Diseases of the Skin & Subcutaneous Tissue...

Dr. Luis Lomeli, a dermatologist, contributed the article that follows.

The French statement su pays des aveugles les borgnes sont rois is true in healthcare. That is, in the land of the blind, the one-eyed are kings. It is my intent to teach Medicine to consumers so that they can get the best care possible at minimal time and cost.

Herein, I cover topics that include Eczema (Atopic Dermatitis), Pytiriasis alba, Diaper dermatitis, Poison ivy/oak/sumac dermatitis, Impetigo, Tinea Cruris (Jock Itch), Tinea corporis (ringworm), Scabies, Psoriasis and Chemical ("Alley") dermatitis.

For skin care and various kinds of dermatitides, students of medicine can choose to learn many different brands but the task of memorizing such products becomes overwhelming and relatively impossible.

For the benefit of the student and patient, only a few products need to be known (all generics) to care for patients with most types of skin conditions. I only prescribe the following topical corticosteroids. Hydrocortisone 1% cream, ointment or lotion and it is not fluorinated and can be used on the face. Hydrocortisone is a low potency corticosteroid and is available over the counter.

Triamcinolone cream 0.1% is relatively potent corticosteroids that I use on patients with Psoriasis. Clinicians must avoid specific areas of the body so as to avoid the development of striae. Triamcinolone is a fluorinated corticosteroid and should never be used on the face. If properly used, corticosteroids infrequently cause skin atrophy or suppression of the hypothalamic-pituitary-adrenal axis.

At times, if the skin dermatitis is severe as in Poison Ivy/Oak, I may prescribe a short course of an inexpensive generic corticosteroid like Prednisone, which I taper over l3 days so as to avoid a rebound of the Poison Ivy/Oak dermatitis.

Clinicians must avoid prescribing TACROLIMUS (Protopic®/Astellas) and PIMECROLIMUS (Elidel®/Novartis) since they are expensive and associated with serious side effects that include cancer (e.g., lymphoma). We have better options.

Some children are born with a triad of Eczema, Allergy Rhinitis (Hay Fever) and Bronchial Asthma. Parents of such children often become exasperated and want a rapid but perilous rapid cure. With time, these conditions resolve on their own as our bodies mount specific immune-mediated (adaptive) responses.

For Atopic Dermatitis (Eczema), skin testing and immunotherapy is not useful, and it is expensive.

For skin fungal infection, Tinea, Jock Itch, I exclusively prescribe Clotrimazole cream 1% which is readily available over the counter. This anti-fungal covers vaginal yeast, athlete's feet, jock itch, and ringworm. I usually mix the cream with hydrocortisone .5% or 1% if there is a lot of inflammation. Hydrocortisone by itself will exacerbate topical fungal infections.

For Tinea Capitis, patients usually require a four to six week course of oral Griseofulvin. For oral thrush, Nystatin is the drug of choice and should, by now, be inexpensive.

Vaseline® ointment can also be useful for dry skin, especially in the winter, mixed with hydrocortisone cream.

For itching, I usually prescribe oral Diphenhydramine (Benadryl®) or prescription Hydroxyzine.

An itchy skin can be a challenging cognitive clinical case as is it often is with Lichen Simplex Chronicus (LSC). Recently, I saw a man with an itchy area over the outer part of the right leg. Over the last seven years, he had made bad financial investments, and he was about to declare bankruptcy. This man required over an hour of my time in order to help him resolve his personal crisis. The skin itching was the least of his problems.

My data will help insure that the consumers are no longer blind and the one-eyed king is put out of business.

• Infections of the skin and subcutaneous tissue;
• Impetigo;
• Cellulitis Cutaneous abscess, furuncle and carbuncle;
• Pemphigoid;
• Dermatitis and eczema;
• Pruritus;
• Psoriasis;
• Urticaria and erythema;
• Sunburn;
• Radiodermatitis;
• Nail disorders;
• Male-pattern baldness;
• Hair colour and hair shaft abnormalities;
• Excess hair;
• Acne;
• Rosacea;
• Sebaceous cyst ;
• Eccrine sweat disorders;
• Apocrine sweat disorders; etc.

DERMATITIS, ECZEMA, IMPETIGO, JOCK ITCH, PITYRIASIS, ETC...

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ARTICLES: Skin: Sunburn, Keratosis, Herpes, Impetigo, Abscess, Psoriasis, etc.