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141. 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

142. 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

143. 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

144. Atopic Dermatitis - Guidelines for Prescribing Topical Corticosteroids

swelling Vesicles form and rupture releasing serous fluid (IE. weeping) Crusts form as serous fluid dries Excoriations caused by scratching Chronic Thickening of skin with accentuated skin marks (lichenification) Hypo- or hyperpigmentation of the skin Scaling, fissures Fibrotic papules Dermal lesions Distribution Infants: trunk, face, and extensor surfaces. (Extensor surface is an anatomy term used to describe certain areas of the body. A body part flexes when it bends and extends when it straightens (...) . The parts of the skin that touch when a joint bends are called the flexor surfaces. The parts of the skin on the opposite side of the joint are called the extensor surfaces.) Children: the flexor surface of the elbow and of the knee. Adults: scalp, face, neck, hands, upper chest, and genital areas. Morphology of lesions: Infants: erythema (redness) and papules (solid skin elevation not containing pus); may develop oozing, crusting vesicles. Children and adults: chronic eczema may lead to skin

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2017 medSask

145. 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

146. 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

147. Persistent Pain with Breastfeeding

be responsible for nipple and/or breast pain in lac- tatingwomen.Anyoftheseconditionsmaybesecondarily infected with Staphylococcus aureus, causing impetigi- nous changes such as weeping, yellow crusting, and blis- ters. 18 (III) 1. Eczematous conditions These conditions can affect any skin, but are com- monly seen on and around the areola in breastfeeding women. Attention to the distribution of skin irritation and lesions may help identify the underlying cause/ trigger. Eczematous rashes vary considerably. B (...) . Adjust level of suction or ?t of ?ange. Eczematous conditions Erythematous skin Acute episodes: blisters, erosions, weeping/oozing, and crust formation Chronic eruptions: dry, scaling, and licheni?ed (thickened) areas. Lesions can be pruritic, painful, or even burning. 18,20 Reduce identi?able triggers. Apply an emollient. Apply low/medium-strength steroid ointment twice daily for 2 weeks (immediately after a breastfeed to maximize contact time before the next breastfeed). 20 Usesecond

2016 Academy of Breastfeeding Medicine

148. WHO guidelines for the treatment of Genital Herpes Simplex Virus

. Over a period of 2–3 weeks, new lesions appear and existing lesions progress to vesicles and pustules and then coalesce into ulcers before crusting over and healing. Lesions on mucosal surfaces may be ulcerative without initially presenting as vesicles (5). Atypical presentations of infections due to HSV-2 may include small erosions and fissures, as well as dysuria or urethritis without lesions. Although HSV-1 and HSV-2 are usually transmitted by different routes and affect different areas

2016 World Health Organisation Guidelines

149. Radiofrequency Ablation for Hypertrophy of the Inferior Nasal Turbinates

conventional surgery include performance of the procedure on an outpatient basis; preservation of the surface mucosa; and fewer adverse events, such as pain, bleeding, crusting and loss of smell. 1 However, it should be noted that squamous metaplasia (benign cancer) has been observed within the scar tissue 7 to 60 days post-intervention. 3 Company or developer Several companies develop and market radiofrequency generators and probes for treating nasal obstruction. For example, the Olympus AFU-100 (...) required by either group following the interventions and no ulceration, crust formation or mucosal erosion was observed. The most common complaints were minor nasal discharge and post-procedural obstructions up to five days following treatment. No further information regarding the frequency of these events was reported. Prokopakis et al 2014 12 The aim of the non-randomised controlled trial was to compare the efficacy of RFA, CO 2 laser ablation and electrocautery for the treatment of rhinitis. Between

