This document summarizes a presentation on recent topics in dermatology given to internal medicine providers. It reviews guidelines for managing simple skin abscesses, latest treatments for hidradenitis suppurativa and atopic dermatitis such as dupilumab, and skin cancer prevention options. Case studies are presented on abscesses, toenail fungus, eczema, and hidradenitis suppurativa. Management options are discussed based on recent clinical trials for these conditions.
Bringing basic dermatology to the pediatric medical home session 3 wartsppochildrens
This patient has atopic dermatitis, not molluscum. The best treatment is:
D. Hydrocortisone 2.5% ointment BID plus emollients for 2-3 weeks or until improved.
Topical corticosteroids are the mainstay of treatment for atopic dermatitis flares to reduce inflammation and itching. Emollients help maintain the skin barrier. Treatments for molluscum like tretinoin or cantharidin would not be appropriate here and could exacerbate the dermatitis.
This document provides an overview of burns, including their anatomy, physiology, classification, treatment, and management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the standard phases of burn care - the emergent/resuscitative phase focuses on fluid resuscitation and wound care, the acute/intermediate phase on preventing infection and wound closure, and the rehabilitation phase on minimizing scarring and functional loss. Complications are also reviewed. The document aims to give healthcare practitioners an understanding of burns and their multifaceted management.
The document discusses allergies to antimicrobials and strategies for evaluating reported drug allergies. It notes that the majority of reported penicillin allergies are not actually confirmed upon testing. Skin testing and graded challenge tests can help determine if patients with reported allergies can safely receive certain antibiotics like penicillin and cephalosporins. The document also reviews scenarios of evaluating patients with possible allergies and emphasizing the importance of diagnostic testing to avoid exposing patients to unnecessary harm from antibiotics they may not actually be allergic to.
• Recognize that the majority of reported penicillin allergies are
not confirmed upon testing and expose patients to undue
harm
• Understand when diagnostic testing, including skin testing, is
indicated to confirm an antimicrobial allergy
• Employ strategies to determine if cephalosporins can be used
in patients with reported penicillin allergies.
Bringing basic dermatology to the pediatric medical home session 3 wartsppochildrens
This patient has atopic dermatitis, not molluscum. The best treatment is:
D. Hydrocortisone 2.5% ointment BID plus emollients for 2-3 weeks or until improved.
Topical corticosteroids are the mainstay of treatment for atopic dermatitis flares to reduce inflammation and itching. Emollients help maintain the skin barrier. Treatments for molluscum like tretinoin or cantharidin would not be appropriate here and could exacerbate the dermatitis.
This document provides an overview of burns, including their anatomy, physiology, classification, treatment, and management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the standard phases of burn care - the emergent/resuscitative phase focuses on fluid resuscitation and wound care, the acute/intermediate phase on preventing infection and wound closure, and the rehabilitation phase on minimizing scarring and functional loss. Complications are also reviewed. The document aims to give healthcare practitioners an understanding of burns and their multifaceted management.
The document discusses allergies to antimicrobials and strategies for evaluating reported drug allergies. It notes that the majority of reported penicillin allergies are not actually confirmed upon testing. Skin testing and graded challenge tests can help determine if patients with reported allergies can safely receive certain antibiotics like penicillin and cephalosporins. The document also reviews scenarios of evaluating patients with possible allergies and emphasizing the importance of diagnostic testing to avoid exposing patients to unnecessary harm from antibiotics they may not actually be allergic to.
• Recognize that the majority of reported penicillin allergies are
not confirmed upon testing and expose patients to undue
harm
• Understand when diagnostic testing, including skin testing, is
indicated to confirm an antimicrobial allergy
• Employ strategies to determine if cephalosporins can be used
in patients with reported penicillin allergies.
chemotherapy or cancer chemotherapy is the treatment modality used for the treatment of a tumor or cancerous disease this ppt give a detailed use of drugs used for the cancer and what all the pracuation can be taken while handling it and can be used as study material for bsc and gnm for their examination purpose as well as apply their knowledge in their clinical practice
A 79-year-old man presented with stage IVA squamous cell carcinoma of the head and neck. He was treated with intensity modulated radiotherapy plus concurrent cetuximab, achieving a complete response with manageable toxicity. Follow-up imaging at 9 months showed no evidence of recurrence.
