Psoriasis Treatment Continued• Phototherapy– NBUVB (Narrow band ultraviolet B)– PUVA (Psoralen combined with ultraviolet A)

• Systemic immunosuppresants– Methotrexate– Acitretin (Soriatane)– Cyclosporine

• Biologics– Etanercept (Enbrel)– Adalimumab (Humira)– Infliximab (Remicade)– Ustekinumab (Stelara)

When to Refer…

• Psoriasis is a chronic condition with intermittent flares

• Above therapies can control disease but not cure it

• A few plaques involving little body surface area can be controlled with topical medications

• However, if more than 5-10% body surface area is involved, a systemic medication may be warranted along with a referral to a specialist

Fungal Infections

• Tinea corporis• Tinea pedis• Tinea manuum• Tinea cruris• Tinea faciale• Tinea barbae• Tinea capitis• Tinea unguium or onychomychosis

Fungal Infections

• Fungal infections of the skin are caused by organisms collectively referred to as dermatophytes– Feed on the keratin in our epidermis. Prefer

warm, moist environments• “Ringworm” is used by the general population

but is a misnomer• Diagnosis: KOH (potassium hydroxide)

preparation

Treatment of Tinea• Topical antifungals (for limited disease)– OTC clotrimazole 1% cream (Lotrimin)– OTC miconazole 2% cream (Micatin)– OTC miconazole powder (Zeasorb AF)– OTC terbinafine 1% cream (Lamisil)– Rx ketoconazole 2% cream

• Systemic antifungals (for tinea capitis, tinea unguium, or extensive involvement)– Griseofulvin (most effective in children with tinea capitis)– Terbinafine 250 mg Qdaily for adults– Ketoconazole– Fluconazole– Itraconazole

Tinea Versicolor• Anti-yeast/anti-dandruff shampoos used as a

face/body wash. Leave on for 5 minutes then wash off. Use daily for a week, then weekly until resolution, then monthly to prevent recurrence– Zinc pyrinthione 1% (Head and Shoulders)– Selenium sulfide 1% (Selsun Blue) or 2.5% (Rx only)– Ketoconazole 1% (Nizoral) or 2% (Rx only)

• If only a few spots, OTC miconazole cream or Rx ketoconazole cream

• Oral: fluconazole (Diflucan) one 200 mg tablet repeated two weeks apart

Seborrheic Dermatitis• Common:– Found in around 5% of the healthy population

• Treatment:– Anti-yeast/anti-dandruff shampoos a few times a week,

can use as face or body wash. Leave on for 5 minutes then wash off• Zinc pyrinthione 1% (Head and Shoulders)• Selenium sulfide 1% (Selsun Blue) or 2.5% (Rx only)• Ketoconazole 1% (Nizoral) or 2% (Rx only)

– Ketoconazole 2% cream BID PRN for face– Hydrocortisone cream 1% or 2.5% BID PRN for face– Clobetasol solution 0.05% BID PRN for severe

inflammation of scalp