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

COMMON LESIONSIN DERMATOLOGY

Recognition DiagnosisTreatmentWhen to Refer