Related Therapeutic strategies

Herpes simplex virus (HSV) occurs in 2 common locations: orofacial (usually due to HSV-1) and genital (usually due to HSV-2).

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Seborrheic dermatitis can be limited to the scalp, but it also can involve the face and any hairy or intertriginous area and rarely can even progress to a generalized erythroderma.

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Chancroid

Timothy Berger Bruce Wintroub

Saturday, January 01, 2011

The diagnosis of chancroid is usually clinical, although improved culture techniques allow isolation of the causative organism H. ducreyi. The therapeutic strategy is to eliminate the pathogenic microorganism.

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Case Note

Case Note: Progressive Depigmentation

History

A 24-year-old woman presents with a six-month history of progressive depigmentation: face, trunk, arms and legs of approximately 30% body surface involvement, otherwise healthy. No family history of autoimmune disease. This Case Note is intended for general practitioners.

Initial evaluation

  • Wood's lamp examination confirms depigmented patches
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Enter your diagnosis

Diagnosis

  • A clinical diagnosis of vitiligo is rendered

Initial Treatment

  • Recommend narrow-band ultraviolet B (NB UVB) phototherapy combined with topical corticosteroid ointment applied b.i.d
  • Follow-up in three months

Follow-up evaluation strategy

Three-month follow-up evaluation

  • Subtle repigmentation, with areas of follicular accentuation of newly pigmented areas
  • Recommend continuing NB UVB phototherapy and topical steroid treatment

Six-month follow-up evaluation

  • Approximately 60% repigmentation noted
  • Continue phototherapy and topical steroid treatment with follow-up evaluation at three-month intervals

General discussion

Vitiligo is a common disorder of depigmentation that is marked by the histologic loss of epidermal melanocytes. It may occur in patterns: localized, segmental, generalized, or a variant with acral predilection and periorificial involvement. Vitiligo may be associated with autoimmune disease.

The duration of vitiligo is lifelong and its disease course may be difficult to predict. The mainstay of treatment includes topical corticosteroid and calcineurin therapies, and narrow-band ultraviolet phototherapy; combined therapy may be most effective therapeutic strategy.

Further reading

Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview, Part I. JAAD. 2011;65(3):473-491.

Felsten LM, Alikhan Al, Petronic-Rosic V. Vitiligo: a comprehensive overview, Part II. JAAD. 2011;65(3):493-514.

Taieb A, Picardo M. Vitiligo. N Engl J Med. 2009;360:160-169.

Whitten ME, Pinart M, Batchelor J, Lushey C, Leonardi-Bee J, Gonzalez U. Interventions for vitiligo. Cochrane Database Syst Rev. 2010;Issue 1.

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