Chapter 52 Skin Problems

Topical corticosteroids

Aristocort Kenalog Valisone Lidex Psorcon Cutivate Temovate Diprolene Ultravate Aclovate DesOwen , Hytone 2.5 % Retinoids such as tazarotene (Tazorac) Vitamin D3 derivative calcipotriene (Dovonex)

ABCDEs for Moles

Asymmetry Border (irregular) Color Diameter Elevation, Enlargement, or Evolution

Topical Corticosteroids Very high

Clobetasol propionate 0.05 % (Temovate) Betamethasone dipropionate 0.05 % (Diprolene) Halobetasol propionate 0.05 % (Ultravate)

Coal tar products

Coal tar and salicylic acid ointment (Aquatar, Estar gel, Fototar, Zetar) anthralin (AnthraDerm, Dritho-Cream) Neutrogena T-Derm Psori Gel

Biologicals

Cyclosporine (Neoral) alefacept (Amevive) etanercept (Enbrel) infliximab (Remicade)

Topical Corticosteroids Low - Medium

Desonide 0.05 % ( DesOwen , Tridesilon) Fluocinolone acetonide 0.025 % (Synalar) Hydrocortisone valerate 0.2 % (Westcort) Betamethasone valerate 0.1 % (Valisone) Fluticasone propionate 0.05 % (Cutivate)

Risk Factors for Skin Cancer

Fair-skinned, fair-haired, blue-eyed people, particularly those of Celtic origin People who sustain sunburn and who do not tan Chronic sun exposure Exposure to chemical pollutants Sun-damaged skin (elderly people) History of X-ray therapy for acne or benign lesions Scars from severe burns Chronic skin irritations Immunosuppression Genetic factors

Pemphigus Risk Factors

Genetic factors highest incidence among those of Jewish or Mediterranean descent. usually occurs in men and women in middle and late adulthood. may be associated with penicilins and captopril and with the disorder myasthenia gravis.

Relevant nursing diagnosis:

Impaired skin integrity, body image

triamcinolone acetonide (Aristocort, Kenalog-10, Trymex)

Intralesional injections can be administered directly into highly visible or isolated patches of psoriasis that are resistant to other forms of therapy.

Tinea unguium (toenails; affects about 50 % of adults ) Treatment

Itraconazole (Sporanox) in pulses of 1 week a month for 3 months in cases of terbinafine failure.

Intralesional therapy Systemic therapy

Kenalog Cordran-impregnated tape Fluoroplex Methotrexate (Folex, Mexate) hydrouria (Hydrea) retinoic acid (Tegison) (not to be used in women of childbearing age)

Ophthalmic herpes zoster occurs when

an eye is involved. This is considered an ophthalmic emergency, and the patient should be referred to an ophthalmologist immediately to prevent the possible sequelae of keratitis, uveitis, ulceration, and blindness.

Two forms of seborrheic dermatitis can occur

an oily form and a dry form.

seborrheic dermatitis oily form

appears moist or "greasy." There may be patches of yellowish-red or gray-white, greasy skin, with white dry scaling macules and/or papules, with slight erythema, predominantly on the forehead, nasolabial fold, beard area, scalp, and between adjacent skin surfaces in the regions of the axillae, groin, and breasts

Bullous pemphigoid symptoms

appears more often on the flexor surfaces of the arms, legs, axilla, and groin. Oral lesions, usually transient and minimal. shallow erosions that heal fairly quickly. Pruritus

Methotrexate

appears to inhibit DNA synthesis in epidermal cells, thereby reducing the turnover time of the psoriatic epidermis. the medication can be toxic, especially to the liver, kidneys, and bone marrow.

Keloids

are benign overgrowths of fibrous tissue at the site of a scar or trauma. They appear to be more common among dark-skinned people. are asymptomatic but may cause disfigurement and cosmetic concern.

Angiomas

are benign vascular tumors that involve the skin and the subcutaneous tissues. They are present at birth and may occur as flat, violet-red patches or as raised, bright-red, nodular lesions. The Strawberry tend to involute spontaneously within the first few years of life, but port-wine usually persist indefinitely

Seborrheic keratoses

are benign, wartlike lesions of various sizes and colors, ranging from light tan to black, that are usually located on the face, shoulders chest, and back.

