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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Therapeutic Strategies

Mucha-Habermann Disease

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Friday, November 14, 2008

Pityriasis Lichenoides et Variolaformis Acuta / Pityriasis Lichenoides Chronica

This condition is a benign and often self-limited lymphocytic vasculitis. Pityriasis lichenoides chronica (PLC) is treated like pityriasis lichenoides et varioliformis acuta (PLEVA). A rare variant of PLEVA, the febrile ulceronecrotic form can be very aggressive and even fatal in adults.

First Steps 

  1. Oral antibiotics, usually tetracycline or erythromycin 250-500 mg 4 times daily.
  2. Mild PLC and PLEVA may be treated with superpotent topical steroids if few lesions are present.
  3. Topical tacrolimus 0.03-0.1% twice daily may be effective.

Alternative Steps

Narrowband UVB, UVA1, or PUVA may be used and are indicated for symptomatic generalized disease. Lesions not in the irradiated fields may not respond.

Subsequent Steps

Most patients are managed with the above modalities. Exceptional patients with progressive or incapacitating disease may be considered for the following therapies:

  1. Phototherapy may be combined with retinoid treatment (acitretin 25-50 mg/day) for refractory cases.
  2. Low-dose oral methotrexate 5.0-20 mg/week is usually efficacious. Recurrences may occur. For severe febrile ulceronecrotic PLEVA, methotrexate in doses up to 75 mg per week may be used.
  3. Pulse intravenous systemic steroids may be used in combination with methotrexate to control severe febrile ulceronecrotic PLEVA.

Pitfalls

  1. Tetracycline is contraindicated in pregnancy and in children under 8 years of age.
  2. Because PLEVA and PLC are benign disorders, methotrexate should be reserved for severe cases, and informed consent is essential.
  3. Lymphomatoid papulosis and PLEVA may appear clinically similar. A biopsy of one or more lesions is necessary to establish the correct diagnosis.
  4. PLEVA and PLC may be associated with a monoclonal T-cell infiltrate. This does not imply the evolution into a malignancy and the presence of a monoclonal population does not alter the management of the patient.

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