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Page 1: aee rers - postgraduatebooks.jaypeeapps.compostgraduatebooks.jaypeeapps.com/pdf/Dermatology/Diagnosis_And...aee rers Diagnosis and Treatment of Common Skin Diseases Final Prelims.indd

Jayp

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rs

Diagnosis and Treatment of Common Skin Diseases

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Diagnosis and Treatment of Common Skin Diseases

New Delhi | London | Philadelphia | Panama

The Health Sciences Publisher

Fifth Edition

VIRENDRA N SEHGAL MD FNASC FAMS FRAS (London)Consultant/PracticingDermatovenereologist

Sehgal Nursing Home Dermatovenereology (Skin/VD) Center

Azadpur, New Delhi, India [email protected]

Formerly• Professor/Head, Department of Dermatology and Venereology, Goa

Medical College, Panaji, Goa, India• Professor/Head,DepartmentofDermatologyandVenereology,University

CollegeofMedicalSciences (UCMS)andAssociatedSafdarjungHospital,New Delhi, India

• Professor/Head (ActingDean),Director-Professor,DepartmentofDerma-tology and Venereology, Maulana Azad Medical College and Associated Lok Nayak Jai Prakash (LNJP) Hospital, New Delhi, India

• Principal/Medical Superintendent/Director-Professor, Department ofDermatology and Venereology, Lady Hardinge Medical College, New Delhi, India

• Director-Professor,DepartmentofDermatology/VenereologyandMedicalSuperintendent,UniversityCollegeofMedicalSciences(UCMS),GuruTegBahadur(GTB)Hospital,NewDelhi,India

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Jaypee Brothers Medical Publishers (P) Ltd.HeadquartersJaypee Brothers Medical Publishers (P) Ltd.4838/24, Ansari Road, DaryaganjNew Delhi 110 002, IndiaPhone: +91-11-43574357Fax: +91-11-43574314E-mail: [email protected]

Overseas Offices

J.P. Medical Ltd.83, Victoria Street, London, SW1H 0HW (UK)Phone: +44-20 3170 8910Fax: +44(0) 20 3008 6180E-mail: [email protected]

Jaypee-Highlights Medical Publishers Inc.City of Knowledge, Building 235, 2nd floorClayton, Panama City, PanamaPhone: +1 507-301-0496Fax: +1 507-301-0499E-mail: [email protected]

Jaypee Medical Inc. 325, Chestnut Street Suite 412, Philadelphia, PA 19106, USAPhone: +1 267-519-9789E-mail: [email protected]

Jaypee Brothers Medical Publishers (P) Ltd.17/1-B, Babar Road, Block-BShaymali, MohammadpurDhaka-1207, BangladeshMobile: +08801912003485E-mail: [email protected]

Jaypee Brothers Medical Publishers (P) Ltd.Bhotahity, Kathmandu, NepalPhone: +977-9741283608E-mail: [email protected]

Website: www.jaypeebrothers.comWebsite: www.jaypeedigital.com© 2016, Jaypee Brothers Medical PublishersThe views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photo copying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contra indications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.Inquiries for bulk sales may be solicited at: [email protected]

Diagnosis and Treatment of Common Skin DiseasesFirst Edition: 1987; Second Edition: 2004; Third Edition: 2010; Fourth Edition: 2015

Fifth Edition: 2016

ISBN: 978-93-86056-77-1

Printed at

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rsDedicated to

Dermatologic Practice

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rsPreface to the Fifth Edition

The success of the previous edition was encouraging enough to warrant enlarging of the current contents to meet the increasing requirements of the audience. Accordingly, the contents of Chapter 3 (Drugs that may Cause Specific Side Effects) are updated by incorporating the definitions of Specific Dermatoses, which may accrue as adverse effects following administration of drug(s) bearing generic and/or brand name in order to facilitate to counter them by appropriate measures, including immediate withdrawal of the incriminating drug(s). The volume of Chapter 5 (Drugs Formulary of Dermatological Preparations) has also been increased by the inclusion of a few recent and a new drug formulary. A new Chapter 6 (Biologics: Therapeutic Applications), an upcoming fascinating subject, has been added to enrich the existing drug choices for various dermatoses. Their indications, the generic and the brand names along with their doses and modes of administration are highlighted. And emphasis on their adverse effects has been vividly outlined as an alert. Emergency Dermatology too has been given attention, and new chapters on Erythroderma and Angioedema have been included emphasizing their diagnostic criteria and management strategies. Recommended Reading is an important inclusion to enrich the text by selected references designed according to the PubMed pattern and Research Gate.