2016 COAG Health Council - Horizon Scanning Technology Briefs

150. Moisturisers improve eczema symptoms and lessen the need for corticosteroids

the opportunity to choose between different moisturisers and use the ones that suit them best. Some may prefer using less oily creams during the day and thicker ointments at night. Share your views on the research. Why was this study needed? Eczema is a chronic skin disorder characterised by itchy dry skin. Scratching and cracking lead to further damage with redness, crusts, and oozing, and the itching can result in sleep deprivation and have a considerable impact on quality of life. Eczema often develops (...) Task Force on Atopic Dermatitis. . Dermatology. 1993;186:23-31. NICE. . London: National Institute for Health and Clinical Excellence; 2007. SIGN. . Edinburgh: Scottish intercollegiate guidelines network; 2011. Why was this study needed? Eczema is a chronic skin disorder characterised by itchy dry skin. Scratching and cracking lead to further damage with redness, crusts, and oozing, and the itching can result in sleep deprivation and have a considerable impact on quality of life. Eczema often

2018 NIHR Dissemination Centre

151. Gynecologic Care for Women and Adolescents With Human Immunodeficiency Virus

as noninfected women. Women infected with HIV are at increased risk of crusted scabies, which should be managed in consultation with a specialist (24). How does treatment of menstrual disorders differ between HIV-infected and non-HIV-infected women? Women with HIV should receive the same evaluation and treatment for menstrual disorders as uninfected women. Menstrual disorders are frequently reported by HIV-infected women, but the role of HIV and HIV-related immunosuppression in menstrual abnormalities

2016 American College of Obstetricians and Gynecologists

152. Management of scabies

is uncommon but can occur in those wearing heavily contaminated clothing or using a bed recently occupied by an infested person. 2 It is more likely to occur with crusted scabies due to the greater number of mites present 4,6,7 and because mites can survive longer for up to 7 days. 8 Clinical Manifestations Classical scabies The main clinical feature of scabies is intense generalised pruritus that is usually worse at night. The pruritus is due to a delayed type-IV hypersensitivity reaction to the mite (...) regions and these are intensely pruritic. They tend to persist after treatment and are thought to result from a hypersensitivity reaction to the mite. Urticarial lesions may rarely occur. 13,14 Presence of itchy papules and nodules on the penis and scrotum are indicative of sexually acquired scabies. Crusted scabies Crusted scabies (Scabies crustosa, Norwegian scabies) occur in immunocompromised states: e.g. in AIDS, leprosy, lymphoma, those receiving systemic or potent topical steroids, organ

2016 British Association for Sexual Health and HIV

153. Insect Bites - Guidelines for Prescribing Topical Hydrocortisone

that can be treated with antihistamines. Refer to physician for allergy testing if desired. (1 to 2 mm fragile pustules and / or honey-colored, crusted erosions) or other bacterial skin infections - can be the consequence of scratching a bite. - infected hair follicles; presenst as red, often itchy, papules and/or pustules at the base of the hair shaft. Subcutaneous folliculitis forms furuncles ( boils) - tender red swellings often with a central pustule. Adverse drug reactions which may present

2016 medSask

154. Kawasaki Disease Patients With Redness or Crust Formation at the Bacille Calmette-Guérin Inoculation Site. (PubMed)

Kawasaki Disease Patients With Redness or Crust Formation at the Bacille Calmette-Guérin Inoculation Site. A specific diagnostic test for Kawasaki disease (KD) is currently unavailable. Redness or crust formation at the Bacille Calmette-Guérin (BCG) inoculation site is listed as a positive sign in the diagnostic guidelines of KD. The purpose of this study was to investigate the epidemiologic features of KD patients with such changes at the BCG inoculation site and to evaluate the specificity (...) of this sign in KD diagnosis.Data on KD patients who received BCG vaccination were analyzed from a Japanese nationwide epidemiologic survey on KD conducted in 2007. Patients who had 5 or 6 principal signs (complete cases) with redness or crust formation at the BCG inoculation site were compared by sex, year of hospital visit, day of first hospital visit, recurrent status, and presence of KD in siblings. To evaluate the specificity of the sign for KD diagnosis, patients aged 2 years or younger who were

