Articles from dermatologist Dr. Donald Scott
- Aldara-cream-imiquimod-application
- Aldara-pictures-basal-cell
- Derm-dilemma-role-of-immune-response-modifiers
- Imiquimod-to-treat-different-cancers-of-the-epidermis
- Imiquimod-tx-for-melanoma-in-situ-lentigo-maligna
- Treatment-of-nodular-basal-cell-w-cryo
- Tx-of-lentigo-maligna (melanoma-in-site)-with-imiquimod
- Dr-sunshine
- Salt-water-pools-HOA
A good way to view skin cancer is as Melanoma Skin Cancer vs. NonMelanoma Skin Cancer. The nonmelanoma skin cancer is treated in a similar way. It includes: BCC, SCC, MCC; precursors to SCC include AKs and SCC in situ.
Red Flags
Any lesion w/ rapid growth, ulceration, spontaneous bleeding, pain
Any nonhealing or enlarging lesion in an immunosuppressed pt
Persistent hyperkeratotic or eroded lesions on the lip, ear, or “H” zone of the face
Any lesion > 2 cm on the extremities or trunk
Bleeding? Scaling, ulceration? Basal cells tend to bleed.
Skin Biopsy Indications
When to Refer
(That’s what pocket primary care medicine says, but from working with Dr. Scott, dermatologist, an FM doc can take care of many BCCs and SCCs and only refer complex ones. Refer all MCC or when unsure of what to do.)
• Clinically suspicious lesion for BCC, SCC, or MCC; red flags (above); thick (hypertrophic) AKs or many lesions that require field tx; bx shows atypical nevus or melanoma
• High-risk individuals: Prior skin CA, solid-organ transplant pts (should be seen q3– 6mos), CLL
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Common skin medications
- Antibiotics for bacterial infections that cause inflammation. If you treat the infection, the inflammation will resolve. E.g. Acne is caused by a bacteria. Also erysipelas, cellulitis, etc.
- Antifungals to treat fungal skin infections that cause inflammation. When you treat the fungus, the inflammation will resolve.
- Anticancer – for BCC and SCC treatment.
- Steroids – to treat non-infectious inflammation e.g. eczema and severe urticaria
- Surgery – E.g. bunch biopsy to remove lesions that are concerning for cancer. Moh’s surgery is also therapeutic.
- Cryotherapy vs Electrodesiccation.
- Antivirals e.g. herpes zoster lesions.
- Antiparasitic – E.g. Permethrin is an anti-parasite medication for scabies and lice (different concentrations).
Emollients are helpful for treating dry skin in general.
Sometimes, you won’t be able to distinguish between a fungal or eczematous cause for a skin inflammation. You may simply try an antifungal and if it doesn’t resolve, try a low potency steroid cream.
Skin conditions can be caused by:
Infectious
- Bacterial, e.g. Cellulitis, folliculitis, erysipelas, etc
- Fungal, e.g. Tinea
- Viral, e.g. different viral exanthems.
Non-infectious
- Autoimmune
- Allergic reactions e.g. poison ivy, oak, sumac; drug allergies; urticaria
- Cancer and pre-cancerous
- Eczema
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Working with Dr. Sickinger
Eczema is a fancy name for dry skin
It’s not curable, only preventative.
Wash with lukewarm water
Moisturizer from head-to-toe.
Preventing eczema: Cerave cream is a moisturizer that is better than Aquaphor and hydrolatum.
Triamcinolone 0.1%
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Foreign body reaction to tattoo on eyelid>>swollen, inflamed eyelids.
-Prednisone oral to treat the inflammation.
-Desonide ointment.
-Baby shampoo to exfoliate the skin.
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Wart on the chin that was frozen multiple times and it kept coming back. Biopsied>>Verucca Vulgaris.
Plan: cryotherapy q2 weeks x5 or so times.
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Bunch vs. shave?
Punch is usually for rashes. For other lesions like BCC etc, shave is good.
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Puffy eyes. Water from allergies. Try antihistamines e.g. Allegra or Zyrtec
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Seborrheic dermatitis is an overgrowth of yeast.
Ketoconazole cream to area.
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Intertrigo
Desonide
Ketoconazole
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Rosacea
Permethrin
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Contact dermatitis on face 2/2 to new vitamin D cream.
Treatment Desonide cream 2 times per day to cheek for rash.
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Granuloma annulare
-Inject Kenalog superficially. Low-dose.
-Then clobetasol cream BID, PRN.
Still need to biopsy to confirm the diagnosis because there are many things that can present like that.
Cryotherapy
Freeze lightly. Too much will damage melanocytes and create a white spot.
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Acne
Benzoyl peroxide and adapalene = epiduo
Shower ASAP after sports or activity that makes you s
PO Prednisone taper over 9 days
Doxycycline
—Must take it with food. Sun burns easily.
Get extractions twice a month.
Biore pore cleansing strips.
Always prescribe prednisone in the morning. It makes people jittery and can’t sleep.