Virendra N Sehgal

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rsPreface to the First Edition

Understanding of drug therapy in the specialty of Dermatology, Venereology and Leprosy, in particular, is paramount for practitioners, who have been responsible for managing most of these patients. Common skin diseases are not difficult to diagnose. Their treatment, however, may be a handicap. An endeavor in preparation of the present Dermatologic Drug Directory has been made to bring together scattered information on their management under this caption, in order to facilitate the family physicians. Commonly used systemic and topical drugs, their availability, dosages, side/untoward effects and contraindications may provide a ready reference and meet the growing needs of the family physicians, medical students, resident doctors and also specialists absorbed in alleviating dermatosis, venereal diseases and leprosy.

Virendra N Sehgal

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rsContents

1. Systemic Drugs Commonly Used in Dermatologic Practice 1

Acyclovir 2Albendazole 2Allopurinol 2Amphotericin–B 3Amylobarbitone 3Antacids 4Antihistaminics 4Astemizole 5Azathioprine 8Azidothymidine 8Beta Carotene 8Bleomycin 9Chloroquine 9Carbamazepine 10Chlordiazepoxide 10Cetirizine 10Chloramphenicol 11Clemastine Fumerate 11Cephalexin 12Collagen Implant 12Colchicine 13Clofazimine 13Cyanocobalamin 14Cyclophosphamide 14Corticosteroids 14Cycloserine 16

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xii Diagnosis and Treatment of Common Skin Diseases

Diamino-Diphenyl Sulphone 17Diazepam 17Doxycycline 17Erythromycin 18Ethambutol 18Etretinate 19Fluconazole 19Ethionamide/Prothionamide 195-Fluorouracil 20Indomethacin 20Interferons 21Grisofulvin 21Gold Salts 21Isotretinon 22Isoniazid 22Itraconazole 23Ketoconazole 23Para-Aminosalicylic Acid and Salts 24Methotrexate 24Levamisole 25Metronidazole 25Minocycline (Cynomycin) 26Penicillins 26Penicillamine 28Paracetamol 28Para-Aminobenzoic Acid 29Pentoxifylline 29Oxyphenylbutazone/Phenylbutazone 29Nifedepine 30Potassium Iodide 30Prednisolone 31Propantheline 31Psoralens 32Pyrazinamide 33Pyridoxine 33Rifampicin 34Ranitidine 34Streptomycin 35

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xiiiContents

Spectinomycin 35Terbinafine 36Tetracycline 36Thalidomide 36Thiabendazole 37Thiacetazone 37Tinidazole 38Trimethoprim + Sulphadiazine 38Trimethoprim + Sulphamethoxazole 38Xanthinol Micotriate 39Vitamin-A 39Zidovudine 40Zinc Sulphate 40Vitamin-E 40Recommended Reading 41

2. Topical Therapy Used in Dermatological Practice 43Wet Dressings 44Lotions 44Medicated Baths 45Acyclovir 46Aluminium Acetate Solution 47Ammoniated Mercury 47Benzoyl Peroxide 48Boric Acid Ointment 48Calcipotriol 48Cantharidin 48Ciclopirox Olamine 49Clotrimazole 49Colchicine 49Corticosteroids 50Crotamiton 50Cryotherapy 502,4-Dinitrochlorobenzene (DNCB) 52Erythromycin 53Fluorouracil 53Gamma Benzene Hexachloride 53

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xiv Diagnosis and Treatment of Common Skin Diseases

Gentian Violet 54Glutaraldehyde 54Hydroquinone 54Iodochlorohydroxyquin 55Liquid Nitrogen 55Local Anesthetics 55Miconazole Nitrate 56Monobenzone 56Mupirocin 56Nystatin (Mycostatin) 57Placental Extract Lotion 57Povidone Iodine 57Psoralen + Ultraviolet–A (PUVA) Therapy 57Quinodochlor 58Salicylic Acid 59Sisomicin 59Silver Nitrate Solution 59Silver Sulphadiazine 60Selenium Sulphide 60Sodium Fusidate 60Sulphur 61Sunscreens 61Paba And Paba Esters 61Tar Derivative Shampoos 62Terbinafine 63Tertracycline 63Tolnaftate 63Tretinoin 63Triamcinolone 64Trichloroacetic Acid 64Urea 65Vitamin A and D 65Vitamin E 65