palmoplantar pustolar Psoriasis induced in a patient treated with infliximab ...Dr. Faramarz Didar
Dr. Faramarz Didar presents a case of a patient with Crohn's disease who developed palmoplantar pustular psoriasis after treatment with infliximab. The patient was initially diagnosed with hand, foot, and mouth disease by her GP and treated unsuccessfully with antibiotics. Dr. Didar then treated the patient with potent topical corticosteroids and saw improvement. A literature review showed that potent corticosteroids are a first-line treatment for anti-TNF induced psoriasis, though use should be limited to 4 weeks. Guidelines recommend discussion in a multidisciplinary team to determine appropriate long-term management, which may include continuing anti-TNF treatment depending on
This document summarizes a presentation on atopic patch testing for identifying allergens that trigger atopic dermatitis. It discusses:
- Patch testing 75 subjects with atopic dermatitis using common allergens like dust mites, pollens, foods and pet dander. 46.66% showed positive reactions, most commonly to parthenium and bermuda grass pollens.
- Counseling patients to avoid identified allergens based on patch test results can help reduce symptoms and lower reliance on medications for atopic dermatitis.
- Advantages of patch testing over skin prick tests include lower risk of reaction and higher specificity. Limitations are lower sensitivity and fewer allergens can
This document provides an overview of burn injuries including definitions, anatomy, stages of wound healing, etiology, incidence, types, classification, extent, location, patient risk factors, pathophysiology, clinical manifestations, diagnostic evaluation, complications, management, prehospital care, fluid therapy, wound care, drug therapy, nutritional therapy, excision and grafting, rehabilitation, nursing management, nursing diagnoses, and a bibliography. The key points covered are definitions of burns, the Lund Browder chart for classifying burn severity, Parkland formula for fluid resuscitation, goals of wound care including cleansing and debridement, and nursing diagnoses related to burns such as impaired skin integrity and risk for infection.
This topic is oriented mainly on the Bailey & Love - 26th edition.
This will be of immense help for the MBBS - Students for the Theory as well as Clinical application.
With thw evolution of the medicine and increasing of the survival rate of cancer patients , its commonly to be seen in dental clinics. OMFS must know about their patients conditions , treatments and how to manage them in order to provide them good care and good life.
Palmoplantar pustolar psoriasis induced with infliximab in treating crohn di...Dr. Faramarz Didar
The document discusses a case of palmoplantar pustular psoriasis (PPP) induced in a patient treated with infliximab for Crohn's disease. It presents the patient's history and skin presentation. The key therapeutic challenge is determining whether the skin condition is a drug reaction or another diagnosis like psoriasis. Evidence from studies and guidelines indicates that potent topical corticosteroids are first-line treatment for drug-induced psoriasis. The author recommends topical corticosteroid therapy as first-line treatment for this patient's PPP, with close monitoring and potentially continuing anti-TNF therapy depending on the response. A multidisciplinary team approach is needed to
This document discusses the classification, pathophysiology, and management of burns. It describes the different types and degrees of burns, from first to fourth degree. It outlines the assessment of burn size and depth. The key aspects of initial and ongoing burn management are presented, including fluid resuscitation, wound care, infection prevention, and complications. Surgical procedures like escharotomy and grafting are also summarized.
This document summarizes guidelines for the topical treatment of psoriasis. It discusses several topical treatment options including corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, salicylic acid, anthralin, coal tar, and combination therapies. It provides details on the efficacy, dosing, safety and guidelines for each treatment. It also discusses when systemic therapies like methotrexate may be appropriate and provides dosing guidelines for methotrexate treatment of psoriasis.
1) A 3-year old girl was brought to the hospital with 18% third-degree burns to her face, scalp, and shoulders from a hot oil accident.
2) She received initial care including fluid resuscitation, daily dressing changes, and antibiotics to treat infections including Staphylococcus aureus and Pseudomonas.
3) After her wounds healed and eschar formed, she underwent a split-thickness skin graft procedure to aid reconstruction, with donor skin taken from her thighs. She was discharged on day 15 with antibiotics to prevent further infection.
(Treatment modality) radiation therapy for cancerPallavi Lokhande
The document provides information about cancer treatment options including radiation therapy. It discusses the various types of radiation therapy such as external beam radiation therapy and brachytherapy. Brachytherapy can be sealed or unsealed sources placed inside or near the tumor. Nursing care focuses on safety measures to minimize radiation exposure for staff and visitors. Common side effects from radiation like skin reactions, mucositis, xerostomia, and diarrhea are described along with symptom management strategies.