2009 Pediatric Infectious Dsease Journal

155. Meibomian cyst (chalazion)

the lacrimal puncta. The person may report history of a watery eye. Blepharitis — suggested by redness of lid margins and crusting on the eyelids, with a history of bilateral ocular burning, itching, foreign body sensation, and photophobia. For more information on recognition and management, see the CKS topic on . Malignant eyelid tumours: Basal cell carcinoma (most common, about 80% to 95% of malignant eyelid tumours) — suggested by a nodule with a pearly edge and surface telangiectasia, and in some cases

2019 NICE Clinical Knowledge Summaries

156. Varicose veins

) are intradermal veins that are less than 1 mm in diameter. Reticular veins are permanently dilated intradermal veins that range between 1–3 mm in diameter. They may be tortuous but are usually asymptomatic. Assess for any , including: Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition), venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface), lipodermatosclerosis (painful, hardened, tight skin), and atrophie

2019 NICE Clinical Knowledge Summaries

157. Cholesteatoma

retraction pocket, with or without granulation tissue and skin debris. Crust or keratin in the upper part of the tympanic membrane. The tympanic membrane may be perforated. Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane, in a person with no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear. If there is significant discharge occluding the tympanic membrane, referral for examination with an otomicroscope and micro (...) , with or without granulation tissue and skin debris. Crust or keratin in the upper part of the tympanic membrane. The tympanic membrane may be perforated. Congenital cholesteatoma (rare) may appear as a white mass behind an intact tympanic membrane, in a person with no prior history of ear discharge, tympanic membrane perforation, or surgical procedures on the ear. If there is significant discharge occluding the tympanic membrane, referral for examination with an otomicroscope and micro-suctioning of the ear

2019 NICE Clinical Knowledge Summaries

158. Seborrhoeic dermatitis

to surrounding skin. Symmetrically distributed lesions — usually one or two body areas are affected but signs may be more widespread. Mild itching (in particular where the scalp is affected). The most commonly affected areas are the: Scalp — lesions can range from mild desquamation (dandruff) to thick brownish crusts adherent to skin and hair. Face (in particular the nasolabial folds, glabellar area, eyebrows, and behind the ears). The eyelids may be red, swollen and flaky (seborrhoeic blepharitis (...) are associated with seborrhoeic dermatitis including chlorpromazine, cimetidine, gold, haloperidol, interferon‐alpha, lithium, and methyldopa. Examine the person looking for: of seborrhoeic dermatitis such as erythematous scaly patches in areas rich in sebaceous glands — severity can vary from mild flaking to widespread, oily, dense scaling or crusting. Consider the need for further investigations: Diagnosis is usually clinical — investigations (such as blood tests, skin scrapings, or skin biopsy) may

2019 NICE Clinical Knowledge Summaries

159. Blepharitis

prevent complications, periodic relapses and exacerbations are typical. Characteristic clinical features include burning, itching, erythema and crusting of the eyelids, worse in the mornings. Conditions commonly associated with blepharitis include dry eye syndrome, seborrhoeic dermatitis and rosacea. The differential diagnosis of chronic blepharitis includes malignant tumours of the eyelid (such as squamous cell, basal cell, or sebaceous cell carcinoma), eczema, infection, infestation (such as pubic (...) — incidence of these complications is greater in children. See the CKS topic on for more information. [ ; ; ] Diagnosis Diagnosis of blepharitis Clinical features When should I suspect blepharitis? Suspect blepharitis if the person has: Characteristic symptoms (often intermittent, with exacerbations and remissions occurring over long periods): Burning, itching and/or crusting of the eyelids. Symptoms are worse in the mornings. Both eyes are affected. Recurrent hordeolum. Contact lens intolerance

2019 NICE Clinical Knowledge Summaries

160. Leg ulcer - venous

of ulceration, malodour, and increased exudate. Examine both legs for signs of venous insufficiency, including: Pitting oedema — rule out non-venous causes of oedema, such as heart failure and chronic kidney disease. See the CKS topics on and . Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition), venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface), lipodermatosclerosis (painful, hardened, tight skin

2019 NICE Clinical Knowledge Summaries

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