Dermatologic Conditions - DOC

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					                       DERMATOLOGIC CONDITIONS
A. Diagnosis

      Common easily diagnosed dermatoses presenting to an STD clinic include:

      1.    Genital Trauma - abraded or ulcerative areas with a history of overt
            trauma or excessive friction.

      2.    Folliculitis - erythematous pustules with hair follicle in the center; may be
            single or multiple.

      3.    Contact Dermatitis - erythematous papulosquamous eruption, often
            pruritic, in areas of known contact to foreign substances (lotions, topical
            medications, soaps, etc).

      4.    Balanitis - often crusting or scaling, erythematous pruritic involvement of
            glans, corona, and foreskin of penis. Usually caused by yeast (but <50%
            KOH positive); may also be caused by Gardnerella vaginalis, group B
            streptococci and anaerobic bacteria, especially in uncircumcised men.

      5.    Tinea versicolor - hyper or hypopigmented macules on trunk, usually
            asymptomatic; KOH+ with “spaghetti and meatballs” pattern.

      Less common conditions, which should always be evaluated by the clinic
            physician, include:
            a.     Impetigo
            b.     Sebaceous cysts
            c.     Herpes zoster
            d.     Fixed drug eruption
            e.     Hidradenitis suppurativa
            f.     Pityriasis rosea

B. Treatment: For clear uncomplicated episodes of common disorders, treatment as

      1.    Genital trauma - good hygiene, avoidance of contact until healed
            (especially sexual activity).

      2.    Folliculitis - good hygiene, hot soaks.

      3.    Contact dermatitis - good hygiene; over-the-counter 1% hydrocortisone
            cream bid x 1 week.

      4.    Balanitis -
            a.)   Candidal - OTC antifungal cream (apply bid x 1 week) or
                   fluconazole 150 mg PO x1. (KOH should always be attempted
                   before treating);
            b.)    nonfungal - if ulcerative, consider empiric treatment for HSV (as
                   outlined under “genital herpes”), anaerobic balantis (especially if
                   uncircumcised) with metronidazole 500 mg PO bid.

      4.    Tinea versicolor - selsun (selenium sulfide) shampoo applied to involved
            area daily for 2-3 weeks. Can also be treated with oral antifungal
            (ketoconazole or fluconazole) in selected cases after discussion with
            attending physician.

      For common problems which persist or for less common conditions, the clinic
      physician should evaluate and individualize therapy.

C. Follow-up: PRN or per clinic physician.

D. Management of contacts: generally none required; may be individualized by
   clinic physician.

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