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121. Shingles

to years after lesions heal (post-herpetic neuralgia). Occurs in approximately 0.4%-1% of adults per year. Cumulative lifetime incidence of 10-20% of the population. Shingles cannot be passed from one person to another. However, the VZV can be spread; someone who has never had chickenpox could develop chickenpox if exposed to someone with shingles. Transmission occurs via direct contact with the fluid from the blisters. A person is not contagious before blisters appear or after crusts develop over (...) , does not cross the body midline May involve any area of skin, but thoracic, cranial ( ), lumbar and cervical dermatomes most common Rash typically consists of macules or papules that evolve into vesicles or pustules: Begins with macule formation, quickly turns into papules Clear vesicles form within 1-2 days of rash onset; new ones appear over 3-5 days Vesicles evolve into pustules within 1 week Lesions ulcerate and crust 3-5 days later Healing occurs within 2 to 4 weeks (but may take longer

2018 medSask

122. Acne - Guidelines for Prescribing Topical Treatment

Occurs near hair-line cosmetic X XX XX X Occurs where cosmetics used occupational XX X X Excoriated X X Crusts, scar, erosions, hyperpigmentation Mechanical XX XX X occurs when sinus tracts (channels) form between acne lesions resulting in the formation of cysts and abscesses. This type of acne is considered severe and often requires systemic treatment. Suspected cases should be referred to their physician. is an acute eruption of large inflammatory nodules, occurring most frequent in males. It also (...) frequently caused by topical steroid use. Skin infections such as (small fragile pustules; honey-coloured crusted erosions) o (red, often itchy, papules and/or pustules, occur at base of a hair shaft). Diagnosis of acne is based on the presence of comedones and / or inflammatory lesions. Patients with mild acne signs / symptoms generally do not require further investigation, however assessment by the patient's primary care provider is recommended in the following situations: Pregnancy Age < 12 years

2018 medSask

123. Conjunctivitis: Bacterial, Viral and Allergic

, thyroid disorder Drug-induced: anticholinergics, beta-blockers, oral contraceptives, ophthalmic products Adverse effect of an ophthalmic product Blepharitis – red eye associated with inflammation of eyelids, crusted eyelashes, scant watery discharge; slow onset, chronic condition, may be associated with rosacea Infectious keratitis – inflammation of the cornea caused by bacteria, viruses or fungi, can progress to corneal ulcers; may be rapid onset, loss of visual acuity, photophobia, severe foreign (...) – glaucoma Hyper-purulent discharge (copious amounts of thick yellow-green pus) with very rapid onset – gonococcal conjunctivitis Visible corneal haze or opacities – keratitis, iritis, glaucoma Focal rather than diffuse redness Contact lens wearer – higher risk of infection, corneal ulceration 1) Non-pharmacologic Avoid contact lens use until symptoms have resolved Discard any eye drop bottles used during infection No-tears baby shampoo (weak solution with warm water) can be used to cleanse crusts from

2018 medSask

124. Guidelines for the Management of Genital Herpes in New Zealand

. The area may be oedematous and can be extremely tender. Pain on urination is typical, particularly in women and spontaneous urination may be impossible. The ulcers dry to form crusts and later heal, leaving a transient red macule with minimal scarring (if any). Less commonly, lesions can pass through the blister phase quickly and blisters may not be noticed. Involvement of the cervix occurs but speculum examination may not be possible. Lesions may also appear extra-genitally, commonly on thighs

2017 New Zealand Sexual Health Society

125. Atopic Eczema

. Barrier disruption leads to inflammation, and 12 protease-antiprotease imbalance is a crucial intermediate step (45). 13 14 Cleansing and bathing 15 The skin must be cleansed thoroughly, but gently and carefully to get rid of crusts and 16 mechanically eliminate bacterial contaminants in the case of bacterial super-infection. 17 Cleansers with or without antiseptics (the duration of action of antiseptics is very limited, 18 thus mechanical cleansing is probably more important) in non-irritant and low

2018 European Dermatology Forum

126. Guidelines of care for the management of cutaneous squamous cell carcinoma Full Text available with Trip Pro

measurement should exclude parakeratosis or scale/crust and should be made from base of the ulcer is present. If clinical evaluation of incisional biopsy suggests that microstaging is inadequate, consider narrow-margin excisional biopsy. Table IV Recommendations for grading and staging of cSCC Stratification of localized SCCs using the NCCN guideline framework is recommended for clinical practice. Clinicians should refer to the BWH tumor classification system to obtain the most accurate prognostication

