Transcript Dermatology in primary care setting

Dermatology in primary care setting
Domina Petric, MD
I.A
FUNGAL SKIN INFECTIONS AND
ANTIMYCOTICS FOR LOCAL USE
Nail fungus (onychomycosis)
• Can be treated with antimycotic nail lacquer.
For example:
• Amorolfinum 50 mg/mL
PurNail.com
Tinea corporis
Galderma SA
DermQuest.com
Tinea pedis
Healthool.com
Tinea corporis, Tinea pedis, Tinea
cruris
• Treatment: antimycotic cream locally once a day
during one week.
• The cream should be applicated on previously
cleaned affected area.
Examples:
• Terbinafinum 10 mg/g cream (not for children
under the age of 12 years)
Other creams
• Terbinafinum gel or skin spray
• Clotrimazolum cream, gel or skin spray
• Miconazolum cream
• Naftifinum cream
• ...
Other indications for application of
antimycotic crem/gel/spray
• Skind candidiasis: once a day during one week.
ePainAssist.com
Other indications for application of
antimycotic crem/gel/spray
• Pityriasis versicolor: once a day (or twice) during
two weeks.
MedicineNet.com
Ketokonazolum shampoo (20 mg/g)
Disease
Pityriasis versicolor
Seborrhoeic dermatitis and
Pityriasis capitis
Dose
Once a day during 5 days
Twice a week during 2 to 4
weeks
Pityriasis capitis symplex (Emaze.com)
I.B
ANTIMYCOTICS FOR SYSTEMIC APPLICATION
Terbinafinum 250 mg (Lamisil,
Mycocur, Terbinax...)
• Tinea pedis: once a day (250 mg per os) during 2-6
weeks
• Tinea corporis: 250 mg per os a day during 4 weeks
• Tinea cruris: 250 mg per os a day during 2-4 weeks
• Onychomycosis: 250 mg per os a day during 6
weeks to three months (can be prolonged to six
months if necessary)
Contraindications:
Side effects:
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loss of appetite
anxiety
depression
headaches
...
II.
EMOLLIENTS AND PROTECTIVE CREAMS
Linola Fett cream (unsaturated fatty
acids)
For treatment of mild to moderately severe forms of
atopic dermatitis:
• twice a day on dry skin
Qsota.com
III.
WOUNDS AND ULCERS TREATMENT
Dexpanthenolum (Pantexol 5% cream
or gel)
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scrathes
hyperkeratosis
minor lesions
after surgical procedures
burns
pruritus
mild dermatosis
Once or twice a day!
Contractubex gel
• For scars, burns, after surgical
procedures...
• It is applied below the bandage for old
scars during night.
• Can be applied in children.
Treatment duration can be weeks or months.
IV.
ANTIPRURITIC DRUGS FOR LOCAL
APPLICATION
Dimentidenum (Fenistil 1 mg/g) gel
• dermatosis, urticaria, skin burns,
insects bites, first degree burns
• two to four times a day
• for short term use (usually three
days)
Chloropyraminum (Synopen 10 mg/g)
unguent
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urticaria, insect bites
two or three times a day
applied in thin layer
it is not recommended for big skin areas
for short term use (three days)
V.
PSORIASIS TREATMENT
Calcipotriolum + betamethasonum
• Daivobet 50 mcg/g + 0,5 mg/g gel
• Enstilar 50 mcg/g + 0,5 mg/g skin foam
Indications:
• scalp psoriasis in adults
• mild to moderate psoriasis vulgaris with
plaques
Scalp psoriasis
WebMD
Psoriasis vulgaris plaque
MedicineNet.com
Treatment
Once a day during:
• 4 weeks for scalp psoriasis
• 8 weeks on other locations
VI.
SKIN ANTIBIOTICS
Mupirocinum
• For example: Betrion 20 mg/g unguent
• Primary skin infections: impetigo, folliculitis,
furunculosis, ectima.
• Secondary skin infections: infected
dermatoses and infected skin injuires.
• Two to three times a day during 10 days!
Impetigo contagiosa
BestOnlineMD
Carbuncle
GeneralHealth
Neomycinum, bacitracinum
• Bivacyn 3500 IU/g + 500 IU/g unguent
• Primary and secondary skin infections:
two to four times a day.
• Not recommended for children under the
age of two years.
Acidum fusidicum
• Fusicutan 20 mg/g unguent and cream
• Primary infections
• Secondary infections caused with sensitive
bacteria: Staphylococcus aureus, Streptococcus
spp. i Corynebacterium minutissimum.
• Three to four times a day!
Gentamicinum
Garamycin 1 mg/1 g unguent
• primary and secondary skin infections
• infected venous ulcers of lower leg
• infected burns and frostbites of smaller
skine area
VII.
CHEMOTERAPEUTICS FOR LOCAL
APPLICATION
Sulfadiazinum argentum
(Dermazin 10 mg/g cream)
• Main indication is prevention and treatment of
infections in the patients with burns.
• Other indications: prevention and treatment of
infected ulcers, wounds, incisions...
• The burn must be cleaned and then Dermazin should
be applicated in a thick layer (2-4 mm) and covered
with sterile gauze.
Sulfadiazinum argentum
(Dermazin 10 mg/g cream)
• It should be applicated at least once a day, but
for more severe burns can be used more then
once.
• Before putting a new layer, the burn/wound
should be cleaned with aseptic solution.
• Steril gauze is not obligatory.
