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4. Skin diseases
Other skin disorders
Eczema (dermatitis)
– A cute ecz em a: eryth em atous p laq ue, p ruritic, vesicular, ooz in g, w ith p oorly
d em arcated an d crum bly bord ers.
– C hron ic ecz em a: erythem atous p laq ue, scaly, d ry, p oorly d em arcated an d p ruritic.
– L ook for a cause ( con tact allergic d erm atitis, fun gal or bacterial in fection w ith a
d istan t focus, m aln utrition ) an d ask about fam ily history.
Treatment 4
– C lean w ith soap an d w ater 2 tim es/ d ay.
– T hen ap p ly:
•for acute ecz em a: calamine lotion 2 tim es/ d ay
•for chron ic ecz em a: zinc oxide ointment 2 tim es/ d ay
– L ook for an d treat an y p re-existin g sk in d isease (scabies, lice etc.).
– F or p atien ts w ith secon d ary in fection s: treat as im p etigo (see p age 1 0 5 ).
– F or p atien ts w ith in ten se p ruritus, an tihistam in es (p rom ethaz in e P O or
chlorp hen am in e
P O at the d osages in d icated below ) for a few d ays.
Urticaria
– P ap ules: tran sien t, erythem atous, oed em atous, p ruritic, resem blin g n ettle stin gs.
– L ook for a cause: food or d rug ( p articularly an tibiotic) allergy, in sect bites; th e
in vasive stage of a bacterial or p arasitic in fection ( ascariasis, stron gylod iasis,
an cylostom iasis, sch istosom iasis, loiasis) , viral in fection ( h ep atitis B or C ) ;
gen eralised d isease (can cer, lup us, d ysthyroid ism , vasculitis).
Treatment
– IpfrtohmeeptharuzirniteusPisOin ten se, an tihistam in es:
C hild ren from 2 to 5 years: 1 0 m g/ d ay in 2 d ivid ed d oses
C hild ren from 5 to 1 0 years: 1 0 to 2 5 m g/ d ay in 2 d ivid ed d oses
C hild ren over 1 0 years an d ad ults: 7 5 m g/ d ay in 3 d ivid ed d oses
or chlorphenamine P O
C hild ren from 1 to 2 years: 1 m g 2 tim es d aily
C hild ren from 2 to 6 years: 1 m g 4 to 6 tim es d aily (m ax. 6 m g/ d ay)
C hild ren from 6 to 1 2 years: 2 m g 4 to 6 tim es d aily (m ax. 1 2 m g/ d ay)
C hild ren over 1 2 years an d ad ults: 4 m g 4 to 6 tim es d aily (m ax. 2 4 m g/ d ay)
– In the even t of an ap hylactic reaction , see p age 1 9 .
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Other skin disorders
Eczema (dermatitis)
– A cute ecz em a: eryth em atous p laq ue, p ruritic, vesicular, ooz in g, w ith p oorly
d em arcated an d crum bly bord ers.
– C hron ic ecz em a: erythem atous p laq ue, scaly, d ry, p oorly d em arcated an d p ruritic.
– L ook for a cause ( con tact allergic d erm atitis, fun gal or bacterial in fection w ith a
d istan t focus, m aln utrition ) an d ask about fam ily history.
Treatment 4
– C lean w ith soap an d w ater 2 tim es/ d ay.
– T hen ap p ly:
•for acute ecz em a: calamine lotion 2 tim es/ d ay
•for chron ic ecz em a: zinc oxide ointment 2 tim es/ d ay
– L ook for an d treat an y p re-existin g sk in d isease (scabies, lice etc.).
– F or p atien ts w ith secon d ary in fection s: treat as im p etigo (see p age 1 0 5 ).
– F or p atien ts w ith in ten se p ruritus, an tihistam in es (p rom ethaz in e P O or
chlorp hen am in e
P O at the d osages in d icated below ) for a few d ays.
Urticaria
– P ap ules: tran sien t, erythem atous, oed em atous, p ruritic, resem blin g n ettle stin gs.
– L ook for a cause: food or d rug ( p articularly an tibiotic) allergy, in sect bites; th e
in vasive stage of a bacterial or p arasitic in fection ( ascariasis, stron gylod iasis,
an cylostom iasis, sch istosom iasis, loiasis) , viral in fection ( h ep atitis B or C ) ;
gen eralised d isease (can cer, lup us, d ysthyroid ism , vasculitis).
Treatment
– IpfrtohmeeptharuzirniteusPisOin ten se, an tihistam in es:
C hild ren from 2 to 5 years: 1 0 m g/ d ay in 2 d ivid ed d oses
C hild ren from 5 to 1 0 years: 1 0 to 2 5 m g/ d ay in 2 d ivid ed d oses
C hild ren over 1 0 years an d ad ults: 7 5 m g/ d ay in 3 d ivid ed d oses
or chlorphenamine P O
C hild ren from 1 to 2 years: 1 m g 2 tim es d aily
C hild ren from 2 to 6 years: 1 m g 4 to 6 tim es d aily (m ax. 6 m g/ d ay)
C hild ren from 6 to 1 2 years: 2 m g 4 to 6 tim es d aily (m ax. 1 2 m g/ d ay)
C hild ren over 1 2 years an d ad ults: 4 m g 4 to 6 tim es d aily (m ax. 2 4 m g/ d ay)
– In the even t of an ap hylactic reaction , see p age 1 9 .
117