Burn injuries are a significant public health problem caused mainly by flames and scalds. Initial management involves stopping the burning process, assessing airway/breathing/circulation, and cooling the burn wound. Classification is based on total body surface area and depth of burn. Early wound excision, coverage with skin grafts, and aggressive fluid resuscitation are crucial for recovery. Long-term complications like contractures may require surgical correction. Proper nutrition, wound care, and rehabilitation are also important for optimal outcomes in burn patients.
1. The document discusses clinical findings, diagnostic testing, risk factors, prevention, and treatment options for acute otitis media and otitis media with effusion.
2. Treatment options include observation, antibiotics, myringotomy, tympanostomy tube insertion, adenoidectomy, and eustachian tube dilation.
3. Complications of tympanostomy tube insertion include acute otorrhea, persistent perforation, early extrusion, and tube blockage.
The document discusses updates to guidelines for treating hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It recommends empiric treatment be based on local antibiograms and risk factors for multidrug-resistant organisms. Empiric therapy should be individualized and de-escalated based on culture results. For patients clinically improving, the recommended duration of antibiotic therapy is 7 days.
Skin infections and infestations can be caused by bacteria, fungi, viruses, or infestations. Common bacterial infections include impetigo, cellulitis, and folliculitis. Fungal infections such as ringworm and candidiasis are also frequent. Viral warts and molluscum contagiosum occur commonly. Infestations like scabies and head lice can spread rapidly among close contacts. Effective treatment depends on the specific causative organism and may involve topical or oral antibiotics, antifungals, antivirals, or pesticides.
Skin infections and infestations can be caused by bacteria, fungi, viruses, or infestations. Common bacterial infections include impetigo, cellulitis, and folliculitis. Fungal infections such as tinea corporis, tinea capitis, and candidiasis are also frequent. Viral warts and molluscum contagiosum are prevalent viral skin infections. Infestations like scabies and head lice are widespread problems. Effective treatment depends on the specific causative organism and may involve topical or oral antibiotics, antifungals, antivirals, or pesticides.
This document provides an overview of burn management and treatment. It discusses the different types of burns including thermal, chemical, electrical, and radiation burns. It describes burn depth classification and assessment tools like the Rule of Nines. It outlines the principles of burn resuscitation and fluid management over the first 72 hours. It also covers monitoring, wound care, infections, surgical procedures, and first aid for burns. The goal is to prevent shock, maintain organ perfusion, control infections, and promote wound healing.
Skin infections and infestations are commonly seen in primary care. They include bacterial infections like impetigo and cellulitis, fungal infections such as ringworm and candidiasis, viral infections including herpes and warts, and infestations like scabies and head lice. Treatment depends on the specific infection, but may involve topical or oral antibiotics, antifungals, antivirals, or insecticide creams and solutions. Accurate diagnosis is important for effective management of skin infections and infestations.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
chemotherapy or cancer chemotherapy is the treatment modality used for the treatment of a tumor or cancerous disease this ppt give a detailed use of drugs used for the cancer and what all the pracuation can be taken while handling it and can be used as study material for bsc and gnm for their examination purpose as well as apply their knowledge in their clinical practice
A 79-year-old man presented with stage IVA squamous cell carcinoma of the head and neck. He was treated with intensity modulated radiotherapy plus concurrent cetuximab, achieving a complete response with manageable toxicity. Follow-up imaging at 9 months showed no evidence of recurrence.
palmoplantar pustolar Psoriasis induced in a patient treated with infliximab ...Dr. Faramarz Didar
Dr. Faramarz Didar presents a case of a patient with Crohn's disease who developed palmoplantar pustular psoriasis after treatment with infliximab. The patient was initially diagnosed with hand, foot, and mouth disease by her GP and treated unsuccessfully with antibiotics. Dr. Didar then treated the patient with potent topical corticosteroids and saw improvement. A literature review showed that potent corticosteroids are a first-line treatment for anti-TNF induced psoriasis, though use should be limited to 4 weeks. Guidelines recommend discussion in a multidisciplinary team to determine appropriate long-term management, which may include continuing anti-TNF treatment depending on
This document summarizes a presentation on atopic patch testing for identifying allergens that trigger atopic dermatitis. It discusses:
- Patch testing 75 subjects with atopic dermatitis using common allergens like dust mites, pollens, foods and pet dander. 46.66% showed positive reactions, most commonly to parthenium and bermuda grass pollens.
