Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Scleroderma Seborrheic Dermatitis 1331

nephrologist, control BP w/ACE inhibitors, dialyze if necessary. Pt

may partially recover renal function after dialysis.

■Pulmonary: 10% of CREST pts develop severe pulmonary hyper-

tension, 5-year survival <10%. Alveolitis & interstitial fibrosis in

45–75%, 5-year survival 45%. For cyclophosphamide therapy, con-

sult rheumatologist for follow-up. Check blood counts frequently &

adjust dose to achieve WBC 3.5–4.5, monitor urine for hematuria.

■Myocardial involvement 20–25%, pericardial 5–16%. Treat w/heart

failure agents, anti-arrhythmic agents.

■Trigeminal neuralgia: analgesics, agents for neuropathic pain

■Barrett’s esophagus, esophageal cancer, candidal esophagitis

■Pneumatosis intestinalis: gas dissection into abdominal wall, may

burst into abdominal cavity, simulating perforated viscus

■Lung malignancy

■Mortality higher in diffuse disease, older onset age, pulmonary &

renal involvement

SEBORRHEIC DERMATITIS

J. MARK JACKSON, MD

history & physical

■History: scaly itchy patches, most often on scalp, central face, in and

behind ears, may also be in central chest

■Physical-red, “greasy” scaly patches in scalp, mid face, nasal creases,

in and behind ears, mid chest, and occasionally genital area (esp.

glans penis)

tests

■Usually none

■Consider HIV testing in young adults with new onset or severe seb-

orrhea.

differential diagnosis

■Psoriasis

■Lupus erythematosus

■Dermatomyositis

■Rosacea/perioral dermatitis

Contact dermatitis

management

What to Do First

■Mild topical corticosteroids (Class 6 or 7) or the topical calcineurin

inhibitors tacrolimus and pimecrolimus