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