2018 American Academy of Dermatology

128. Brodalumab (Kyntheum) - plaque psoriasis

107059 Monkey 5/sex/group including 2/sex/group recovery SC: 0, 25, 90, 350 IV: 350 4 weeks + 13 weeks recovery 350 • no brodalumab-related adverse effects • at 350 mg/kg, small areas of broken, crusted skin; these areas were partly associated with ulcers or inflammation; findings were reversible 107713 Monkey 6/sex/group including 2/sex/group recovery SC: 0, 25, 90, 350 3 months + 17 weeks recovery 90 • at 350 mg/kg, brodalumab-related adverse effects at injection sites: - increased incidence (...) of discoloration, thickening, and/or crusting; - slight to marked, subacute to chronic histiocytic inflammation - abscess at injection site in 1 F • at 90 mg/kg: macroscopic and microscopic injection site findings less-severe, non-adverse • evidence for reversibility of inflammation at injection sites Assessment report EMA/381484/2017 Page 21/135 Study ID Species/Sex/ Number/Group Dose/Route mg/kg/week Duration NOAEL (mg/kg) Major findings 107714 Monkey 4/sex/group + 2/sex/group recovery control + high dose

2017 European Medicines Agency - EPARs

129. CRACKCast E191 – Weapons of Mass Destruction

and pharyngeal mucosa. A maculopapular rash soon appears, which becomes vesicular and finally pustular. In contrast to chickenpox, the rash first appears on the face and forearms, later spreading to the legs and trunk. All the lesions in any one area of the body are at the same stage. During the next 8 to 14 days, the pustules crust over and separate from the skin, leaving pitted scars. Highly recommend this resource from the CDC: [5] How are nerve agents treated (3 drugs)? Unlike biological WMD

2018 CandiEM

131. Shingrix vaccine for herpes zoster

may be preceded by prodromal pain or itching, after which erythematous macules or papules appear. These progress into vesicular lesions, then into pustules. The pustules typically crust over within the course of about ten days. In many patients, the HZ rash heals and painful symptoms resolve entirely within about four weeks. 6 In up to about thirty percent of patients, however, the pain will persist for months beyond the initial rash, known as postherpetic neuralgia (PHN). 3 PHN is conventionally

2018 Therapeutics Letter

132. Corticosteroid-eluting bioabsorbable stent or spacer insertion during endoscopic sinus surgery to treat chronic rhinosinusitis

4 of 75 5 Safety Safety This section describes safety outcomes from the published literature that the Committee considered as part of the evidence about this procedure. For more detailed information on the evidence, see the interventional procedure overview. 5.1 Crusting, granulation and scarring of the middle turbinate 1 week after the procedure was reported in 1 patient in a randomised controlled trial (RCT) of 105 patients treated by a corticosteroid-releasing bioabsorbable stent in 1 side (...) , but was considered to be exacerbated by presence of crusting sticking to the stent. The condition resolved without sequelae after stent removal. 5.3 Infection at 2-week follow-up was reported in 1 patient in the RCT of 105 patients treated by a corticosteroid-releasing bioabsorbable stent in 1 side and a non-corticosteroid-releasing bioabsorbable stent in the other. The patient was treated with a prednisone taper and antibiotics. The infection resolved without sequelae. 5.4 Peri-orbital cellulitis was reported

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

133. Tinea Corporis Infection - Guidelines for Prescribing Topical Antifungals

to 10 cm in circumference Itchiness and burning sensation are common, but may be asymptomatic Outbreaks common in close-contact sports Rule out the following conditions which can resemble tinea corporis. With the exception of seborrheic dematitis, these conditions do not respond to topical antifungal treatment. Bacterial infections such as - pustules with honey-colored crusts or fluid-filled blisters. - appears as yellow, greasy, scales on scalp and may extend down to face and upper chest

2017 medSask

134. Superficial Bacterial Skin Infections - Guidelines for Prescribing Topical Antibiotics for impetigo and folliculitis

of impetigo Begins as a single, red sore which forms a blister When the blister breaks, a yellowish exudate dries to form a crust Areas affected are most commonly the face and extremities (arms, legs) Sores are not painful, but may be itchy Multiple lesions may form Minimal redness around lesion Fever is rare Lymph nodes may be tender More severe form of impetigo Presents initially as rapidly enlarging soft bullae with sharp margins Blisters do not have a red border, but surrounding skin may be reddened (...) When blister breaks, in 3-5 days, it forms an oozing, yellow crust Areas affected are usually moist diaper areas, armpits and legs Systemic symptoms more likely, such as fever and diarrhea Small red, often itchy, papules and/or pustules at the base of hair shafts especially on neck, groin or armpits Secondary lesions which may follow folliculitis Start as a tender, reddened area or a folliculitis Progress to a hard, tender area with a white pustule at the center The pustule may break open and drain

