4-65
Using Advanced Tools: Lab: KOH of scale from lesion to insure the process is not fungal.
Assessment: Diagnose based on the characteristic clinical presentation.
Differential Diagnosis
Seborrheic dermatitis - dry scalp
Lichen simplex chronicus - small, very itchy, papule(s)
Candidiasis - KOH positive
Drug reaction - history of drug exposure
Plan:
Treatment: Only with topically administered agents.
Primary:
- NEVER GIVE ORAL STEROIDS as they may cause a systemic pustular eruption and kill the patient.
- Use topical uorinated corticosteroids (betamethasone, ucinolone, clobestasol) in an ointment base.
Apply after soaking off the scale in a salt-water bath bid x 2 weeks (then move to non-uorinated steroid
ointment). Apply the ointment to the skin when still wet then pat dry. - Never apply uorinated steroid to the face or in occluded areas like the groin or axilla
Alternative: Triamcinalone ointment
Symptomatic: Hydroxyzine (atarax) 25-75 mg po q4 hrs for pruritus.
Empiric: Ultraviolet exposure (20 min exposure to noonday sun) will accelerate the resolution of the lesions.
Patient Education
General: Lesions can be exacerbated by stress and illness
Medications: NO oral steroids, beta-blockers, lithium, NSAIDs. All can exacerbate the lesions.
Prevention and Hygiene: Use antifungal soaps.
Follow-up Actions
Reevaluation: If lesions do not start to thin in 2-3 weeks referral is needed
Evacuation/Consultation Criteria: Referral is not usually indicated, unless unstable. Consult dermatology
as needed.
Skin: Pseudofolliculitis Barbae
MAJ Daniel Schissel, MC, USAIntroduction: Pseudofolliculitis barbae (PFB) is a common disorder of the pilosebaceous unit of the beard. It
is caused by multiple factors and is more common in those with very curly beard hair. Affected persons may
have a genetic predisposition due to abnormal formation of the hair follicle. When hair is lifted and shaved
it retracts into the pilosebaceous unit. Curly hair can then penetrate the side of the follicular unit and cause
a mechanical irritation in the skin, or the curly hair may exit appropriately and then curl back into the surface
of the face again, causing an irritation.
Subjective: Symptoms
Rapid development of papules and pustules in the beard area after shaving.
Objective: Signs
Using Basic Tools: Follicular-based papules and pustules below the jawline and on the anterior neck.
Long-standing lesions may become nodular, cystic or granulomatous.
Assessment: Diagnose based on history and clinical ndings.
Differential Diagnosis
Acne - lesions also in other areas
Irritant contact dermatitis - lesions also in other areas.