- Counseling patients to avoid identified allergens based on patch test results can help reduce symptoms and lower reliance on medications for atopic dermatitis.
- Advantages of patch testing over skin prick tests include lower risk of reaction and higher specificity. Limitations are lower sensitivity and fewer allergens can
This document provides an overview of burn injuries including definitions, anatomy, stages of wound healing, etiology, incidence, types, classification, extent, location, patient risk factors, pathophysiology, clinical manifestations, diagnostic evaluation, complications, management, prehospital care, fluid therapy, wound care, drug therapy, nutritional therapy, excision and grafting, rehabilitation, nursing management, nursing diagnoses, and a bibliography. The key points covered are definitions of burns, the Lund Browder chart for classifying burn severity, Parkland formula for fluid resuscitation, goals of wound care including cleansing and debridement, and nursing diagnoses related to burns such as impaired skin integrity and risk for infection.
This topic is oriented mainly on the Bailey & Love - 26th edition.
This will be of immense help for the MBBS - Students for the Theory as well as Clinical application.
With thw evolution of the medicine and increasing of the survival rate of cancer patients , its commonly to be seen in dental clinics. OMFS must know about their patients conditions , treatments and how to manage them in order to provide them good care and good life.
Palmoplantar pustolar psoriasis induced with infliximab in treating crohn di...Dr. Faramarz Didar
The document discusses a case of palmoplantar pustular psoriasis (PPP) induced in a patient treated with infliximab for Crohn's disease. It presents the patient's history and skin presentation. The key therapeutic challenge is determining whether the skin condition is a drug reaction or another diagnosis like psoriasis. Evidence from studies and guidelines indicates that potent topical corticosteroids are first-line treatment for drug-induced psoriasis. The author recommends topical corticosteroid therapy as first-line treatment for this patient's PPP, with close monitoring and potentially continuing anti-TNF therapy depending on the response. A multidisciplinary team approach is needed to
This document discusses the classification, pathophysiology, and management of burns. It describes the different types and degrees of burns, from first to fourth degree. It outlines the assessment of burn size and depth. The key aspects of initial and ongoing burn management are presented, including fluid resuscitation, wound care, infection prevention, and complications. Surgical procedures like escharotomy and grafting are also summarized.
This document summarizes guidelines for the topical treatment of psoriasis. It discusses several topical treatment options including corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, salicylic acid, anthralin, coal tar, and combination therapies. It provides details on the efficacy, dosing, safety and guidelines for each treatment. It also discusses when systemic therapies like methotrexate may be appropriate and provides dosing guidelines for methotrexate treatment of psoriasis.
1) A 3-year old girl was brought to the hospital with 18% third-degree burns to her face, scalp, and shoulders from a hot oil accident.
2) She received initial care including fluid resuscitation, daily dressing changes, and antibiotics to treat infections including Staphylococcus aureus and Pseudomonas.
3) After her wounds healed and eschar formed, she underwent a split-thickness skin graft procedure to aid reconstruction, with donor skin taken from her thighs. She was discharged on day 15 with antibiotics to prevent further infection.
(Treatment modality) radiation therapy for cancerPallavi Lokhande
The document provides information about cancer treatment options including radiation therapy. It discusses the various types of radiation therapy such as external beam radiation therapy and brachytherapy. Brachytherapy can be sealed or unsealed sources placed inside or near the tumor. Nursing care focuses on safety measures to minimize radiation exposure for staff and visitors. Common side effects from radiation like skin reactions, mucositis, xerostomia, and diarrhea are described along with symptom management strategies.
Burn injuries are a significant public health problem caused mainly by flames and scalds. Initial management involves stopping the burning process, assessing airway/breathing/circulation, and cooling the burn wound. Classification is based on total body surface area and depth of burn. Early wound excision, coverage with skin grafts, and aggressive fluid resuscitation are crucial for recovery. Long-term complications like contractures may require surgical correction. Proper nutrition, wound care, and rehabilitation are also important for optimal outcomes in burn patients.
1. The document discusses clinical findings, diagnostic testing, risk factors, prevention, and treatment options for acute otitis media and otitis media with effusion.
