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Herpes Simplex
Herpes Simplex
• Grouped vesicles that recur in the same location
• May be preceded by a prodrome of symptoms
including itching, burning, tingling, painful
sensations
• Treatment is suppressive, not curative
• HSV1 usually causes herpes labialis (cold sores),
and HSV2 usually causes genital herpes
• Primary infection ranges from going unnoticed to
being severe with fever, myalgias,
lymphadenopathy, necrotic ulcers, etc.
Recurrent Herpes Simplex Treatment
• Valacyclovir:
– 2000 mg BID for 1 day for herpes labialis,
– 500 mg BID for 3 days for genital herpes
• Acyclovir:
– 400 mg TID for 5 days
• Famciclovir:
– 125 mg BID for 5 days
• Acyclovir 5% ointment:
– 6 times daily for 7 days
• Chronic suppressive:
– Valacyclovir 500-1000 mg Qdaily
– Acyclovir 400 mg BID
– Famcicloir 250 mg BID
Herpes Zoster
Dermatomes
Herpes Zoster
Herpes Zoster
• Caused by a reactivation of the latent
varicella-zoster virus (in the herpes family) in
patients who have had varicella (chicken pox)
• May have a prodrome of itching, pain,
headache, myalgias
• After the several week disease course,
postherpetic neuralgia may present, which is
characterized by months of skin pain and
burning
Herpes Zoster Treatment
• Antivirals
– Valacyclovir 1000 mg TID for 7 days
– Acyclovir 800 mg 5 times a day for 7 days
– Famciclovir 500 mg TID for 7 days
• Pain/nerve medication
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Gabapentin 300 mg BID or TID
Pregabalin 100 mg BID or TID
Amitriptyline 25-100 mg QHS
Analgesics and NSAIDs
OTC capsaicin cream BID or TID
Folliculitis
Folliculitis Treatment
• Antibacterial soaps daily
– OTC Dial
– OTC Lever 2000
• Hospital strength antiseptic cleansers 1-2 times per week
– OTC Hibaclens (chlorohexadine)
• Bleach baths or bleach spritzers 1-2 times per week
– ½ cup of bleach in a tub of bath water
– 1 tablespoon of bleach in spray bottle
• Topical antibiotics
– Mupirocin 2% ointment (can be used on affected areas and in staph colonized
areas: nose, axilla, umbilicus, groin. Use BID for 5 days and repeat monthly)
– Clindamycin 1% lotion, solution, or gel
• Oral antibiotics
– Doxycycline 100 mg BID (may require several month course)
– Clindamycin 300 mg QID
– Bactrim DS BID
Furunculosis
Urticaria
Urticaria
• An individual hive lasts less than 24 hours
• Common: about 20% of population has had hives
at some point in their lives
• Causes:
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Medications
Contact urticaria caused by latex
Recent infection
Foods
Idiopathic
Autoimmune
Urticaria Treatment
• Discontinue suspected drugs
• Avoid aspirin and NSAIDs
• Antihistamines
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OTC diphenhydramine 25 mg QID
Rx hydroxyzine 10-25 mg QID
OTC cetirizine (Zyrtec) 10 mg BID
OTC fexofenadine (Allegra) 180 mg BID
• Tricyclic drugs
– Doxepin 25-75 mg QHS
• Immunosuppresants
– Prednisone 0.5 mg/kg daily
Other Common Skin Eruptions
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Scabies
Impetigo
Acne vulgaris
Rosacea
Lichen planus
Recognition
Diagnosis
Treatment
When to Refer
COMMON LESIONS
IN DERMATOLOGY