■ If identified within 72 hr, oral antiviral therapy can speed healing and decrease pain (PHN): Acyclovir 800 mg 5 x d x 7 d, famciclovir 500 mg tid x 7 d, or valacyclovir 1000 mg tid x 7 d.

■ If tip of nose involved/V1 dermatome facial involvement: Urgent ophthalmology consult—Ocular involvement can lead to blindness.

■ PHN: Difficult to manage, best prevented by immediate antiviral therapy; analgesics, topical lidocaine, capsaicin, narcotics, nerve blocks, gabapentin, tricyclic antidepressants may be helpful; pain clinic referral. Prednisone occasionally used in elderly in addition to antivirals for herpes zoster (controversial).

Hidradenitis Suppurativa

Hidradenitis Suppurativa Pictures Groin

Etiology: Chronic recurrent inflammatory condition wherein hair follicles are occluded and become secondarily infected. Associated with obesity, diabetes, and smoking; genetic and hormonal components.

History: Pain, odor, and drainage affecting axillae and/or groin.

Physical: Comedones, pustules, and nodules, abscesses, sinuses, and scarring. Severe form associated with acne conglobata, pilonidal sinus, & dissecting cellulitis of scalp.

Investigations: Clinical diagnosis; can swab for bacterial cultures.

DDx: Folliculitis, infected cysts, inflammatory bowel disease.


■ Distressing condition with no satisfactory treatment.

■ Topical and systemic antibiotics (e.g., clindamycin and tetracycline), intralesional corticosteroids, hormonal therapy, retinoids (e.g., isotretinoin, acitretin).

■ Daily cleansing with antibacterial soaps.

■ Female patients benefit from antiandrogen therapy such as cyproterone acetate or spironolactone.

■ Surgery is required for more recalcitrant cases and can be curative.

■ Encourage patients to quit smoking and lose weight.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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