2017 medSask

135. Diaper Dermatitis, Irritant and Candidal - Guidelines for Prescribing Topical Antifungals and Hydrocortisone

. - 1 to 2 mm fragile pustules and honey-colored, crusted erosions. (Refer to guideline for Bacterial Infections.) - acute, widespread, pruritic dermatitis. Lesions typically occur on the palm, soles or between the fingers. Not a solid rash. - severe rash. Red/orange or yellow/brown scaly papules, erosions, or petchiae. - sharply demarcated erythematous scaly papules and plaques. There may be a family history of psoriasis. Lesions will typically be elsewhere on the body as well. Lack of response

2017 medSask

136. Cold Sore - Guidelines for Prescribing Oral Antivirals

on the vermilion border of the lip and on the border between skin and mucosa around the nostrils. The vesicles break, leaking a clear, sticky fluid, then crust over and heal without scarring within 7 to 10 days. Prodromal tingling and burning sensation in the location of the eruption may occur 2 to 24 hours before the appearance of the vesicle, but this does not occur in all cases. Patients complain of pain, unsightly appearance and possibly itching. Transmission up to 60 hours after initial symptoms (...) and the lesions will have honey-coloured crusts, contrast to the clear crusts seen with cold sores. - lesions that occur on the inside of lips and are not preceded by formation of a vesicle. Will not occur on external lip. - inflammation that occurs on the corners of the mouth, which can resemble a cold sore. However, angular cheilitis will not cause any lesions to form. - presence of typical lesions on skin and mucous membranes, spread to head, trunk and extremities. Lesions can occur rarely

2017 medSask

137. Allergic Rhinitis - Guidelines for Prescribing Intranasal Corticosteroids

– 11 yrs: 1 spray in each nostril daily. Max 100 ug/day Formulation contains phenylethyl alcohol which has a floral scent; ** Available with or without phenylethyl alcohol * Now available as an OTC product. Private insurance may not cover, and you cannot bill the assessment fee if choosing fluticasone. Provide verbal and printed instructions on use of INCS: Use of saline spray to clean nose prior to corticosteroid if the nose is crusted or contains mucus. Spray should be directed away from

2017 medSask

138. Scabies

on the anterior trunk and limbs. Crusted scabies occurs in immuno-compromised hosts and may be associated with reduced or absent pruritus. Recommended treatments are permethrin 5% cream, oral ivermectin and benzyl benzoate 25% lotion. Alternative treatments are malathion 0.5% aqueous lotion, ivermectin 1% lotion and sulfur 6-33% cream, ointment or lotion. Crusted scabies therapy requires a topical scabicide and oral ivermectin. Mass treatment of large populations with endemic disease can be performed (...) is an obligate human parasite. Adult parasites die outside their human host within 24-36 hours [5]. Immature mites can survive one week [6]. The mites and mite products (faeces, eggs and dead parasites) generate an immediate or delayed (type IV) hypersensitivity reaction with scabies symptoms typically starting 3-6 weeks after primary infestation and 1-3 days after re-infestation [7], [8]. In classical scabies there are under 5-15 mites/host. Crusted scabies is characterized by a much higher burden of mites

2017 European Dermatology Forum

139. Herpes Zoster - Diagnosis

. Agius, T. M. Lesser, and J. Sellner. The ?nal recommendations were formally con- sented within the expert panel of the guideline. Generalconsiderations Classically, HZ is a unilateral, dermatomal 18–20 eruption, with skin lesions evolving simultaneously from erythematous macules to papules, vesicles, pustules, and ?nal crusting after about 5– 7 days. Usually not the entire dermatome is involved. Clinical signs include pruritus, paresthesia, dysesthesia or anaesthesia. Local lymphadenopathy may (...) , especially when the typical zosteriform distribution is lack- ing. Other zosteriform dermatoses are tobe excluded. 30 Moleculartechniques PCR is the most sensitive method reaching 95–100% sensitivity and speci?city 31,32 (Table 3). A vesicle ?uid swab can be per- formed on an ulcerated or oozing lesion or after deroo?ng a vesicular lesion. VZV can also be recovered by PCR from lesion crusts or by swabbing the dried lesion with a moistened swab. Salivary ?uid or buccal swabs taken during the acute rash

2017 European Dermatology Forum

140. Diagnosis and treatment of respiratory illness in children and adults.

and rhinorrhea. Harms : The most common side effects of intranasal corticosteroids are nasal irritation (dryness, burning and crusting) and epistaxis. Nasal septal perforation has been reported. Benefit-Harms Assessment : Given the efficacy and relative safety of intranasal corticosteroids in controlling the spectrum of allergic rhinitis symptoms and relative to harms, which can be decreased by use of the proper technique for administration, the ICSI work group recommends intranasal corticosteroids

2017 National Guideline Clearinghouse (partial archive)

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