Aog

TABLE 16.3 (continued)

Condition

Treatment

Remarks

Infections Intertrigo

Larva migrans Lichen planus

Lichen simplex (neurodermatitis)

Lupus erythematosus (affecting the skin)

Malignancies

Marginal blepharitis (various organisms)

Nappy rash

Pediculosis (Sice) (head, body,genitals)

Pemphigus and pemphigoid see p. 3 14

Cleansing lotions.powders.A dilute corticosteroid with anticandidal cream is often helpful.

Albendazole (single dose) or topical thiabendazole-

Antipruritics; potent topical corticosteroid (rarely systemic).

Antipruritics; topical corticosteroid; explain scratch-itch cycle to patient.

Photoprotection is essential. Potent adrenal steroid topically or intralesionally. Hydroxychloroquine or mepacrine. Monitor for retinal toxicity when treatment is long-term. Other agents include auranofin, acetretm and in severe chilblain LE. thalidomide.

Actinic keratoses and Bowen's disease can be treated with topical 5-fluorouracil (skin irritation is to be expected) or cryotherapy. Imiquimod is a possible topical alternative. Extensive lesions may respond to phocodynamic therapy: the skin is sensitised using a topical haematoporphyrin derivative, e.g. aminolaevulinic acid, and irradiated with a visible light or laser source. CutaneousT-cell lymphoma in its early stages is best treated conservatively; PUVA will often clear lesions for several months or years; alternatives include topical nitrogen mustard, e.g. carmustine. Erythrodermic disease may respond to photopheresis (e x traco r po rea I pho toe hem oth era py ).

Ointment containing adrenal steroid and an antimicrobial.

Prevention: rid reusable nappies of soaps, detergents and ammonia by rinsing. Change frequently and use an emollient cream, e g, aqueous cream, to protect skin. Costly disposable nappies are useful. Cure; mild; Zn cream or calamine lotion, plus above measures. Severe; adrenal steroid topically, plus antimicrobial.

Permethrin, phenothrin,carbaryl or malathion: (anticholinesterases, with safety depending on more rapid metabolism in man than in insects, and on low absorption).

Milder cases of pemphigoid can be treated with dapsone or a combination of nicotinamide and tetracycline. A potent adrenal steroid should be used:other immunosuppressives, e.g. azathioprine, mycophenolate mofetil for adrenal sparing; gold.

To cleanse, lubricate and reduce friction.

May be drug caused, e.g. a phenothiazine or antimalarial.

Covering the lesion so as to prevent scratching.e.g. with a medicated bandage, sometimes breaks the vicious cycle.

A systemic disease, but discoid lupus erythematosus typically has no systemic manifestations.

Undue persistence can be due to allergy to treatment.

Usually two applications 7 days apart to kill lice from eggs that survive the first dose

Oral hygiene and general nutrition very important.

TABLE 16.3 (continued)

Condition

Treatment

Remarks

Photosensitivity

see p. 305

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