©Bobonich 2016

Vesicles (≤ 1 cm)

Dyshidrotic eczemaHerpes simplexImpetigoVaricella/zosterTinea pedisScabiesContact dermatitisHand foot & mouthPolymorphic light eruptionGrover’s diseaseArthropod assaults Erythema multiformeDermatitis herpetiformisId reaction

Bullae (≥ 1cm)

Bullous ImpetigoBullous tineaTrauma/ThermalBullous erythema multiformeStaph Scalded SkinStephens Johnson Syndrome Toxicepidermal necrolysisAutoimmune blistering diseaseBullous drug eruptionLichen planusPorphyria cutanea tardaDiabetic bullae

Pustular

Acne vulgarisRosacea Drug-induced pustular acneFolliculitisCandidiasis, pityrosporumScabiesPustular psoriasisPerioral dematitisSubcorneal pustulosisINFECTIOUS

Fluid-filled lesions

Culture can be a KEY diagnositic

©Bobonich 2016

Flesh color

Rough surfaceSkin tagsVerrucaOpen comedonesActinic keratosisCorns/callusEpidermal nevus

SmoothMolluscum contagiosumBasal cellVerruca/HPVEpidermoid cystsLipomasKeloids/hypertrophic scarGranuloma annulareNeurofibromasPearly penile papulesAdnexal tumors

Brown

FrecklesSkin tagsLentiginesNevi (Intradermal, compound, junctional)Seborrheic keratosisTinea versicolor (pinkish)PostinflammatoryhyperpigmentationErythasmaDermatofibromaCafé au laitMongolian spotMelanomaPigmented basal cellDysplastic nevusCongenital nevusFixed drug eruption (purple)Becker’s nevus

White

Pityriasis albaIdiopathic guttate hypomelanosisTinea versicolorAsh leaf maculeMiliaKeratosis pilarisPostinflammatory hypopigmentationNevus anemicusMorpheaform basal cell skin cancerVitiligoPiebaldismLichen sclerosus et atrophicusMorpheaTuberous sclerosis

YellowXanthelasmaSebaceous hyperplasiaNecrobiosis lipoidicaMorphea ©Bobonich 2016

EczematousEpithelial disruption

Atopic dermatitisIrritant contact dermatitisAllergic contact dermatitisDyshidrotic eczemaNummular eczemaStasis dermatitisScabies Secondary lesions (dermatitis herpetiformis, tinea, psoriasis, etc)Seborrheic dermatitisPolymorphic light eruptionLichen planusEczematous reaction patterns Xerotic eczemaExfoliative erythroderma

PapulosquamousNo epithelial disruption

PapulesPityriasis roseaKeratosis pilarisSeborrheic dermatitisTineaLichen planusSecondary syphilis Guttate psoriasisPityriasis lichenoides

(PLC or PLEVA)

Red, scaly lesions

Prominent plaquesPsoriasisTineaLupus erythematosus Discoid lupus erythematosusCutaneous T cell lymphoma

(mycosis fungoides)Pityriasis rubra pilarisLichen planusDarier’s diseaseExfoliative erythroderma

©Bobonich 2016

©Bobonich 2016

Inflammatory lesionsMonomorphic (same size & shape)

usually solitarypapules and dome-shaped

Macules & papulesArthropod assaultsSpider and cherry angiomasScabiesAcneKeratosis pilarisCandidiasisPyogenic granulomasGranuloma annulareViral exanthemsEarly psoriasis lesionsPityriasis rosea (w/o scale)Secondary syphilis (the ‘great imitator’)Pityriasis lichenoidesGrover’s disease,

Vascular reactionsPolymorphic (varied size & shape),

multiple, often confluent, flat-topped

Transient RosaceaUrticaria

Purpuric/non-blanchablePetechiae Coagulation disordersLeukocytoclastic vasculitis Henoch-Schonlein purpura EcchymosesMeningococcemiaRocky Mountain

Spotted FeverVascular ulcers

Persistent/blanchingKawasaki diseaseStaph scalded skinToxic shock syndromeRed man syndromeAngioedemaAutoimmune blistering

diseasesErythema multiformeErythema nodosumDrug eruptionUrticarial vasculitis

NodulesFurunclesCarbunclesEpidermoid cystsCellulitisErythema nodosumAcne vulgarisMycosis fungoides

Red, smooth lesions

©Bobonich 2016

Class & Indications Generic name Dermatophyte Yeast Gram + Gram - Anti-inflammatory

Polyenes (fungistatic)

Candidiasis Nystatin 0 ++++

Azoles (fungistatic)

Tinea

Pityriasis/tinea versicolor

Candidiasis

Seborrheic dermatitis

Miconazole + +++

Clotrimazole + +++

Ketoconazole + +++ ++ ++

Oxiconazole + +++

Econazole + +++ + + +

Sertaconazole + +++ ++

Allylamines/ Benzylamine (fungicidal)

Tinea

Pityriasis/tinea versicolor

Naftifine + + +++

Terbinafine +++ + +++

Butenafine ++++ ++ +++

Other Agents

Tinea; Onychomycosis; Candidiasis

Pityriasis/tinea versicolor; Seborrheic

dermatitis

Ciclopirox ++ ++++

C. Albicans

+++ +++ +++

Pityriasis/tinea versicolor

Seborrheic dermatitis

Selenium sulfide

(RX & OTC)

+++

Pityrosporum

Bobonich& Nolen (2015)

Indications and Effectiveness of Topical Antifungals