Transcript Facial Rashes/eruptions

Facial
Rashes/eruptions
Emily McGrath
Dermatology Consultant
Royal Devon and Exeter Hospital
Overview
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Cases
Discuss differential – points in the history and
examination to help
Management tips
Case 1
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21 year old female
4 year history of acne
Tried Panoxyl over the
counter
Treatment
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Topical
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BPO
Azaleic acid
Retinoids
Antibiotics
Oral
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Antibiotics
Isotretinoin
Oral Antibiotics
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No benefit in concomitant oral and topical antibiotics.
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Intermittent benzoyl peroxide recommended during oral
antibiotics to eliminate resistant strains.
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Dose: evidence to support erythromycin at 1g/day rather
than 500mg/day. No evidence regarding dose of other oral
antibiotics.
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Treatment should be at least 3 months, maximal effect by
6 months – then if relapse, change drug.
Case 2
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17 year old 6th Former
2 year history of
worsening acne.
On 250mg bd
oxytetracycline.
Case 3
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6 year old girl
Itchy face, neck, arms.
Worsening over past 3
months.
Not responding to
hydrocortisone.
Mum asks about allergy
tests.
Atopic eczema - top tips
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Emollients - trial then large quanitities.
Soap substitutes - simplify
Topical steroids - appropriate to severity
Short bursts of moderate / potent steroids to
achieve control
Topical tacrolimus 0.1% - equivalent strength to
mod potent top steroid. Maintenance.
Allergy: consider to be relevant if
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Instant urticaria/itching after eating/ contact
Severe/ resistant eczema especially if bowel sx +/- FTT
Case 4
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51 year old school
teacher.
Worsening facial rash.
Uncomfotable,
especially in hot
weather.
Rosacea
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Subtypes:
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Erythematotelangectatic
Papulopustular
Phymatous
Treatment
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Depends on subtype
Avoid triggers
Sun protection
Topical azaleic
acid/metronidazole
Oral antibiotics
Rosacea
Mild or moderate papulopustular rosacea
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Metronidazole
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Gel (Metrogel®) 0.75%......................................................................£9.95 (40g)
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Cream (Rozex®) 0.75%..................................................................£15.28 (40g)
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Apply twice daily for 3-4 months
Moderate or severe papulopustular rosacea
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Oxytetracycline
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Tablets 500mg twice daily for 3-6 months.................................................£5.68
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Lymecycline (unlicensed)
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Capsules 408mg once daily ………………………………..….£22.45 (3 months)
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Review at 2 months and continue for a total of 3 months if responding well.
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Repeat 3 monthly course when rosacea flares.
Case 5
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55 year old art teacher.
Worsening facial rash
over 2 weeks.
Sore, weeping.
Case 6
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38 year old IT worker
Persistent lesion R
cheek
Case 7
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35 year old nurse
Irritating rash past 2
years central face
Joint Formulary
For moderate and severe disease affecting the scalp
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Ketoconazole shampoo............................................................£3.02 (120mL)
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Use twice a week
For more severe erythema and flaking on the scalp add
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Betamethasone scalp application............................................£3.81 (100mL)
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Apply to dry hair morning and evening and allow to dry
Disease affecting face and body
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Ketoconazole cream.......................................................................£3.40 (30g)
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Apply once or twice a day until resolution then reduce frequency to daily or
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alternate daily use.
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For inflamed skin
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Daktacort® cream………………..…………………………………...……….£1.83
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Apply once or twice a day until resolved.
Case 8
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75 year old man
Rough patches on
forehead.
Sore in strong sunlight.
Solar (actinic) keratosis:
Treamtent
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Treatment:
 Diclofenac
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5FU
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Photodynamic Therapy
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Cryotherapy
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Curettage