Hudsykdommer for Turnuslegen
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Transcript of Hudsykdommer for Turnuslegen
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Holger Benthien
Hudsykdommer for Turnuslegen
Stavanger, 14.2.2012
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Pityriasis rosea
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Tinea corporis
Microsporum canis
• dyrkning + mikroskop
• Lamisilkrem > 4 uker
• Terbinafin (<20kg: 62,5mg, 20-40kg: 125mg, >40kg og voksne
: 250mg) 4 uker
• Griseofulvin (20mg/kg/kv)
>8 uker
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diagnose
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Tinea corporis
Microsporum canis
• dyrkning + mikroskop
• Lamisilkrem > 4 uker
• Terbinafin (<20kg: 62,5mg, 20-40kg: 125mg, >40kg: 250mg)
4 uker
• Griseofulvin (20mg/kg/kv)
>8 uker
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nummulat mikrobielt eksem
• Betnovat med
chinoform
• Apolar med Dekvalin
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Parapsoriasis en plaque
Mycosis fungoides
• stansebiopsi
• TL-01 UVB-
lysbehandling
• P. en grandes
plaques: lokale
kortikosteroider
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Lues II (syfilid)
• TPHA/TPPA
• VDRL
• 19S-IgM-FTA-abs-
test
• benzathinpenicillin
(Tardocillin) 2,4mill IE
im, 1-2x (1 uke mellomrom)
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Pityriasis rosea
• virus (herpes?)
• ingen såpe, ingen klorvann
• hudpleie, fuktighetskrem
• TL-01 uvb-lys
• steroider
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Cafe au lait flekker
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Nevrofibromatose
Morbus Recklinghausen
• Cafe-au-lait flekker
• axillary freckling
• nevrofibromer
• Irisharmatome (Lisch-
knuter)
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Morbus Recklinghausen
• > 5 Cafe-au-lait-flekker
• nevrofibromer
• axillary/inguinal freckling
• optikusgliom
• Lischknuter
• beinforandringer
• førstegrads slektning med NF1
2 kriterier
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Erythema nodosum
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Erythema nodosum
Årsak
• Streptokokkinfeksjon, luftveisinf.
• Yersiniainfeksjon
• Tuberkulose
• Sarkoidose (Løfgrens-syndrom)
Terapi
• NSAID
• orale glukokortikoider
• antibiose: penicillin, doksycyklin
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Vaskulitt allergica
leukozytoklastisk vaskulitt
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Purpura Schoenlein-Henoch
• streptokokker
• sulfonamider
• indre organer
• kortison lokal, systemisk
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Erythema chronicum migrans
Borrelia-lymfocytom
• flåttbit (50% infisert)
• serologi (pos. etter 2-
6 uker)
• Doksycyklin 200mg i
14 dager
• Amoksicillin 0,5mgx3 i
14 dager
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Keratosis follicularis
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Keratosis follicularis
Ulerythema ophryogenes
• Karbamid (Urea pura) 5 – 10%: Canoderm
• Vit-A-syre, Tretinoin: Aberela
• steroider: Elocon
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Ulerythema ophryogenes
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(Pseudo)akanthosis nigricans
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tinea corporis
• dyrkning + mikroskop
• Lamisil krem i 4 uker
• Terbinafin tbl. 250 mg
i 4 uker
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Erythrasma
• Corynebacterium
minutissimum
• Lamisil krem 2-4 uker
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M. Hailey-Hailey
Pemphigus chron.benig.familiaris
• Candidose? Lamisil
• hudlege prøvebiopsi
(pemfigus vegetans...)
• lokal kortikosteroide +
antibiotikum
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(Pseudo)akanthosis nigricans
• vektreduksjon!
• Karbamidkrem 5-10%: Canoderm
• Vit-A-syre: Aberelakrem
• ved behov Dalacin- eller Lamisilkrem
• Isotretinoin oral
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Papillae coronae glandis
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Condylomata accuminata
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Condylomata accuminata
• kryobehandling med flytende nitrogen
• Aldara (Imiquimod) annenhverdag i 3-4 mnd
• Wartec (Podophyllotoxin) 2x daglig i 3 dager, 1 uke pause, 3-4 behandlingsperioder
Papillae coronae glandis
• ingen behandling!
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Angiokeratoma scroti
Talgkjertler
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Kortisonkrem Luger et al, JDDG 7, 2004: 629-634
BMV Betnovat
Daivobet
CP Dermovat
HC Mildison
TRI Pevisone
MM Elocon
HCB Locoid
vasokonstriksjon 8 12 4 8 8 4
effektivitet 10 15 5 10 10 10
hudatrofi 12 12 6 12 6 6
Systemisk effekt 2 4 2 4 2 2
Terapeutisk
index 1,2 1,5 1 1,06 2 1,4