Terminology
1
macule  patch
papule   plaque
nodule   tumor
vesicle   bulla (bullae)  pustule  wheal


2
scale
crust
fissure
erosion  ulcer
lichenification
scar
atrophy
excoriation: linear erosion

Multiple, pruritic, oval, pea-sized, erythematous papules with scales over upper back for one year 

purpura   壓不會退
erythema  壓會退 ,血管擴張


Topical  use agent
medicated bath
polytar 1:8000 去scale
zephrine 1:10000
medicated bath qd: scrub bath with sulfur powder 5%

olive oil 洗去crust
simple ointment/vaseline after bath

ODT (Occlusive dressig technique)
wet dressing: direct/indirect

CBO   Chlorpheniramine, Lidocaine, Hexachlorophene, Methyl Salicylate, Menthol, Camphor

ZnO:  intertrigo, HSV1

止癢 1'+2'+sinequan qn , 冰敷


Steroids
prednisolone
0.5mg/kg anti-inflammation
1mg/kg    immunosuppression


短  1 hydrocortisone
中  4 predisolone
     5 methylprednisolone/triamcinolone
長30 dexamethasone/betamethasone


cream   acute, 濕, 日, intertriginous area, face, genital 
oint       chronic, 乾, 厚, 夜, fussure ->lubrication, palms, soles
lotion    hair

tachyphylaxis-> 改intermittent (擦3休2)
tail off 才不會reboud phenomenon

oral antibiotics作local apply易contact deramtitis



1 超強
clobesol
2 強
topsym
3 中強
septon
nerisone
45 中
elomet
topicon
6 弱
rinderon
locacorten
7 最弱
ureson

Drug % Vehicle

Very high potency

   
    Clobetasol propionate (Dermovate®) 0.05 cream
    Clobetasone propionate (Cloba®) 0.05 oint

High potency

   
    Betamethasone dipropionate (Septon®) 0.064 cream
    Diflucortolone valerate (Nerison®) 0.1 fatty ointment
    Fluocinonide (Topsym®) 0.05 cream
    Fluocinonide (Topsym®) 0.05 lotion
  Intermidiate potenc    
    Fluticasone propionate (Cutivate®) 0.05 cream
    Mometasone furoate (Elomet®) 0.1 cream , ointment

Low potency

   
    Hydrocortisone acetate (Cort-s®) 1 ointment



doxepin:
sinequan 25mg
ichderm cream


Acne
輕度痤瘡 (Mild acne)之治療局部抗生素 ( q.d.)上午
1. Benzoyl peroxide(2,5,10%)--Panoxyl gel(泛娜)
2. Azelaic acid ( 20%) ---Skinoren cream(思麗安) 美白
3. Clindamycin ( Cleocin -T solution) (麗歐迅)
4. Erythromycin ( Stiemycin solution ) (史帝黴新)

局部 retinoids ( q.n.)夜間
1. Tretinoin ( 0.025, 0.05, 0.1% cream) (愛膚露)
2. Isotretinoin cream(Isotrex gel 0.05%)(愛索思)
3. Adapalene ( Differin gel---RAR-g ) (痘膚潤)

痤瘡之治療Moderate acne( 中度痤瘡 )
1. 前述外用療法
2. 口服tetracycline500mg bid, erythromycin 500mg qid或 minocycline 100mg qd x 1-3m,  Severe acne(嚴重痤瘡=nodulocystic acne)

Isotretinoin( Roaccutane)
口服0.5-2 mg/Kg/day pc x 4-5m
a. 抑制皮脂分泌 b. 使毛孔角化正常

Off-lable use
antiandrogen: spironolactione



Furuncle
fucidin 250mg q12h, conlifu(oint) 

Folliculitis   淺, papule, pustule, erosion ->SA
Furuncle     深  -> I&D, cephalexin 250mg qid x 10days
Carbuncle  兩個以上


Fungus
mentax
pasca         含salicylate, cadida無效
econazole  cadida
exelderm
fundex(undacid)
canesten


Onychomycosis
refulen     一年
loceryl      qw      手24w腳36-48w 
sporanox 1# bid 手6w 腳12w
lamisil      1# qd


Alopecia areata
r/o ANA, T4, VDRL(syphilis), Hb
kenacort 2cc(20mg) intralesional injection


Urticaria (in 24hr, chronic > 30days)
dermatographism
loratadine(clarityne) + vistaril x 7 days (chronic 1m)
calamine



Bullous pemphigoid
subepidermal blister    水泡厚, 不易破, tense

Pemphigus
intraepidermal bulla     oral ulcer, Nilolsky's sign, prednosolone 1-2mg/kg


Herpes
acyclovir 500mg q8 x 7 days (V1, S1)  (+ 自費cream) > 癢calamine  破ZnO  膿neomycin 
zovirax 4#(800mg) q4 x7 days      (herpes simplex 200mg)
valtrex 2#(1g) q8 x 7days (72hr)

tryptanol, tofranil
neurontin
epidermis不留疤

Warts (HPV infection, 小出血點)
duofilm (corn)
liquid N2
electrosurgery
CO2 laser


禁 topical steroid
fugus
herpes
perioral dermatitis


Atopic dermatitis
tacrolimus  (protopic)  IV,V
pimecrolimus  (elidel)  VII


Amyloidosis amyloid depisits無毛囊開口
clobesol 表皮增生較厚 (+urea +ODT)
ablative laser


Prurigo
duoderm 軟化, 防抓
clobesol   (SK厚)

Lichen simplex chronicus
salic
clobesol







其他

Miliaria  汗疹(痱子)

idiopathic guttate hypomelanosis 四肢小雨點狀

Corn: 泡沙威龍>>剪皮>>Duofilm>>ODT
 
Tetracycline治療acne, psoriasis
1. 抑制P. acne
2. 抑制N及E的chemotaxis, 阻止IgE引起之antihistamine釋放及mast cell釋出炎性介質
3. 抑制L之blast transformation, 導致抑制B lymphocyte之活性及降低IL的校價
4. 抑制collagenase activity

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