Drug allergy Fixed drug eruption StevenJohnson syndrome Toxic

Drug allergy

Fixed drug eruption

Steven-Johnson syndrome

Toxic Epidermal Necrolysis

SJS/ TEN ตองแสดงคำเตอน ความเสยงผนแพยาชนดรนแรง ในฉลากและเอกสารกำกบยา allopurinol carbamazepine phenobarbital phenytoin lamotrigine ibuprofen meloxicam tenoxicam nevirapine sulfadiazine sulfadoxine sulfamethoxazol sulfasalazine amoxycillin rifampicin dapsone

Urticaria

Urticaria Pathogenesis

Urticaria

Urticaria

Urticaria Ig. E mediated release of Histamine Antigen >> shell fish temperature parasite Drug >> ASA , Penicillin

Acute Urticaria Treatment Mild symptom >> H 1 antagonist soothing lotions Severe symptom >> doctor

Chronic Urticaria Treatment >> H 1 antagonist soothing lotions หลกเลยงสารกอการแพ

Eczema

Eczema

Treatment Stage of Eczema Wet dressing acute NSS 3% boric Burrow soln subacute Topical steroid Antihistamine Moderate potency Chronic Moderate To high potency +Keratolytic Antibiotics If infected

Eczema

Endogenous Eczema Atopic Dermatitis

Treatment Skin hydrating Occlusive emollient Topical steroid therapy up to symptom Topical calcineurin inhibitor Tacrolimus Pimecrolimus

Endogenous Eczema Seborrheic Dermatitis

Treatment Loosening and removal of scales and crust 3% salicylic in olive oil Salicylic, Coal tar shampoo Inhibit yeast colonization Imidazole cream/ shampoo oral antifungal in severe case Reduction erythema and itching Low potency steroid cream/ lotion Control secondary infection

Exogenous Eczema Irritant Contact Dermatitis >> Acid, Base

Exogenous Eczema Allergic Contact Dermatitis >> โลหะ เครองสำอาง พช สารเคม

Treatment of symptoms Acute >> Topical drying agents Chronic >> Emollients Pruritus >> Oral Antihistamine Avoidance of additional encounters

Corticosteroid S/E Local Atropic changes Acne form eruption Hypertrichosis Pigmentary changes Infection Allergic reaction Systemic Suppression of Hypothalamic Pituitary-adrenal axis Metabolic side effect

Antifungal

Fungal Infections Superficial fungal infection Deep fungal infection

Superficial Fungal Infections Tinea versicolor ������ Malassezia furfur

Superficial Fungal Infections Dermatophytosis ������ Trichophyton Microsporum Epidermophyton

Dermatophytosis Tinea capitis Tinea corporis

Dermatophytosis Tinea cruris Tinea unguium

Dermatophytosis Tinea Pedis Tinea manuum

Superficial Fungal Infections Candidiasis ������ Candida albican

Antifungal Therapy Topical Systemic

Antifungal Therapy

Topical Fungal Therapy Keratolytic agent Whitfield ointment 6%Benzoic acid ���� antifungal 3%Salicylic acid ���� keratolytic �� keratin �����������������������������

Topical Fungal Therapy Agent effective only for Tinea versicolor Selenium sulfide suspension Sodium thiosulfate solution Propyline glycol solution (50%)

Topical Fungal Therapy Agent effective only for Candida infection Polyene antibiotic Nystatin

Topical Fungal Therapy Agent effective only for Dermatophytes Tolnaftate Undecylenic acid

Topical Fungal Therapy Broad spectrum antifungal agents Imidazole compounds

Topical Fungal Therapy Broad spectrum antifungal agents Ciclopirox olamine

Topical Fungal Therapy Broad spectrum antifungal agents Allyamine Terbinafine

Systemic Fungal Therapy Griseofulvin Dose 500 -1000 mg/day effective only for Dermatophytes Clinical uses Tinea capitis Tinea corporis Tinea unguium(finger) Duration 4 -6 weeks 6 -12 weeks 4 -6 months 0 0 0 0 (toe) 12 months ADR ���� GI disturbance Photosensitivity: SLE porphyria

Systemic Fungal Therapy Azole Group Imidazole Ketoconazole CYP 3 A 4 inhibitor Triazole Fluconazole Itraconazole CYP 3 A 4 inhibitor

Systemic Fungal Therapy Ketoconazole ��������������� DI Antacid, CYP 3 A 4(strong)->H 2 blocker, PPI>> ketoconazole Macrolide, Ca 2+-block, etc. ->toxic ADR ���������� ��������������� gynecomastia oligospermia ��������� (long term use( ������������ (1/15000 ( ��� 80%����� Enz transminases , alkaline phosphatase �������������������

Systemic Fungal Therapy Ketoconazole Adult 200 -400 mg/day Children ≥ 2 yrs 3. 3 -6. 6 mg/kg/day Clinical uses Dosage Duration Tinea versicolor 200 mg/d 10 days Dermatophytes 200 -400 mg/d ≥ 4 weeks Candidiasis 200 -400 mg/d 1 -2 weeks

Systemic Fungal Therapy Fluconazole Adult 200 -400 mg/day Children ≥ 2 yrs Loading dose 6 -12 mg/kg/day Maintenance dose 3 -12 mg/kg/day ����������������� Cr. Cl DI Antacid, CYP 3 A 4(strong)->H 2 blocker, PPI>> fluconazole ADR ���������� ������ (dose>400 mg/day(

Systemic Fungal Therapy Fluconazole Clinical uses Dosage Duration Tinea versicolor 400 mg/d Single dose Tinea pedis 150 mg weekly 3 -4 weeks Tinea unguium 150 mg weekly 24 weeks

Systemic Fungal Therapy Fluconazole>> Candidiasis Clinical uses Oropharyngeal Dosage children 6 mg/kg loading adult Vaginal Duration 3 mg/kg maintenance 2 weeks 100 -200 mg/day 7 -14 days 150 mg singledose

Systemic Fungal Therapy Itraconazole Clinical uses Dosage Tinea versicolor 200 mg/d 7 days Cure rate 75 -94% Tinea corporis 100 mg/d 14 days - Tinea pedis 100 -200 mg/d 2 -4 weeks 200 mg bid Duration 1 week

Systemic Fungal Therapy Itraconazole Clinical uses Dosage Duration 200 mg/d 6 weeks 200 mg bid pulse /2 months 200 mg/d 12 weeks 200 mg bid pulse /3 months Tinea unguium Fingernail Toenail

Systemic Fungal Therapy Itraconazole Clinical uses Dosage Duration Oropharyngeal 200 mg/d 1 -2 weeks Esopharyngeal 100 -200 mg/d ≥ 3 weeks Vaginal 200 mg/bid singledose Candidiasis

Candidiasis Clotrimazole Toche treatment 1 tab every 4 hrs 14 days prophylaxis 1 tab tid Miconazole oral gel children> 2 yrs-adult 2. 5 ml qid children 6 mo-2 yrs 1. 25 ml qid ใชตอเนอง 1 สปดาหหลงอาการหาย

Antiviral

Viral Infections Herpes simplex

Herpes simplex Genital HSV Acyclovir Children 40 -80 mg/kg/day 3 -4 divided dose chronic 80 mg/kg/day 3 divided dose Adult Initial 200 mg qid 10 days or 400 mg tid 5 -10 days recurrent 200 mg qid 5 days or 400 mg tid 5 days chronic support 400 mg bid or 200 mg 3 -5 times/day 12 mo

Viral Infections Herpes zoster

Viral Infections Herpes zoster

Herpes zoster Acyclovir Adult 800 mg every 4 hrs 7 -10 days Acyclovir cream or ครมพญายอ apply every 4 hrs >> 5 times/day Neurophatic Pain>> Analgesic /? /3 B Bacterial infection>> Antibiotic

Viral Infections Chickenpox

Chickenpox Varicella virus ����� 10 -20 ��� Treatment Paracetamol ������ Antihistamine ���� CPM, Hydroxyzine ������ Antiviral start within 24 hrs rash onset Acyclovir Children >40 kg + Adult Children ≥ 2 yrs <40 kg 800 mg qid 5 days 20 mg/kg/dose qid 5 days

Scabiasis Sarcoptes scabis var. Hominis Life cycle 10 -14 days

Scabiasis ������� bacterial infection

Pediculosis Pediculus humanus capitis Pediculus humanus corporis Phthirus puris

Treatment Benzyl benzoate lotion 25% body>>neck to toe leave for 24 hrs 3 days Permethrin cream 5% body >>neck to toe leave for 8 -14 hrs Hair >> leave for 10 mins

Treatment Lindane cream 1% body >>neck to toe Adult leave for 8 -12 hrs children leave for 6 -8 hrs Hair >>shampoo 4 -5 mins lotion/ cream 12 hrs C/I >> premature infant, uncontrolled seizure Precipitated sulfur ointment 3 - 5% body >>neck to toe 3 -5 days

Treatment Malathion (A-lices®) leave for 10 mins Carbaryl shampoo 0. 6%

STD

Gonorrhea

Gonorrhea

C. trachomatis

C. trachomatis

C. trachomatis