia may complicate dapsone therapy.

Lotions (aluminium acetate, calamine), wet dressings or soaks (sodium chloride, potassium permanganate); topical corticosteroid cream or lotion with antimicrobial if infected.

Emollients are the mainstay of treatment. Zinc oxide cream or paste, with mild keratolytic if skin thickening present (salicylic acid or coal ur added): topical corticosteroid ointment.

Keratolyses and moisturising creams and emollients: topical corticosteroid

Chelating agent if due to a heavy metal. Cooling creams and powders locally. Adrenal steroid systemically when severe.

In severe coses: combined oestrogen/ progestogen contraceptive pill: or cyproterone plus ethinyloestradiol (Dianette). Spironolactone, cimetidine have been used.

Astringents reduce sweat production, especially aluminium chloride hexahydrate (20%) in ethyl alcohol (95%). Antimuscarinic (topical or systemic) may help and high local concentrations can be obtained with iontophoresis. Minimally invasive sympathectomy is occasionally necessary; complications include compensatory hyperhidrosis elsewhere-Temporary remission (16 weeks) is achieved by injection of botulinum toxin, most effectively in the axilla.

Emollients to hydrate and smooth the skin, e.g. emulsifying ointment and urea-based creams, e.g. Calmurid. Very severe variants may need acetretin.

Remove the cause where possible. Often exacerbated by soap and water. Antipruritics (not antihistamines or local anaesthetics) may be added to lotions, creams or pastes.

Gamolenicacid (Epogam,evening primrose oil) is of unproven benefit.

For severe chronic dermatitis consider phototherapy (PUVA).azathioprine or cyclosporin in short courses-

Local cosmetic approaches: epilation by wax or electrolysis: ┬┐epilation (chemical), e.g. thioglycollic acid, barium sulphide. Laser epilation Is expensive and the results are transient.

Treatment better in theory than in practice: the volume of sweat dilutes the topical application; the characteristic smell is produced by bacterial action, so cosmetic deodorants contain antibacterials rather than substances that reduce sweat production.

Avoid degreasing skin, e.g. by domestic detergents.

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