1. Eczema
1.1. Hydration essential
1.2. OTC: Aquaphor, Eucerin
1.3. Rx: Topical steroids
1.3.1. Topical calcineurin inhibitors (if steroids failed)
1.3.1.1. **Tacrolimus (Protopic)**
1.3.1.1.1. Do not use in children < 2 yo
1.3.1.1.2. Associated w/ lymphoma & skin cancer; use only as second-line
1.3.2. Topical PDE-4 inhibitors
1.3.2.1. **Crisaborole (Eucrisa)**
1.3.3. MAb (IL-4 antagonist)
1.3.3.1. **Dupilumab (Dupixent)**
1.3.3.1.1. Avoid live vaccines
1.3.4. JAK inhibitors
1.3.4.1. **Ruxolitinib (Opzelura)**
1.3.4.1.1. BBW: HSV infections, higher rates of malignancy, thrombosis, major CV events, mortality
1.3.4.2. **Upadicitinib (Rinvoq)**
2. Hyperhidrosis
2.1. Rx: **Glycopyrronium topical (Qbrexza)**
2.1.1. Do not use in conditions exacerbated by anticholinergis (glaucoma, UC, myasthenia gravis)
2.1.2. Wipe dry skin in the underarm area w/ single-use pre-moistened cloth
2.1.3. Wash hands w/ soap & water after
3. Inflammation & Rash
3.1. Steroid vehile influences strength
3.1.1. Ointment > creams > lotions > solutions > gels > sprays
4. Drugs that can discolor skin/secretions
4.1. Brown
4.1.1. Entacapone, levodopa, methyldopa
4.2. Brown/black/green
4.2.1. Iron (stool), methocarbamol
4.3. Brown/yellow
4.3.1. Nitrofurantoin, metronidazole, riboflavin
4.4. Purple/orange/red
4.4.1. Chlorzoxazone
4.5. Orange/yellow
4.5.1. Sulfasalazine
4.6. Yellow-green
4.6.1. Propofol
4.7. Red-orange
4.7.1. Phenazopyridine, rifampin
4.8. Red
4.8.1. Anthracyclines
4.9. Blue
4.9.1. Methylene blue, mitoxantrone
4.10. Blue-gray
4.10.1. Amiodarone, chloroquine
5. Acne
5.1. Topical retinoids
5.1.1. Avoid in pregnancy
5.1.2. Limit sun exposure, apply daily @ bedtime
5.1.3. If irritation occurs, use lower strength or decrease frequency to every other night
5.1.3.1. **Tretinoin, Adapalene**
5.1.4. Takes 4-12 weeks to see response, & may worsen initially
5.2. Other topicals
5.2.1. **BPO**
5.2.1.1. Can bleach clothing, limit sun exposure
5.2.2. Topical abx & combos
5.2.2.1. **Erythromycin/BPO (Benzamycin)**
5.2.2.1.1. Refrigerate
5.2.2.1.2. 3-month expiration after mixing
5.2.2.2. **Clindamycin/BPO (Benzaclin)**
5.2.2.2.1. Takes 2-6 weeks for effect & up to 12 for full benefit
5.2.2.3. **Minocycline foam (Amzeeq)**
5.2.3. Others
5.2.3.1. **Salicylic acid, azaleic acid (Azelex)**
5.2.3.2. **Dapsone (Aczone)**
5.2.3.2.1. Avoid in G6PD deficiency
5.2.3.3. **Clascoterone (Winlevi)**
5.2.3.3.1. HPA axis suppression may occur
5.2.3.3.2. Keep refrigerated before dispensing; room temp after
5.3. Other retinoids
5.3.1. **Isotretinoin (Claravis)**
5.3.1.1. Only approved for severe, refractory nodular acne
5.3.1.2. iPLEDGE
5.3.1.2.1. Birth defects; must have 2 neg pregnancy tests before starting; do not get pregnant until at least 1 month after tx stopped; avoid progestin-only COCs
5.4. PO ABX
5.4.1. **Minocycline (Solodyn)**
5.4.1.1. Can cause photosensitivity
5.4.1.2. Fetal harm (like other tetracyclines)
5.4.1.3. Teeth discoloration up to 8 yo
6. Cold sores
6.1. Infection usually due to HSV-1 unless oral/genital sex > HSV-2
6.2. Prodromal period optimal time to start tx to reduce blister duration
6.2.1. OTC: **Docosanol (Abreva)**
6.2.1.1. Apply 5x daily at first sign of outbreak, continue until healed
6.2.2. Rx: **Acyclovir (Zovirax)**
6.2.2.1. Cream/ointment
6.2.2.2. Apply 5x daily x 4
6.3. Natural product **lysine** used for prevention/tx
7. Dandruff
7.1. Can be due to either eczema or yeast overgrowth
7.1.1. OTC: **Ketoconazole (Nizoral A-D), Selenium, Pyrithione zinc**
7.1.1.1. Rub shampoo in well, leave for 5 mins then rinse out; shampoo daily
7.1.1.2. Nizoral A-D: apply 2x weekly up to 8 weeks; can cause skin irritation
7.1.2. Rx: **Ketoconazole 2% (Nizoral)**
8. Alopecia
8.1. Can be caused by hypothyroidism, zinc/vit D deficiency
8.1.1. **Finasteride (Propecia)**
8.1.1.1. Do not dispense to pts taking Proscar for BPH
8.1.1.2. C/I in pregnancy
8.1.1.3. 1mg (lower than Proscar)
8.1.2. **Minoxidil (Rogaine)**
8.1.2.1. 5% strength more effective but causes more facial hair growth
8.1.2.2. Flammable