TOC & Search | Palm Index | Rx  | Pt. Ed UC | PubMed | Refs | Disclaimer | Home


  • Links
  • General
  • African-American
  • Malignancy: Cutaneous Manifestations
  • Pitted keratolysis
  • Rosacea
  • Swimmer’s Itch
  • Melanoma Genetics
  • Therapeutics
  • Skin Sores and Ulcers
  • prevention
  • pressure sores: staging and tx
  • venous leg ulcers
  • debriding
  • debriding and heavily exudating wounds
  • exudative wounds (not debriding)
  • partial-thickness wounds/ulcers

  • Links

    General Notes

    Interpreting KOH preps

    Atopic vs. seborrheic dermatitis in infants

    supposedly cannot have atopic derm. prior to 2m of age. THREE Ls (for atopic): late (>3mo), lateral (perioral sparing), and lichenification. Atopic always pruritic!

    Cryotherapy tips

    Caterpillar dermatitis

    Erythema Multiforme

    Granuloma Annulare

    Hyperhidrosis of the soles of feet

    “Tanning the feet” (discolors the soles)


    Lichen Planus

    Lichen Simplex Chronicus

    Lumbar striae

    Strep Guttate Psoriasis


    Warts are weird. In children just about anything seems to make them go away, including using occluding tape and sometimes simply suggestion. Sometimes though (even in children) nothing seems to work for years -- then they disappear.


    Facial (flat)



    Normal variations


    Infant & Child

    Malignancy: Cutaneous Manifestations

    Melanoma Genetics

    1. dysplastic nevi + 2 or more 1st degree relatives w/ melanoma = almost certain to develop.

    2. significant risk of nonfamilial melanoma with

    Pitted keratolysis


    Swimmer’s Itch, Cutaneous Schistosomiasis

    Skin Sores and Ulcers


    pressure sores: staging and therapy

    I. pink skin, does not normalize when pressure removed.

    II. cracked, blistered, broken skin. Shallow to full thickness skin injury.

    III. distinct ulcer margin, dermis penetrated to fatty tissues and fascia.

    IV. penetration to bone and muscle

    venous leg ulcers

    Any leg ulcer with an arterial peripheral pulse can be treated as a venous ulcer. Compression is key to therapy.



    Venous leg ulcers: EMLA cream in a thick layer (max 10g) together with occlusive plastic wrap applied for 30-45 minutes prior to procedure. After debriding, cover with sterile petrolatum dressing; or below as indicated.

    Nu-Gel Collagen Wound Gel (J&J)

    Provides a moist wound environment and encourages autolytic debridement. Mild debridement.

    Wet-to-dry dressings

    Effective but non-selective, remove granulation tissue as well as necrotic tissue. The occlusive dressings also produce debridement through leukocytic migration. Can use Dakins solution (dilute QID, good for staph, strep, liquefy necrotic tissue) or normal saline.

    Elase ointment: 10gm and 30gm tube

    Works on necrotic soft tissue and purulent discharge. If there’s a hard eschar it must be removed or have slits made to allow penetration. Apply qD or more, change dressing BID-TID. Irrigate with saline each changing. Recheck weekly.


    Semi-occlusive zinc releasing dressing. Supplied as 10x10 cm and 6x7 cm sizes.
    Good for stripping of an eschar, apply directly to facilitate debridement

    debriding and heavily exudating wounds


    Gauze dressing, impregnated with hypertonic saline solution. Supplied as 5x5 cm and 10x10 cm patches. Apply dry. Useful for severe exudation wound with debris. Use until wound bed is clean.



    Activated charcoal cloth dressing that removes debris and controls odor and necrosis in chronic wounds. Less debriding than Mesalt. Supplied as 10x10 cm and 20x10 cm patches. Example: management of a necrotic breast mass.


    exudative wounds (not debriding)

    Sorbsan (calcium alginate, Dow-Hickam)

    Tielle Hydropolymer dressing  (J&J)

    Fibracol Collagen-Alginate (J&J)

    partial-thickness wounds/ulcers

    For "road rash", start with Nu-Gel or Duoderm CGF, can switch to Bioclusive or Tegaderm as heals (cheaper).


    Tegaderm (3M), Bioclusive (J&J)

    Duoderm Extra-Thin CGF and CGF Spots

    Nu-Gel occlusive-hydrogel (J&J)

    Duoderm CGF

    Topical Steroids

    widespread use

    Mix steroids with a 1 lb jar of EUCERIN (or acid mantle cream for less greasy feel).


    Creams are usually best, lotions for hairy areas or large surfaces, gels for mucosal surfaces. Ointments are more potent. Start strong, if get response change to weaker prep. Occlusion increases effect 10x. If something worsens on steroids r/o fungus. PULSE DOSING: get remission with 2 weeks of diprolene then use Sat-Sun only and emollient rest of week.


    avail. 15, 60 g size

    HIGH POTENCY (scrape for fungus prior to use)



    Therapeutics (see steroids below)


    systemic antibiotics (inflammatory acne)

    topical therapy

    actinic keratosis

    antifungals and onychomycosis


    systemic, esp. onychomycosis

    Costly, side-effects, variable effect, can recurr.

    atopic dermatitis

    (Hurwitz, Clinical Pediatric Dermatology)

    dove soap, emollient (eucerin or acid mantle cream) post bathing, erythromycin if any evidence of pyoderma (TID x 2w then BID x 2-3w more), cotton clothes, dietary revision. If icthyosis (present 20%) add 3-6% lactic acid to HC mixture. Lacticare (6% NH4 lactate) good for eliminating scales.

    dietary revision

    (food in under 2yo, inhalant in over 4 yo)


    drugs and lotions

    wet compresses

    Burrow’s Solution (AlAcetate)

    head lice

    All therapy requires consistent louse combing to remove any nits. Treat, comb, cut hair short if possible, then recomb.


    Zeesorb Powder


    eucerin cream (oily), nutraderm, acid mantle cream (emollient, less greasy feel).

    plantar wart

    scrape and duofilm BID (lactic/ASA); (same as ASA but 2x strength)

    poison ivy/contact dermatitis

    prednisone 1-2 mg/kg over 2 week taper. For recalcitrant might need 3 weeks, ex 60 mg qD for 1 week, 40 mg qD for 1 week, 20 mg qD for 1 week. For blistering eczema Burrow's soln soaks 1:40, Domboro (Al subacetate) 1 pill to pint water and soak. Medrol dose pack starts with two low a dose and finishes too soon.


    Sarma lotion (OTC, methol and camphor)


    calcipotriene: few side effects, works as well as steroids.


    DX by placing immersion oil on skin, scrape with scalpel, trsfr to slide, view 10x. Itching 4-6 w post initial infestation. No old clothes, bedding x 72h.

    sebaceous cyst

    Iodine Crystal to dry up a sebaceous cyst

    seborrheic dermatitis

    shampoo qD, topicort GEL (liquefies) .05% qD.


    DOVE, PURPOSE, NEUTROGENA. If cannot use soap at all try cetaphil lotion as subst.


    Author: John G. Faughnan.  The views and opinions expressed in this page are strictly those of the page author. Pages are updated on an irregular schedule; suggestions/fixes are welcome but they may take weeks to years to be incorporated. Anyone may freely link to anything on this site and print any page; no permission is needed for citing, linking,  printing, or distributing printed copies.