• Redness,Telangiectasia,blushing,papules,pustules;
  cheeks,nose;rhinophyma 
• Triggers: heat, hot drinks, spicy food, sunlight,exercise,alcohol,emotions,menopausal flushing 
• a/w opthalmic ds  
• Flushing warmth 
• no comedones 

1. Episodic Erythema 
2. Persistent Erythema with telangiectasia 
3. Persistent erythema, telangiectasia, papules, tiny pustules
4. Deep erythema, dense telangiectasia, papules, pustules, nodules, solid edema of central face, rhinophyma 

• Avoid Triggers 
• Mild 
• Topical Metronidazole,
• Sodium sulfacetamides
• Azelaic acid cream
• Brimonidine gel (Marvaso)
• Decreases the size of the blood vessel (vasoconstriction)
• Pt. with persistent erythema 
• New treatment for rosacea
• Works temp - last 12 hrs
•  Response in 4-8 weeks 

• Topical creams 
• Systemic ( oral antibiotic) 
• tetracycline, minocycline, doxycycline 
• Laser - reduce telangiectasia 
• Heats the hemoglobin and RBC, which causes it to disappear 
• Works well 

• When topical is inadequte ( mod - sev) 
• Tetracycline 250-500 mg PO bid on empty stomach 
• Rhinophyma
• Early intervention 
• Excision to remove excess edema on nose 
• Laser: only txt for telangtectasias 

• Prevention of flare-ups
• Reduction or elimination of alcoholic and hot beverages 
• Exercise in cool enviornment 
• Daily facial moisturizer with sunscreen 
• Green based cosmetic foundations 
• calms & hides redness down 

Seborrheic Dermatitis

• Often coexist with psoriasis 
• Very common dermatosis characterized by redness and scaling occuring in regions where the sebaceous glands are most active 
• Caused by overgrowth of yeast ( M. Furfur aka pityrosporum) 
• Not contagious  

• Signs
• Yellowish red dry scale with "greasy"  macules and papules 
• Scaliness in the T zone 
• Scalp margins, nasal folds, eyebrows, behind ears, submammmary, groin, body folds
• Acutely ill , parkinson ds. HIV pt. strokes 
• Cradle Cap- severe dermatitis of the scalp seen in babies 
• Symptoms 
• Pruitis can be variable 
• Worse with perspiration 
• Worse during the winter  

• Very common 
• Affects majority of individuals at some point in their lives 
• Is chornic. Can re-occur at times of stress 
• Pt. with HIV, parkinson patients and those hospitalized are more prone to getting this 
• Can get secondarily infected - b/c people pick at the skin 

• Scalp: zinc pyrithione/ selenium shampp daily , tar or ketoconazole shampoo 
• topical steroids - come as a foam ; mild or low potent steroids
• Facial & Nonhairy: mild CS cream intermittently (avoid eyes), ketoconazole creams 
• Intriginous Areas: Low-pot CS lotions or creams bid x5-7 d, then 1-2x/wk for maintenance 
• Eyelid Margins: gentle cleaning with baby shampoo 

• Caution with long term steroid use 
• Steroids should not be used long term 
• Can cause atrophy, acne breakouts 
• Hard to treat something like this , so just caution the pt. 

• Common , benign, chronic , inflamm. ; genetic + env. triggers 
• Koebner Phenomenon - injury/irritation of normal skin -> lesions of psoriasis 
• Worsened by obesity 

• Itching 
• BL; scalp, elbows, knees, palms and soles, nails
  (oil drop) 
• red, sharply-defined plaques w/ silvery scales 

• Atopic dermatitis ( poor demarcation, flexural) 
• Intertrigo & candidiasis ( culture) 

• Plaque: m/c 
• Guttate: small red scaly papules or plaques
• Looks like raindrops on the skin; mc follows strep infection 
• Inverse: Armpits,groins, skin folds
• Pustular: White blisters, surrounded by red; hands & feet, a/w TOB 
• Erythrodermic: Intense redness, large areas, emergency 
• Overall body redness 
• Thick scale over top of it 

• Most commonly on elbows,knees, palms, soles and scalp 
• Usually occurs bilaterally 
• Nails 
• Tiny pitts ( oil drop sign) 
• May loosen, thicken or crumble 
• Onycholysis 
• Seperate the nail from the nail bed 
• Hard to differentiate from fungus - so do a culture 

• Never use systemic CS to tx flares 
• Limited ds ( <10% BSA) 
• Small plaques: phototherapy 
• Large plaques: high - to ultra- high-potency top. CS cream or ointment 
• scalp: tar shampoo daily 
• Vit. D analog 
• Retinoids: exfoliate thickened skinm can be irritating 

• 10-30% BSA 
• UV phototherapy 

• ( >30% BSA) 
• OP narrowband UVB 3x/wk - stops rapid cell turnover 
• PO retinoids: long t1/2, avoid in women of childbearing age 
• Cyclosporine: ADRs 
• Biologics: Stelara, Enbrels; injection, safer, future  direct; targets T cells to tx inflammation 

• Atopic Dermatitis 
• Contact Dermatitis 
• Nummular Dermatitis 
• Diaper Dermatitis 

• AKA eczema 
• atopic refers to the tendency for excess inflammation in the skin 
• Tendency toward chronic or chornically relapsing dermatitis 
• Often genetically related 
• Most common in infants to young adults 
• TRIAD - eczema , asthma, allergies 