Contraindications:
It should not
be used during first
trimester and during
lactation of the
baby up to two
months of life.
peanuts and soya allergy
preterm babies and
neonates (kernicterus)
pregnant women that are
close to childbirth
(kernicterus)
Aciclovirum (Herplex 50 mg/g cream)
• Herpes simplex type one infections!
• It should be applied five times a day (every
four hours) and only during the day.
• Treatment duration is 4-10 days.
• It is indicated for skin of the face and lips.
• It can be used for children.
Zovirax 5% aciclovirum cream
Caution with
immunodeficient patients.
Docosanulum (Erazaban 100 mg/g
cream)
• Only for immunocompetent adults and children
older then 12 years.
• For reccurent HSV 1 infection of the lips.
• It should be applied only in early stage of herpes
infection (prodromal stage) in a thin layer 5 times a
day (not during night).
VIII.
CORTICOSTEROIDS FOR LOCAL
APPLICATION
Methylprednisoloni aceponas
• Advantan 1 mg/g cream and unguent
Indications:
• atopic dermatitis, neurodermitis
• contact, degenerative, numular and other
eczema
• eczema in children
Methylprednisoloni aceponas
• The drug should be applicated once a day in a thin
layer on the affected area during max. 12 weeks in
adults.
• It should not be used for children under the age of 3
years.
• Duration of treatment for children older then 3
years should not be more then 4 weeks.
Contraindications:
• hypersensitivity
• tuberculous or syphilitic changes near the
affected area
• chikenpox, herpes zoster
• rosazea, perioral dermatitis
• atrophic skin diseases, skin ulcers
Contraindications:
• postvaccinational skin changes near the
affected area
• acne rosacea
• acne vulgaris
• bacterial and fungal skin diseases
Aclometasonum
Afloderm cream and unguent
• dermatoses on sensitive skin areas (face,
intertriginous area)
• chronic dermatoses in children and older people
(sensitive skin)
• treatment of larger skin area, especially in children
• continuation of treatment after strong CS
Application
Contraindications:
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hypersensitivity
acne
skin tuberculosis
HSV infections
chikenpox
vaccination
• perioral
dermatitis
• rozacea
• bacterial and
fungal infections
Betamethasonum
Beloderm 0,5 mg/g unguent and cream
• all types of dermatoses and eczema
• chronic plaques psoriasis of hands and feet
• scalp psoriasis
• ONE to TWO times a day (for adults and
children older then 12 years)
Betamethasonum
• Cream is usually applied for wet dermatoses
and unguent for dry lesions.
• Treatment duration should not be longer then
2 weeks.
• If used in children, treatment should be
maximum 5 days long.
Cream/unguent/solution
Skin solution is for hairy skin areas.
Cream
Wet
dermatoses
Unguent
Dry
dermatoses
Mometasonum
Elocom 1 mg/g cream and unguent
• for inflammatory and pruritic symptoms
of dermatoses
• psoriasis, atopic dermatitis, irritational
dermatitis, allergic dermatitis
Application is once a day.
Corticosteroids:
Moderately strong:
Strong:
Aclometasonum
Betamethasonum
Momethasonum
Methylprednisoloni
aceponas
Prednicarbatum
VIII. B
CORTICOSTEROIDS AND ANTIBIOTICS
COMBINATIONS
Mild CS and AB:
Oxytetracyclinum, hydrocortisonum
Geocorton 30 mg/g + 10 mg/g unguent
• infected eczema
• primary irritational dermatitis
• allergic seborrhoeic dermatitis
• infected insects bites
Bethametasonum + gentamicinum
• Belogent/Diprogenta 0,5 mg + 1 mg/g cream and unguent
• Cream: infflamatory manifestations of dermatoses.
• In adults application is 1-2 times a day and in
children only 1 time a day.
• Treatment duration: 7 days (children) up to 10 days
(adults).
• Application max. on 10% of body surface area.
Bethametasonum + gentamicinum
Contraindicated in pregnancy!
Not recommended during
lactation.
Bethametasonum + gentamicinum
• Unguent: indicated for skin infections
(bacteria sensitive on gentamicinum)
if the affected skin area is small.
• For examle: external ear canal
infection/infflamation...
Betamethasonum, clotrimazolum, gentamicinum
Triderm cream and unguent
• Secondary bacterial infection:
tinea pedis, tinea cruris, tinea
corporis, candidiasis, tinea
versicolor
CS for scalp (infflamation, dermatoses)
• Alpicort solution (prednisolonum,
acidum salicylicum)
• Belosalic solution (betamethasonum,
acidum salicylicum)
• ...
IX.
ANTISEPTICS
Antiseptics and disinfectants:
• Bepanthen Plus (dexpanthenolum,
chlorhexidinum)
• Betadine (povidonum iodinatum): Betadine
unguent, Betadine 7,5% solution and 10%
solution
• Octanisept (octenidinum, phenoxyethanolum)
X.
ACNE TREATMENT
For acne:
• Aknet solution (clindamycinum)
• Dercome Clear skin suspension (benzolis
peroxydum cum acqua)
• Roaccutane capsules 10 mg
• Sona gel and cream (adapalenum)
• ...
Literature:
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Mediately.com
HALMED
PurNail.com
Galderma SA
DermQuest.com
Healthool.com
GeneralHealth
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ePainAssist.com
MedicineNet.com
Emaze.com
Qsota.com
WebMD.com
BestOnlineMD