Smart Phrases And Workups – Derm

CELLULITIS	

Cellulitis
Exam: ***
WBC***
*** with erythema
- clinda, Bactrim, doxycycline, or minocycline

ECZEMA	
Eczema
Exam: ***
- moisturize with plain hydrated petrolatum, Cetaphil, or CeraVe BID/TID
- mid/high potency steroid BID x2 weeks
- erosions: petrolatum or mupirocin ointment BID x1-2 weeks

ERYTHEMA MULTIFORME	
Erythema Multiforme
Targetoid lesions on palms/soles
***recent viral infection
- NSAIDs, cool compresses, topical steroids, antihistamines

HSV	
Herpes Simplex Virus
- f/u DFA or PCR from vesicle base
Uncomplicated gingivostomatitis: acyclovir 400 mg TID x7-10d
Uncomplicated genital: valacyclovir 1000 mg PO BID x10 days OR acyclovir 400 mg PO TID x10d OR famciclovir 250 mg TID

SHINGLES	
Shingles
On ***
Uncomplicated: valacyclovir 1000 mg PO q8h x7 days or acyclovir 800 mg PO 5x/day x7-10 days
Disseminated (>20 vesicles in >2 dermatomes): acyclovir 10 mg/kg IV q8h
Immunosuppressed: acyclovir 10 mg/kg IV q8h, IVFs
Post-herpetic neuralgia: gabapentin 300 mg PO daily
- on discharge, recommend high lysine, low arginine diet to prevent recurrence

PURPURA FULMINANS	
Purpura Fulminans (skin DIC)
Microvascular occlusion with paltelet-fibrin thrombi >> retiform purpura
Etiology:  infection (Strep, Staph, H flu, N meningitidis, Capnocytophaga, VZV, CMV, Babesia), APS, malignancy, protein C/S deficiency
- trend DIC labs q2h
- f/u BCx
- skin biopsy
- antibiotics

PSORIASIS	
Psoriasis
Short term tx with topical steroids, calcipotriene, moisturization +/- plastic wrap
Long term tx with phototherapy, acitretin, MTX, biologics (JAAD 2011;65:137)

TINEA PEDIS	
Tinea pedis
- topical imidazole (econazole 1% cream QD or clotrimazole 1% cream BID x2-4 weeks) or terbinafine 1% cream BID x2 weeks to entire foot
CELLULITIS

Cellulitis
Exam: ***
WBC***
*** with erythema
- clinda, Bactrim, doxycycline, or minocycline

ECZEMA
Eczema
Exam: ***
- moisturize with plain hydrated petrolatum, Cetaphil, or CeraVe BID/TID
- mid/high potency steroid BID x2 weeks
- erosions: petrolatum or mupirocin ointment BID x1-2 weeks

ERYTHEMA MULTIFORME
Erythema Multiforme
Targetoid lesions on palms/soles
***recent viral infection
- NSAIDs, cool compresses, topical steroids, antihistamines

HSV
Herpes Simplex Virus
- f/u DFA or PCR from vesicle base
Uncomplicated gingivostomatitis: acyclovir 400 mg TID x7-10d
Uncomplicated genital: valacyclovir 1000 mg PO BID x10 days OR acyclovir 400 mg PO TID x10d OR famciclovir 250 mg TID

SHINGLES
Shingles
On ***
Uncomplicated: valacyclovir 1000 mg PO q8h x7 days or acyclovir 800 mg PO 5x/day x7-10 days
Disseminated (>20 vesicles in >2 dermatomes): acyclovir 10 mg/kg IV q8h
Immunosuppressed: acyclovir 10 mg/kg IV q8h, IVFs
Post-herpetic neuralgia: gabapentin 300 mg PO daily
- on discharge, recommend high lysine, low arginine diet to prevent recurrence

PURPURA FULMINANS
Purpura Fulminans (skin DIC)
Microvascular occlusion with paltelet-fibrin thrombi >> retiform purpura
Etiology: infection (Strep, Staph, H flu, N meningitidis, Capnocytophaga, VZV, CMV, Babesia), APS, malignancy, protein C/S deficiency
- trend DIC labs q2h
- f/u BCx
- skin biopsy
- antibiotics

PSORIASIS
Psoriasis
Short term tx with topical steroids, calcipotriene, moisturization +/- plastic wrap
Long term tx with phototherapy, acitretin, MTX, biologics (JAAD 2011;65:137)

TINEA PEDIS
Tinea pedis
- topical imidazole (econazole 1% cream QD or clotrimazole 1% cream BID x2-4 weeks) or terbinafine 1% cream BID x2 weeks to entire foot

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