3. Drugs that may Cause Specific Side Effects 67Drugs Causing Acneiform and Pustular Eruptions 68Drugs Causing Alopecia 68Drugs Causing Eczema (Eczematous)/Dermatitis 69

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xvContents

Drugs Causing Erythema Multiforme 69Drugs Causing Erythema Nodosum 70Drugs Causing Scarlatiniform and Morbilliform (Exanthematic) Eruption 70Drugs Causing Exfoliative Dermatitis 70Drugs Causing Fixed Drug Eruptions 71Drugs Causing Gynaecomastia 71Drugs Causing Hair Color Change 71Drugs Causing Hirsutism 72Drugs Causing Hypertrichosis (Excessive Hair) 72Drugs Causing Leucocytoclastic Angiitis 72Drugs Causing Lichenoid Eruptions 73Drugs Causing Lupus Erythematosus-like Lesions 73Drugs Causing Lymphadenopathy 73Drugs Causing Nail Discolorations 74Drugs Causing Pemphigus-like Lesions 74Drugs Causing Photosensitivity 74Drugs Causing Purpuric Eruptions 75Drugs Causing Toxic Epidermal Necrolysis 75Drugs Causing Urticaria 75Drugs Causing Vesicobullous Lesions 76

4. Instant Diagnostic Criteria and Treatment of Common Skin Disorders 79

Acne Vulgaris 80Alopecia Areata 85Atopic Dermatitis 88Bullous Pemphigoid 93Dermatitis Herpetiformis 95Chronic Benign Familial Pemphigus (Hailey-Hailey Disease) 98Erythrasma 99Folliculitis 101Hidradenitis Suppurativa 104Keloids and Hypertrophic Scars 106Infectious Eczematoid Dermatitis 109Impetigo 111Miliaria/Sweat Rash 114

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xvi Diagnosis and Treatment of Common Skin Diseases

Leprosy 116Leprosy Reactions 122Hyperhidrosis 124Chickenpox 125Herpes Zoster 127Candidiasis 131Lichen Planus/Lichenoid Interface Dermatosis 137Pityriasis Rosea 143Lichen Sclerosus Et Atrophicus 146Melasma/Chloasma 148Molluscum Contagiosum 154Pediculosis Capitis 156Pediculosis Corporis and Pubis 157Pemphigus 159Pitted Keratolysis 164Pityriasis Versicolor 166Psoriasis 169Recurrent Aphthous Ulcerations 180Rosacea 182Scabies 187Seborrheic Dermatitis 191Sexually Transmitted Infections Syphilis 193Chancroid 197Gonorrhea 201Nongonococcal Urethritis 204Herpes Simplex/Herpes Progenitalis 206Donovanosis 209Lymphogranuloma Venereum 214Dermatophytosis/Dermatomycosis 217Urticaria 227Vitiligo 231Verrucae Vulgaris/Common Warts 239Cutaneous Tuberculosis 244Lichen Simplex Chronicus/Prurigo Nodularis 255Chilblains 259Twenty Nail Dystrophy/TND 262Sarcoidosis 264Associated Syndromes 266

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xviiContents

Seborrheic Keratosis/Verruca/Senile Wart 268Pseudoacanthosis Nigricans/Type 3 Acanthosis 269Pigmented Nevus/Mole/Melanocytic Nevus/ and Nevus Pigmentation 272

5. Drugs Formulary of Dermatological Preparations 277

Topical Agents 278Systemic Agents 290Shampoos 298Face Wash 301

6. Biologics: Therapeutic Applications 303

7. Emergency Dermatology: Erythroderma 311Erythroderma 312Pityriasis Rubra Pilaris 312Airborne Contact Dermatitis/ABCD 318Atopic Dermatitis 320Toxic Epidermal Necrolysis 322Psoriasis 323Pemphigus Foliaceus 326

8. Emergency Dermatology: Angioedema 329Management 334

Index 337

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Emergency Dermatology: Angioedema

CHAPTER

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330 Diagnosis and Treatment of Common Skin Diseases

Angioedema/angio-oedema and  Quincke’s edema  is the rapid swelling (edema) of the  dermis, subcutaneous tissue (Swelling. Dorland’s Illustrated Medical Dictionary (31st edn.). Saunders. 2007), mucosa and submucosal tissues. It is very similar to urticaria, but urticaria, commonly known as hives, occurs in the upper dermis, may affect any part of the body where skin and/or mucous membrane is/are lose including the upper respiratory tract. The term angioneurotic edema was used for this condition in the belief that there was nervous system involvement, but this is no longer thought to be the case.

