Psoriasis Treatment Continued Phototherapy – NBUVB (Narrow band ultraviolet B) – PUVA (Psoralen combined with ultraviolet A) Systemic immunosuppresants – Methotrexate – Acitretin (Soriatane) – Cyclosporine Biologics – Etanercept (Enbrel) – Adalimumab (Humira) – Infliximab (Remicade) – Ustekinumab (Stelara)

When to Refer… Psoriasis is a chronic condition with intermittent flares Above therapies can control disease but not cure it A few plaques involving little body surface area can be controlled with topical medications However, if more than 5-10% body surface area is involved, a systemic medication may be warranted along with a referral to a specialist

Fungal Infections Tinea corporis Tinea pedis Tinea manuum Tinea cruris Tinea faciale Tinea barbae Tinea capitis Tinea unguium or onychomychosis

Fungal Infections Fungal infections of the skin are caused by organisms collectively referred to as dermatophytes – Feed on the keratin in our epidermis. Prefer warm, moist environments “Ringworm” is used by the general population but is a misnomer Diagnosis: KOH (potassium hydroxide) preparation

Treatment of Tinea Topical antifungals (for limited disease) – OTC clotrimazole 1% cream (Lotrimin) – OTC miconazole 2% cream (Micatin) – OTC miconazole powder (Zeasorb AF) – OTC terbinafine 1% cream (Lamisil) – Rx ketoconazole 2% cream Systemic antifungals (for tinea capitis, tinea unguium, or extensive involvement) – Griseofulvin (most effective in children with tinea capitis) – Terbinafine 250 mg Qdaily for adults – Ketoconazole – Fluconazole – Itraconazole

Tinea Versicolor Anti-yeast/anti-dandruff shampoos used as a face/body wash. Leave on for 5 minutes then wash off. Use daily for a week, then weekly until resolution, then monthly to prevent recurrence –Z–Zinc pyrinthione 1% (Head and Shoulders) –S–Selenium sulfide 1% (Selsun Blue) or 2.5% (Rx only) –K–Ketoconazole 1% (Nizoral) or 2% (Rx only) If only a few spots, OTC miconazole cream or Rx ketoconazole cream Oral: fluconazole (Diflucan) one 200 mg tablet repeated two weeks apart

Seborrheic Dermatitis Common: – Found in around 5% of the healthy population Treatment: – Anti-yeast/anti-dandruff shampoos a few times a week, can use as face or body wash. Leave on for 5 minutes then wash off Zinc pyrinthione 1% (Head and Shoulders) Selenium sulfide 1% (Selsun Blue) or 2.5% (Rx only) Ketoconazole 1% (Nizoral) or 2% (Rx only) – Ketoconazole 2% cream BID PRN for face – Hydrocortisone cream 1% or 2.5% BID PRN for face – Clobetasol solution 0.05% BID PRN for severe inflammation of scalp