2. Treatment options include observation, antibiotics, myringotomy, tympanostomy tube insertion, adenoidectomy, and eustachian tube dilation.
3. Complications of tympanostomy tube insertion include acute otorrhea, persistent perforation, early extrusion, and tube blockage.
The document discusses updates to guidelines for treating hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It recommends empiric treatment be based on local antibiograms and risk factors for multidrug-resistant organisms. Empiric therapy should be individualized and de-escalated based on culture results. For patients clinically improving, the recommended duration of antibiotic therapy is 7 days.
Skin infections and infestations can be caused by bacteria, fungi, viruses, or infestations. Common bacterial infections include impetigo, cellulitis, and folliculitis. Fungal infections such as ringworm and candidiasis are also frequent. Viral warts and molluscum contagiosum occur commonly. Infestations like scabies and head lice can spread rapidly among close contacts. Effective treatment depends on the specific causative organism and may involve topical or oral antibiotics, antifungals, antivirals, or pesticides.
Skin infections and infestations can be caused by bacteria, fungi, viruses, or infestations. Common bacterial infections include impetigo, cellulitis, and folliculitis. Fungal infections such as tinea corporis, tinea capitis, and candidiasis are also frequent. Viral warts and molluscum contagiosum are prevalent viral skin infections. Infestations like scabies and head lice are widespread problems. Effective treatment depends on the specific causative organism and may involve topical or oral antibiotics, antifungals, antivirals, or pesticides.
This document provides an overview of burn management and treatment. It discusses the different types of burns including thermal, chemical, electrical, and radiation burns. It describes burn depth classification and assessment tools like the Rule of Nines. It outlines the principles of burn resuscitation and fluid management over the first 72 hours. It also covers monitoring, wound care, infections, surgical procedures, and first aid for burns. The goal is to prevent shock, maintain organ perfusion, control infections, and promote wound healing.
Skin infections and infestations are commonly seen in primary care. They include bacterial infections like impetigo and cellulitis, fungal infections such as ringworm and candidiasis, viral infections including herpes and warts, and infestations like scabies and head lice. Treatment depends on the specific infection, but may involve topical or oral antibiotics, antifungals, antivirals, or insecticide creams and solutions. Accurate diagnosis is important for effective management of skin infections and infestations.
Similar to 06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christopher M Hull, MD.pdf (20)
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
Christina Spears, breast cancer genetic counselor at the Ohio State University Comprehensive Cancer Center, joined us for the MBC Support Group for Black Women to discuss the importance of genetic testing in communities of color and answer pressing questions.
Can Allopathy and Homeopathy Be Used Together in India.pdfDharma Homoeopathy
This article explores the potential for combining allopathy and homeopathy in India, examining the benefits, challenges, and the emerging field of integrative medicine.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
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KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
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At Apollo Hospital, Lucknow, U.P., we provide specialized care for children experiencing dehydration and other symptoms. We also offer NICU & PICU Ambulance Facility Services. Consult our expert today for the best pediatric emergency care.
For More Details:
Map: https://cutt.ly/BwCeflYo
Name: Apollo Hospital
Address: Singar Nagar, LDA Colony, Lucknow, Uttar Pradesh 226012
Phone: 08429021957
Opening Hours: 24X7
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06. Dermatology Pearls and News Flash (Power Point Presentation) Autor Christopher M Hull, MD.pdf
1. Department of Dermatology
Dermatology Pearls and News Flash
ACP Utah Chapter Scientific Meeting 2017
• Christopher M Hull, MD
• Department of Dermatology
• University of Utah School of Medicine
• Christopher.hull@hsc.utah.edu
2. Department of Dermatology
Conflict of interest
• No conflicts to disclose
• I have chosen articles of interest published in the past year
3. Department of Dermatology
Educational Objectives
• Review recent dermatology topics of
importance to internal medicine
• Understand current guidelines for managing
simple abscess
• Be familiar with latest treatment options for
hidradenitis suppurativa and atopic dermatitis
• Review recent information about skin cancer
prevention option for high risk patients
4. Department of Dermatology
Presentation of case
• A 22 year old previously healthy female
presents to clinic with a 3 day history of
erythema, edema and pain of L thigh
• Exam: fluctuance, erythema, 3 cm nodule L
thigh
5. Department of Dermatology
• How would you treat this patient?
