TABLE 16.3 (continued)
Larva migrans Lichen planus
Lichen simplex (neurodermatitis)
Lupus erythematosus (affecting the skin)
Marginal blepharitis (various organisms)
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)
see p. 305
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