1. Facial Rashes/eruptions
Emily McGrath
Dermatology Consultant
Royal Devon and Exeter Hospital

2. Overview
Cases
Discuss differential – points in the history and examination to help
Management tips

3. Case 1 21 year old female 4 year history of acne
Tried Panoxyl over the counter

4. Treatment Topical Oral BPO Azaleic acid Retinoids Antibiotics
Isotretinoin

5. Oral Antibiotics
No benefit in concomitant oral and topical antibiotics.
Intermittent benzoyl peroxide recommended during oral antibiotics to eliminate resistant strains.
Dose: evidence to support erythromycin at 1g/day rather than 500mg/day. No evidence regarding dose of other oral antibiotics.
Treatment should be at least 3 months, maximal effect by 6 months – then if relapse, change drug.

6. Case 2 17 year old 6th Former 2 year history of worsening acne.
On 250mg bd oxytetracycline.

7. Case 3 6 year old girl Itchy face, neck, arms.
Worsening over past 3 months.
Not responding to hydrocortisone.
Mum asks about allergy tests.

8. Atopic eczema - top tips
Emollients - trial then large quanitities.
Soap substitutes - simplify
Topical steroids - appropriate to severity
Short bursts of moderate / potent steroids to achieve control
Topical tacrolimus 0.1% - equivalent strength to mod potent top steroid. Maintenance.
Allergy: consider to be relevant if
Instant urticaria/itching after eating/ contact
Severe/ resistant eczema especially if bowel sx +/- FTT

10. Case 4 51 year old school teacher. Worsening facial rash.
Uncomfotable, especially in hot weather.

12. Rosacea Subtypes: Treatment Depends on subtype Avoid triggers
Erythematotelangectatic
Papulopustular
Phymatous
Treatment
Depends on subtype
Avoid triggers
Sun protection
Topical azaleic acid/metronidazole
Oral antibiotics

13. Rosacea Mild or moderate papulopustular rosacea Metronidazole
Gel (Metrogel®) 0.75% £9.95 (40g)
Cream (Rozex®) 0.75% £15.28 (40g)
Apply twice daily for 3-4 months
Moderate or severe papulopustular rosacea
Oxytetracycline
Tablets 500mg twice daily for 3-6 months £5.68
Lymecycline (unlicensed)
Capsules 408mg once daily ………………………………..….£22.45 (3 months)
Review at 2 months and continue for a total of 3 months if responding well.
Repeat 3 monthly course when rosacea flares.

14. Case 5 55 year old art teacher. Worsening facial rash over 2 weeks.
Sore, weeping.

16. Case 6
38 year old IT worker
Persistent lesion R cheek

17. Case 7
35 year old nurse
Irritating rash past 2 years central face

18. Joint Formulary For moderate and severe disease affecting the scalp
Ketoconazole shampoo £3.02 (120mL)
Use twice a week
For more severe erythema and flaking on the scalp add
Betamethasone scalp application £3.81 (100mL)
Apply to dry hair morning and evening and allow to dry
Disease affecting face and body
Ketoconazole cream £3.40 (30g)
Apply once or twice a day until resolution then reduce frequency to daily or
alternate daily use.
For inflamed skin
Daktacort® cream………………..…………………………………...……….£1.83
Apply once or twice a day until resolved.

19. Case 8 75 year old man Rough patches on forehead.
Sore in strong sunlight.

20. Solar (actinic) keratosis: Treamtent
Treatment:
Diclofenac
5FU
Photodynamic Therapy
Cryotherapy
Curettage