• A. Incision and drainage
• B. Treat with oral antibiotics
• C. Incision and drainage followed by oral
antibiotics
• Background: recent studies have recommended
incision and drainage alone for simple abscess
– Singer et al. Systemic antibiotics after I+D of simple
abscess: meta analysis. Emerg Med J 2013
6. Department of Dermatology
Management of simple abscesses
• Talan et al. Trimethoporim-sulfa vs placebo for
uncomplicated skin abscess. NEJM 2016
• Randomized controlled trial of 5 US E.D.
comparing trimethoprim/sulfa to placebo in
patients undergoing I+D
• Outcome: clinical cure of abscess at day 7-14
7. Department of Dermatology
Results
• 45.3% cultures positive for MRSA
• Clinical cure 80.5% in T-S group compared to
73.6% in I+D only group (MITP) and 92.9% TS
vs 85.7% (PP)
• T-S superior in secondary measures:
– Lower subsequent surgical drainage
– Lower skin infections at new sites
– Lower infections in household members
– TS had more GI side effects
8. Department of Dermatology
Conclusions
• In settings where MRSA is prevalent, T-S
treatment resulted in a higher cure rate
among patients with a drained abscess
compared to placebo
– Differences are small but significant
– Only 1 antibiotic studied
– In both arms, the abscesses subsequently resolved
– IDSA published guidelines
9. Department of Dermatology
Presentation of case
• A 40 year old healthy female presents for
treatment of toe nail fungus.
• Previous treatments: Vicks vapor rub, apple
cider vinegar and topical clotrimazole without
improvement
• Past medical history: hypothyroid, acne
• Medications: thyroid replacement, tretinoin
cream
11. Department of Dermatology
How would you treat this patient?
• No treatment. Medications too risky
• Oral ketoconazole
• Oral terbinafine
• Topical efinaconazole
• Topical clotrimazole
12. Department of Dermatology
Answer
• No treatment. Medications too risky
• Oral ketoconazole
• Oral terbinafine
• Topical efinaconazole
• Topical clotrimazole
13. Department of Dermatology
Evaluating the need for laboratory
testing in the treatment of
onychomycosis
• Mikailov et al. Cost effectiveness of confirmatory testing
before treatment of onychomycosis JAMA Derm 2016
• Kanzler. Reevaluating the need for laboratory testing in the
treatment of onychomycosis JAMA Derm 2016.
14. Department of Dermatology
Onychomycosis therapy
• Empirical treatment with terbinafine is more
cost effective than confirmatory testing with
minimal effect on patient safety
• Confirmatory testing before treatment with
efinaconazole 10% is associated with reduced
costs
15. Department of Dermatology
Onychomycosis treatment
• When onychomycosis is suspected. Treat w/ course of
terbinafine
– If no response, could be saprophyte or yeast (don’t
respond to terbinafine). Treat with pulse fluconazole
200mg weekly x 3-9 months
– Cost for terbinafine and fluconazole is low
– Cost of efinaconazole is high (cure rates 15%). Better to
have confirmation of onychomycosis
– Safety of oral agents is good
• Significant liver injury is uncommon and most resolve with
discontinuation of the drug
• Need to reconsider need for extensive lab testing for derm drugs
like pulse anti fungal therapy, isotretinoin, spironolactone and
others
16. Department of Dermatology
Presentation of case
• 24 year old male with asthma and seasonal
allergies presents to clinic with worsening
eczema
• Current treatment: triamcinolone 0.%
ointment, neosporin, loratadine and
diphenhydramine as needed
• Prior treatments: clobetasol ointment,
pimecrolimus cream, cephalexin, medrol dose
pack, prednisone
18. Department of Dermatology
How would you treat this patient?
