2) Pityriasis versicolor – Tinea versicolor – white, pink, or brown macules, mostly in the trunk in the adults and face in the children, round and coalescing macules, very fine scales in the macule, hypo or hyperpigmented lesions, Mx – Ketoconazole 2% shampoo applied over the lesions kept overnight for 3 consecutive days, Ciclopirox shampoo applied over the lesions and kept for few minutes and rinsed and continue treatment for 2 weeks, any Imidazole antifungal cream applied over the lesion bid for 2 weeks. Oral therapy includes Fluconazole single oral dose of 400 mg and a repeat dose of 200-400 mg fluconazole given 1 week later OR Itraconazole 200 mg daily for 5-7 days.
3) Scabies – Initiallty itching localized to areas of lesions and the later becoming generalized pruritus, characteristic lesions are burrows (multiple straight or S-Shaped ridges, which appearas short, wavy, threadlike scaling lines, sometimes with a smallblack dot located at one end, representing the burrowing mite), papules, vesicles, excoriations, secondary impetigo, folliculitis or eczemaitization is not uncommon, characteristic distribution is finger webs, wrist, antecubital fossa, posterior aspect of elbow joint, nipples, umbilicus, lower abdomen, genitalia, gluteal cleft, inner thighs, in children plamoplantar and scalp lesions commoner, Mx – Permethrin 5% applied all over the body and kept overnight and washed off, a second application 1 week later if necessary, can be used even in children 2/12 and above, Gamma benzene hexachloride 10-20% lotion or cream applied all over the boy and kept for 8-12 hrs and washed off, apply well onto the areas of lesions particularly, continue treatment for 3 consecutive days, clothes washed and dried well before using again, all close contacts should be treated at the same time.
4) Pityriasis rosea – seen in adolescents and young adults, illness lasting 6-8 weeks, confers life-long immunity, 2-6 cm round, pink, scaly patch usually in the trunk, but can appear anywhere in the body, called ‘herald patch’, followed by a macular eruption mostly in the trunk and proximal limbs (face, hand and feet spared except in children), rarely papules too can be seen, macules are the main primary skin lesion with a collarette of fine scales (that is a rim of fines scale at the edge of the macule with free edge of the scale pointing to the center of the macule), macules number from few and sparse to many and confluent, are positioned with long axis parallel to the rib, come in crops for 7-10 days, with an overall appearance of Christmas tree-like appearance, Mx - Depends on the severity of the disease ranging from no treatment, emollient creams, night time antihistamines, medium potency steroid creams, exposure to sunlight, oral erythromycin 250 mg qid, children 25-40 mg/kg/day in 4 divided doses, continued for 2 weeks, acyclovir 800 mg five times daily,
5) Varicella zoster – 1-2 days of fever, followed by the typical vesicular rash, period of infectivity lasts from day 1 of the illness to about 4-5 days after the onest of the vesicular eruption, pruritus, excoriations, secondary bacterial infections, scarring following healing if severe skin infections, lesion evolution include erythematous maculopapules, to clear fluid vesicles with a base of areola (dew drops on a rose petal), umbilication of vesicles, vesicles turning purulent, crusting within 5 days, 3-5 crops of similar cycles within 5 days, in 1 area lesions of various stages of lesion evolution are seen, within 1-3 weeks crusts fall off and usually lesions heal without scarring, most common complication is secondary bacterial skin infection, lesions distribution mostly on the chest, abdomen and proximal part of the limbs, face and distal extremities relatively spared, Mx – Acyclovir 800 mg qid PO for 5 days from D1, symptomatic treatment with antihistamines, local antibiotics for secondary infections, systemic antibiotics if severe secondary skin infections, paracetamol for fever. Varicella prevention without exposure adults - 2 doses with 6-week intervals, children 1-12 yrs - 1 dose, varicella prevention after exposure within 3 days for exposure - injection 1 dose, after 3 days before the onset of rash - acyclovir tx.
6) Viral fevers and maculopapular rashes -
7) Molluscum contagiosum -
8) Urticaria
9) Tinea corporis - starts as a small patch of erythematous macules and/or papules, patch enlarges with a clear demarcation border, border activity marked by vesicles and scaling, while borders enlarged center clears leaving an area of normal skin in the middle of the lesion, Mx – Econazole, Ketoconazole, Clotrimazole cream locally bid application for 4 weeks, relapse and reinfection common and continue watching for it, Fluconazole orally 150 mg/week for 4 weeks,
10) Id reactions OR Dermatophytid reactions – grouped vesicles, pustules, or papules in a patient with tinea pedis or intertrigo.