• in infants often seen as oozing, red, crusting condition on face and scalp 
• After infancy, skin tends to be less red. 
• Dry, pink, with scale or thickening 
• May see bleeding or infection 
• in kids and adults often see ACF, popliteal fossa, neck and face 
• Hypo/hyperpigmentation 
• VERY ITCHY , scratch , rash cycle 
• Burning and stining from constant itching 

• Avoid hot, long water exposure 
• esp kids 
• Gentle soaps, moisturizers, laundry detergents 
• No fabric softners 
• Use humidifiers at home 

• Acute or chronic that results from direct skin contact with chemicals or allergens 
• jewelry - nickle is a common allergen 
• Neosporin 
• Poison Ivy - usually in a line in different area 
• Are often red and scaly. Can be vesicular and weepy 
• Very itchy 
• Look for pattern on exposed skin, in bizarre 

• Generalized, pruitic, sharply demarcated, round ( coin-shaped) lesion of eczematous inflam.
• Usually starts with few isolated spots on legs 
• Tends to recur in same area
• Check IgE - would be normal 

• Follow proper skin care 
• Antihistamines may help with itching 
• T/C allergy testing 
• Oral steroids if severe
• Abx if secondary infection 
• Non- steroid creams for face and kids 
• Tacrolimus, Pimecrolimus, Epiceram, Hylatopic 
• Steroids Cream 
• use with caution on face, axillam groin- not to use long term 
• Don't use in kids

• Diaper occludes the skin and predisposes to inflammation and infection 
• Irritant contact vs. Candida 
• Candida more like erosion 
• Red,scaly, eroded, painful 
• Treat - Low potent steroid or anti-yeast cream 

• Scaly papular eruption around the mouth, nose, and eyes 
• Also get periorbital dermatitis- around the corner of the eyes 
• Like a acne breakout and a eczema breakout
• Occurs mostly in females , may slightly be pruitic 
• Treatment 
• Low potent steroid cream 
• Topical Abx 
• If severe, oral abx
• Most of the time used oral abx ( doxy) 
• couple of wks to decrease the inflam 

• Eczematous Dermatitis of the legs, associated with edema, varicose and dilated veins and hyperpigmentation 
• Is chronic, often recurs 
• Pruitic 
• Txt 
• Medium to high potent steroid cream 
• Emollient 
• Prevention of ulcers 
• Compression stockings - helps facillitate the blood flow 

• Chronicus
• Circumscribed Neurodermatitis
• General Considerations: scratch-itch cycle in chronic eczema pts.
• Inflammatory disorder of unknown etiology
• Skin, nail, hair and mucous membranes may be affected. 
• Skin lesions may be pink, but overtime become purple with well defined borders

• Chronicus
• Dry, leathery, hypertrophic, lichenified, circumscribed plaques on neck, ankles, perineum
• Most often found in ankles and wrists and presents with pink to purple well defined papules
• rectangular, thickened, hyperpigmented
• accentuated skin lines

• Itching is variable, most often intermittent – mild to severe
• Mucous membranes – shows a white lacy reticulated pattern (Whickam’s striae)

Linchen Simplex Chronicus : Diagnosis

• psoriasis (redder, whiter scales on elbows, knees, scalp, nails)
• lichen planus (violaceous, smaller polygonal papules)
• nummular dermatitis (coin-shaped)

• CHRONICUS - VERY DIFFICULT
• superpotent topical CS ± occlusion (extra-genital)
• steroid injections, ↑ emollients
• Sedating antihistamines for pruritus
• Oral steroids for severe cases
• Group I or II topical steroids
• Steroid intralesional injections

• common, mild, acute inflamm.; females; young adults; spring, fall
• First lesion appears.  Two weeks later more similar smaller “spots”  appear.
• neck down to the middle of the thigh is the m.c area

• mild itching
• oval, fawn-colored ( large single pink patch) herald plaques (≤ 2 cm) w/ “cig paper” centers and collarette scale (classic)...more after 2 wks (smaller)
• lesions follow cleavage lines on trunk (Xmas tree pattern)
• 50% of patients will have itching (especially when overheated)
• Physical activity – like jogging, bathing in hot water may cause rash to temporarily worsen or reappear for several weeks

• syphilis (serology, if typical lesions are absent)
• tinea corporis (fewer lesions)
• ACEi, metronidazole, flu vax can imitate

• Often none req.
• steroid creams, avoid heat; oral steroids or UVB if severe
• Re-assurance - benign , no scar formation behind
• Avoid aggravating activities (hot showers, exercise)
• Oral steroids if severe
• UVB treatment if severe

• Depigmenting disease of unknown origin that causes destruction of melanocytes.
• M=F, 1% of pop
• Develop at ages 10-30 y.o 
• Most likely on hands, fingers, face, body folds, axilla, groin
• Look at these locations first ( esp mouth area) to determine diff dx.

• Treatment
• • Sunscreen
  • Concealers/camouflage
  • Limited use of low to high potent steroid cream (depending on areas involved)
  • UVB treatment
  • Removal of remaining normal pigment (Monobenzone cream)
  • Pt. have less pigment than more of your pigment - do this sometimes!

• Chronic, scarring, disease occuring in the axillae, anogenital regions, and under female breasts.
• Occurs deep in the skin around oil glands and hair follicles.  
• Hallmark is double comedone (double barrel)
• Sinus tracts are common.  
• Extensive, deep, dermal inflammation results in large, painful abscesses

• I & D
• steroid injections
• Long term antibiotics
• Surgery