[NP-Clinical] Derm King and others....

[Theodore Scott]

In this age group the leading culprit is tinea versicolor.  The most
effective OTC fix is applying Nizoral AD shampoo (ketoconazole 1%) to the
affected skin about 20 minutes before a shower and rinsing off in the
shower.  This must be done weekly until the pigment evens out which may take
3 months.  There is apparently no benefit to doing it more often.   If in
doubt and you have a microscope in you setting, do a skin scrape at the
margin of one of the macules and do a KOH prop.  You will be looking for the
green refractile groups of spores and hyphae (spaghetti and meatballs) of
Pityrosporum also known as Malassezia furfur.  The other OTC products like
selenium (i.e. Selsun blue) and zinc pyrothyronate (Head and Shoulders)
don't seem to work as well.

 

Hope this helps

Ted Scott NP-C

 

  _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Christine Smith
Sent: Wednesday, February 21, 2007 4:00 PM
To: ACC-Circle at listserve.com; np-clinical at nurse.net
Subject: [NP-Clinical] Derm King and others....

 

Ted and other Derm experts...

It

I need some help with a dx for a 19 yo male. He saw me for another problem
but asked if I knew anything about his chronic - over 5 years long skin
condition. Initially, when I first glanced at his thorax I thought it was
Pityriasis. He is a thin athletic Italian looking Caucasian covered from
chest/back to legs with a sort of  variegated pink/red rash - mainly flat,
no scaling that I can recall, all over - most of them appear round or oval
like but they all seem to kinda' run into each other. Sort of looks like he
is mottled  but pink and red mottling. It does blanch.  No real sharp edges.
No itch, no sx. 

 

He said that he was given some kind of cream several years ago and it went
away after a few months using the cream but then returned. No other family
members with it. Mother confirms the story/hx. She does not recall what the
condition or the cream was called. He thinks it is worse in the sun and does
not usually go shirtless but it is on his legs, buttocks and even his feet
sometimes.

 

No insurance so begging once again for a free internet consult :>)

 

Christine Smith, NP

Antioch, CA

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