©Bobonich 2016
Vesicles (≤ 1 cm)
Dyshidrotic eczemaHerpes simplexImpetigoVaricella/zosterTinea pedisScabiesContact dermatitisHand foot & mouthPolymorphic light eruptionGrover’s diseaseArthropod assaults Erythema multiformeDermatitis herpetiformisId reaction
Bullae (≥ 1cm)
Bullous ImpetigoBullous tineaTrauma/ThermalBullous erythema multiformeStaph Scalded SkinStephens Johnson Syndrome Toxicepidermal necrolysisAutoimmune blistering diseaseBullous drug eruptionLichen planusPorphyria cutanea tardaDiabetic bullae
Pustular
Acne vulgarisRosacea Drug-induced pustular acneFolliculitisCandidiasis, pityrosporumScabiesPustular psoriasisPerioral dematitisSubcorneal pustulosisINFECTIOUS
Fluid-filled lesions
Culture can be a KEY diagnositic
©Bobonich 2016
Flesh color
Rough surfaceSkin tagsVerrucaOpen comedonesActinic keratosisCorns/callusEpidermal nevus
SmoothMolluscum contagiosumBasal cellVerruca/HPVEpidermoid cystsLipomasKeloids/hypertrophic scarGranuloma annulareNeurofibromasPearly penile papulesAdnexal tumors
Brown
FrecklesSkin tagsLentiginesNevi (Intradermal, compound, junctional)Seborrheic keratosisTinea versicolor (pinkish)PostinflammatoryhyperpigmentationErythasmaDermatofibromaCafé au laitMongolian spotMelanomaPigmented basal cellDysplastic nevusCongenital nevusFixed drug eruption (purple)Becker’s nevus
White
Pityriasis albaIdiopathic guttate hypomelanosisTinea versicolorAsh leaf maculeMiliaKeratosis pilarisPostinflammatory hypopigmentationNevus anemicusMorpheaform basal cell skin cancerVitiligoPiebaldismLichen sclerosus et atrophicusMorpheaTuberous sclerosis
YellowXanthelasmaSebaceous hyperplasiaNecrobiosis lipoidicaMorphea ©Bobonich 2016
EczematousEpithelial disruption
Atopic dermatitisIrritant contact dermatitisAllergic contact dermatitisDyshidrotic eczemaNummular eczemaStasis dermatitisScabies Secondary lesions (dermatitis herpetiformis, tinea, psoriasis, etc)Seborrheic dermatitisPolymorphic light eruptionLichen planusEczematous reaction patterns Xerotic eczemaExfoliative erythroderma
PapulosquamousNo epithelial disruption
PapulesPityriasis roseaKeratosis pilarisSeborrheic dermatitisTineaLichen planusSecondary syphilis Guttate psoriasisPityriasis lichenoides
(PLC or PLEVA)
Red, scaly lesions
Prominent plaquesPsoriasisTineaLupus erythematosus Discoid lupus erythematosusCutaneous T cell lymphoma
(mycosis fungoides)Pityriasis rubra pilarisLichen planusDarier’s diseaseExfoliative erythroderma
©Bobonich 2016
Inflammatory lesionsMonomorphic (same size & shape)
usually solitarypapules and dome-shaped
Macules & papulesArthropod assaultsSpider and cherry angiomasScabiesAcneKeratosis pilarisCandidiasisPyogenic granulomasGranuloma annulareViral exanthemsEarly psoriasis lesionsPityriasis rosea (w/o scale)Secondary syphilis (the ‘great imitator’)Pityriasis lichenoidesGrover’s disease,
Vascular reactionsPolymorphic (varied size & shape),
multiple, often confluent, flat-topped
Transient RosaceaUrticaria
Purpuric/non-blanchablePetechiae Coagulation disordersLeukocytoclastic vasculitis Henoch-Schonlein purpura EcchymosesMeningococcemiaRocky Mountain
Spotted FeverVascular ulcers
Persistent/blanchingKawasaki diseaseStaph scalded skinToxic shock syndromeRed man syndromeAngioedemaAutoimmune blistering
diseasesErythema multiformeErythema nodosumDrug eruptionUrticarial vasculitis
NodulesFurunclesCarbunclesEpidermoid cystsCellulitisErythema nodosumAcne vulgarisMycosis fungoides
Red, smooth lesions
©Bobonich 2016
Class & Indications Generic name Dermatophyte Yeast Gram + Gram - Anti-inflammatory
Polyenes (fungistatic)
Candidiasis Nystatin 0 ++++
Azoles (fungistatic)
Tinea
Pityriasis/tinea versicolor
Candidiasis
Seborrheic dermatitis
Miconazole + +++
Clotrimazole + +++
Ketoconazole + +++ ++ ++
Oxiconazole + +++
Econazole + +++ + + +
Sertaconazole + +++ ++
Allylamines/ Benzylamine (fungicidal)
Tinea
Pityriasis/tinea versicolor
Naftifine + + +++
Terbinafine +++ + +++
Butenafine ++++ ++ +++
Other Agents
Tinea; Onychomycosis; Candidiasis
Pityriasis/tinea versicolor; Seborrheic
dermatitis
Ciclopirox ++ ++++
C. Albicans
+++ +++ +++
Pityriasis/tinea versicolor
Seborrheic dermatitis
Selenium sulfide
(RX & OTC)
+++
Pityrosporum
Bobonich& Nolen (2015)
Indications and Effectiveness of Topical Antifungals