A. Prednisone taper
B. Mometasone cream BID
C. Diphenhydramine and hydrocortisone 1%
cream BID
D. Dupilumab
E. UVB Phototherapy
19. Department of Dermatology
Answer
A. Prednisone taper
B. Mometasone cream BID
C. Diphenhydramine and hydrocortisone 1%
cream BID
D. Dupilumab
E. UVB Phototherapy
20. Department of Dermatology
• New Drug for Severe Eczema is Successful in 2
New Trials
– Gina Kolata, Oct 1, 2016
– “on Saturday the results of 2 large clinical trials of
a new drug offered hope to an estimated
1.6million adult Americans with uncontrolled
moderate-severe atopic dermatitis…”
21. Department of Dermatology
Dupilumab for atopic dermatitis
• Simpson et al. 2 phase 3 trials of dupilumab vs
placebo in atopic dermatitis. NEJM 2016
– Dupilumab monoclonal antibody that binds and
inhibits IL-4 and IL-13 (type 2 cytokines)
– Adults with moderate-severe atopic derm
inadequately controlled on topical treatment
– 1:1:1:1 dupilumab 300mg sq weekly, 300mg sq every
other week or placebo, placebo
– Primary outcome: proportion of patients with IGA of 0
or 1 (clear, almost clear) or reduction of 2 points or
more from baseline at week 16
22. Department of Dermatology
Results-dupilumab
• Big study: 671 study 1, 708 study 2
• IGA 0/1: 38% dupilumab every 14 days, 37%
dupilumab weekly, 10% placebo both arms
– Significantly more patients in dupilumab arms
achieved EASI 75% reduction compared to
placebo
– Reduction in pruritus, decreased
anxiety/depression, and improved quality of life
– Injection reactions and conjunctivitis greater in
dupi arms
23. Department of Dermatology
How do we treat moderate-severe
atopic dermatitis?
• Skin care, emollients, bleach baths, anti itch
products, antibiotics
• Topical corticosteroids and calcineurin inhibitors
• Systemic steroids
• Phototherapy
• Immunosuppressive medications:
– Cyclosporine, methotrexate, mycophenolate,
azathioprine
• And soon, dupilumab
24. Department of Dermatology
Presentation of case
• 30 year old female presents to clinic with a 5
year history of recurrent draining nodules of
the bilateral axillae, inguinal folds, proximal
thighs
• Previous treatments: topical clindamycin
lotion, I+D, intralesional steroids,
trimethoprim/sulfa, doxycycline
27. Department of Dermatology
How do you treat this patient?
A. Excision of all nodules
B. Refer to another provider
C. Clindamycin lotion BID
D. Treat with adalimumab
E. Minocycline 100mg BID x 10days
28. Department of Dermatology
Answer
A. Excision of all nodules
B. Refer to another provider
C. Clindamycin lotion BID
D. Treat with adalimumab
E. Minocycline 100mg BID x 10days
29. Department of Dermatology
Adalimumab for hidradenitis
suppurativa (HS)
• Kimball et al. 2 phase 3 trials of adalimumab
for HS. NEJM 2016
– Period 1: adalimumab 40mg weekly vs placebo x
12 weeks
– Period 2: adalimumab 40mg every other week vs
adalimumab 40mg weekly x 24 weeks
• Primary end point: 50% reduction in abscess and
inflammatory nodule count and no increase in abscess
or draining fistula counts
30. Department of Dermatology
Adalimumab and HS: results
• Clinical response at week 12 for adalimumab
>placebo (41.8% vs 26%) and (58.9% vs 27.6%)
• Also superior for lesions, pain, Sartorius score
• SAEs were low in both period 1 and period 2
• Conclusion: treatment with adalimumab 40mg
weekly as compared to placebo resulted in
significantly higher clinical response rates in both
trials at 12 weeks. Rates of SAEs were similar in
study groups
31. Department of Dermatology
Hidradenitis Suppurativa Treatments by Hurley Stage
Hurley Stage I and II Topical, injectable and
intralesional
• Topical antibiotics (e.g. clindamycin 1%)
• Intralesional corticosteroids
Oral options • Oral antibiotics
• Hormonal therapies
• Metformin
Surgical and physical options • Less invasive surgical approaches
• Laser therapy
• Photodynamic therapy
Hurley Stage II and III (Includes Stage I to II
approaches)
• More invasive surgical approaches
• Systemic retinoids
• Biological treatments
All Stages • Weight loss
• Pain control
• Smoking cessation
• Zinc supplementation
• Antimicrobial wash
Also consider infliximab, anakinra
32. Department of Dermatology
Case example
• 28 y.o. female with a many year history of
recurrent painful oral ulcers
• Multiple ulcers present in mouth nearly every
day
– No genital ulcers
33. Department of Dermatology
How would you treat this patient?
