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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 – – – – – 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: – – – – – – Medications Contact urticaria caused by latex Recent infection Foods Idiopathic Autoimmune Urticaria Treatment • Discontinue suspected drugs • Avoid aspirin and NSAIDs • Antihistamines – – – – 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 • • • • • Scabies Impetigo Acne vulgaris Rosacea Lichen planus Recognition Diagnosis Treatment When to Refer COMMON LESIONS IN DERMATOLOGY