Instant Diagnostic Criteria

• Non-pitting, skin-colored/erythematous ill-defined edema.• Attended by burning sensation and/or pain.• Pruritus conspicuously absent in contrast to urticaria charac-

terized by wheal/hives and pruritus.• Rigorous attempts to find the offending agent.• Skin of the face, around the mouth, the mucosa of the mouth,

tongue and/or throat (Figs 8.1A and B)• Acquired angioedema: It is immunologic, nonimmunologic,

or idiopathic. (Axelrod S, Davis-Lorton, M. Urticaria and angioedema.  The Mount Sinai Journal of Medicine, New York.  2011;78(5):784–802.  doi:10.1002/msj.20288.PMID 21913206.)

Hereditary Angioedema

It exists in 3 forms:• Caused by a genetic mutation inherited in an  autosomal

dominant  form, distinguished by the underlying genetic abnormality.

• Three forms of hereditary angioedema (HAE): – Types I and II caused by mutations in the SERPING1 gene,

which result in either diminished levels of the  C1-inhibitor protein (type I HAE) or dysfunctional forms of the same protein (type II HAE).

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331Emergency Dermatology: Angioedema

Figs 8.1A and B: (A) Acquired angioedema; (B) Angioedema face

A

B

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332 Diagnosis and Treatment of Common Skin Diseases

Tabl

e 8.

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333Emergency Dermatology: AngioedemaTa

ble

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334 Diagnosis and Treatment of Common Skin Diseases

– Type III linked with mutations in the  F12  gene, which encodes the coagulation protein factor XII.

• All forms of HAE lead to abnormal activation of the comple-ment system, and all forms can cause swelling elsewhere in the body, such as the digestive tract. If HAE involves the larynx, it can cause life-threatening asphyxiation. (Zuraw BL. “Clinical practice. Hereditary angioedema”.  N Engl J Med.  2008;359(10):1027–36.doi:10.1056/NEJMcp0803977. PMID  18768946.)

• Pathogenesis: This disorder is suspected to be related to unopposed activation of the contact pathway by the initial generation of kallikrein and/or clotting factor XII by damaged endothelial cells. The end product of this cascade, bradykinin, is produced in large amounts and is believed to be the predominant mediator leading to increased vascular permeability and vasodilation that induces typical angio-edema ‘attacks’. (Loew, Burr.  “A 68-year-old woman with recurrent abdominal pain, nausea, and vomiting”. MedScape. Retrieved, 19 October 2012.)

MAnAgEMEnT

See Tables 8.1 and 8.2.

RECoMMEnDED READIng

1. Bork K. Pasteurized and nanofiltered, plasma-derived C1 esterase inhibitor concentrate for the treatment of hereditary angioedema. Immunotherapy. 2014;6(5):533-51. doi: 10.2217/imt.14.33. Epub 2014 Mar 17. Review.

2. Busse P, Bygum A, Edelman J, et al. Safety of C1-esterase inhibitor in acute and prophylactic therapy of hereditary angioedema: findings from the ongoing international Berinert patient registry. J Allergy Clin Immunol Pract. 2015;3(2):213-9. doi: 10.1016/j.jaip.2014.08.014. Epub 2014 Oct 29.

3. Ghazi A, Grant JA. Hereditary angioedema: epidemiology, manage-ment, and role of icatibant. Biologics. 2013;7:103-13. doi: 10.2147/BTT. S27566. Epub 2013 May 3.

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4. Grigoriadou S, Longhurst HJ. Clinical Immunology Review Series: An approach to the patient with angioedema. Clin Exp Immunol. 2009;155(3):367-77.

5. Petraroli A, Squeglia V, Di Paola N, et al. Home Therapy with Plasma-derived C1 Inhibitor: A Strategy to Improve Clinical Outcomes and Costs in Hereditary Angioedema. Int Arch Allergy Immunol. 2015;166(4):259-66.

6. Pham H, Santucci S, Yang WH. Successful use of daily intravenous infusion of C1 esterase inhibitor concentrate in the treatment of a hereditary angioedema patient with ascites, hypovolemic shock, sepsis, renal and respiratory failure. Allergy Asthma Clin Immunol. 2014;10(1):62. doi: 10.1186/s13223-014-0062-9. eCollection 2014.