A. Dexamethasone elixir swish and spit
B. Medrol dose pack
C. Valacyclovir episodically for flares
D. Silver nitrate application to lesions
E. Apremilast
F. Colchicine
34. Department of Dermatology
Answer
A. Dexamethasone elixir swish and spit
B. Medrol dose pack
C. Valacyclovir episodically for flares
D. Silver nitrate application to lesions
E. Apremilast
F. Colchicine
35. Department of Dermatology
Introduction
• Recurrent aphthous ulcers (RAU), recurrent
aphthous stomatitis (RAS)
• Most common oral ulcerative condition
• Shallow, round ulcers with a pseudomembrane
and peripheral erythema
• Size varies: 1mm to >10mm
• 5-25% of general population
• More common in females, adults <40yrs,
Caucasians
36. Department of Dermatology
Systemic conditions associated with
aphthous ulcers
• Behcet’s disease
• Sweet’s syndrome
• Reiter’s syndrome
• Inflammatory bowel disease
• HIV infection
• Celiac disease
• Systemic lupus erythematosis
• Cyclic neutropenia
37. Department of Dermatology
Diagnostic tests for aphthous ulcers
• Nutritional deficiencies:
– Iron, ferritin, folate, vitamin B1, B2, B6, B12, zinc
• CBC
• ANA
• HIV
• Total IgA, IgA tissue transglutaminase
• Mucosal biopsy (edge of lesion. Get some epithelium)
• If bullous disease suspected, studies for
immunofluorescence
• Endoscopy
38. Department of Dermatology
Hatemi et al. Apremilast for Behcet’s syndrome.
Phase 2 Placebo controlled Study. NEJM 2015
• 111 patients w/ Behcets received apremilast
30mg BID vs placebo x 12 weeks with an
extension phase where all received apremilast
• Primary end point: number of oral ulcers
• Mean number of oral ulcers reduced in
apremilast arm
– Also reduced pain
– Nausea, vomiting, diarrhea higher in apremilast
arm
39. Department of Dermatology
Topical Treatment
• Corticosteroid gels (clobetasol gel)
– Other vehicles for oral mucosa available (orabase)
– Dexamethasone elixir
• Topical anesthetics
– Viscous lidocaine, benzocaine lozenges, Magic
mouthwash
• Antimicrobial agents
– Chlorhexadine rinse
– Topical tetracyclines
• Topical sucralfate
– 5mL 4x/day
40. Department of Dermatology
My Treatment strategy
• For minor RAS:
– topical corticosteroid gel BID +/- topical anesthetic
agent
• For major RAS:
– Colchicine 0.6mg BID along w/ corticosteroid gel and
topical anesthetic agent
– If no response, add/switch to dapsone
– If no response, consider azathioprine, TNF inhibitor,
apremilast
– Also vitamin B12, zinc, omega 3
42. Department of Dermatology
Reduction of non-melanoma skin
cancer in high-risk patients
• Chen et al. Phase 3 randomized trial of
nicotinamide for skin cancer
chemoprevention. NEJM 2015
• Nicotinamide 500mg BID vs placebo in high
risk patients x 1 year
– 386 patients with at least 2 skin cancers in
previous 5 years
– Evaluated number of new skin cancers and safety
43. Department of Dermatology
Nicotinamide and skin cancer
• At 12 months, rate of new NMSC was lower by
23% in nicotinamide arm (both BCC and SCC)
– Number of AKs was 11% lower at 3 months, 14%
lower at 6 months and 13% lower at 12 months
– No difference if AE between groups
– Benefits dissipated when nicotinamide
discontinued
– Compliance with nicotinamide 90% (whereas
sunscreen compliance was 50%)
45. Department of Dermatology
References
• Talan et al. Trimethoporim-sulfa vs placebo for uncomplicated skin
abscess. NEJM 2016
• Kimball et al. 2 phase 3 trials of adalimumab for HS. NEJM 2016
• Simpson et al. 2 phase 3 trials of dupilumab vs placebo in atopic
dermatitis. NEJM 2016
• Chen et al. Phase 3 randomized trial of nicotinamide for skin cancer
chemoprevention. NEJM 2015
• Cunningham et al. Randomized trial of calcipotriol combined with 5-
fluorouracil for skin cancer precursor immunotherapy. J Clinical
Investigation 2016
• Mikailov et al. Cost effectiveness of confirmatory testing before treatment
of onychomycosis JAMA Derm 2016
• Kanzler. Reevaluating the need for laboratory testing in the treatment of
onychomycosis JAMA Derm 2016.
• Hatemi et al. Apremilast for Behcets syndrome-phase 2 placebo controlled
study. NEJM 2015