Moles

are common skin tumors of various sizes and shades, ranging from yellowish brown to black. They may be flat, macular lesions or elevated papules nodules that occasionally contain hair. Most pigmented nevi are harmless lesions.

Warts

are common, benign skin tumors caused by infection with the human papillomavirus, which belongs to the DNA virus group. People of all ages may be affected, but the warts occur most frequently between the ages of 12 and 16 years.

People who have been exposed to varicella by primary infection or by vaccination

are not at risk for infection after exposure to patients with herpes zoster.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syn drome (SJS)

are potentially fatal skin disorders and the most severe forms of erythema multiforme.

Actinic keratoses

are premalignant skin lesions that develop in chronically sun-exposed areas of the body. They appear as rough, scaly patches with underlying erythema. A small percentage of these lesions gradually transform into cutaneous squamous cell carcinoma

scabies Secondary lesions

are quite common and include vesicles, papules, excoriations, and crusts.

Recurrent episodes

are subsequent episodes of the same viral type.

side effects of corticosteroids.

atrophy, hypopigmentation, striae, and telangiectasias

Pemphigus is an

autoimmune disease involving immunoglobulin G.

A person with seborrheic dermatitis is advised to

avoid external irritants, excessive heat, and perspiration; rubbing and scratching prolong the disorder. To avoid secondary infection, the patient should air the skin and keep skin folds clean and dry

(Nikolsky's sign).

blistering or sloughing of uninvolved skin when minimal pressure is applied

Pemphigus Treatments

bring the disease under control as rapidly as possible prevent loss of serum and the development of secondary infection promote re-epithelization Corticosteroids are administered in high doses Immunosuppressive agents (eg, azathioprine, cyclophosphamide, gold) Plasmapheresis

Two topical nonsteroidal treatments introduced within the past few years are

calcipotriene (Dovonex) and tazarotene (Tazorac).

Ultraviolet radiation therapy

can be beneficial as a form of treatment as well in patients with seborrheic dermatitis

The role of the nurse is to teach the patient about prevention of skin

cancer and about self-care after treatment

Patients with seborrheic dermatitis may develop a secondary

candidal (yeast) infection in body creases or folds and may have to use a topical antifungal (eg, ciclopirox or ketoconazole)

The patient is cautioned that seborrheic dermatitis is a

chronic problem that tends to reappear.

Bullous pemphigoid risk factors

common in the elderly, with a peak incidence at about 60 years of age. no gender or racial predilection disease can be found throughout the world.

Pemphigus Complications

complications arise when the disease process is widespread. susceptible to secondary bacterial infection. Fluid and electrolyte imbalance Hypoalbuminemia

TEN and SJS Symptoms

conjunctival burning or itching cutaneous tenderness fever cough sore throat headache extreme malaise, and myalgias (ie, ache and pains). rapid onset of erythema Large, flaccid bullae develop in some areas Fingernails, toenails, eyebrows, and eyelashes may be shed along with the surrounding epidermis. skin is excruciatingly tender loss of skin leaves a weeping surface condition is also referred to as "scalded skin syndrome."

Exfoliative dermatitis causes.

considered to be a secondary or reactive process to an underlying skin or systemic disease. may appear as a part of the lymphoma group of diseases and may precede the clinical manifestations of lymphoma.

seborrheic dermatitis dry form

consisting of flaky desquamation of the scalp with profuse of fine, powdery scales, is commonly called dandruff.

Isolation maybe required if the condition is

contagious

TEN & SJS Treatment

control of fluid and electrolyte balance prevention of sepsis prevention of ophthalmic complications. Supportive care is the mainstay of treatment. Protecting skin with topical agents Temporary biological dressings

Cyclosporine A

cyclic peptide used to prevent rejection of transplanted organs, has shown some success in treating severe, therapy-resistant cases of psoriasis. its use is limited by side effects such as hypertension and nephro toxicity.

latent viruses are reactivated because of

declining cellular immunity

epidermopoiesis

development of epidermal cells

Patients with persistent candidiasis should be evaluated for

diabetes.

The goal of therapy is to control the

disorder and allow the skin to repair itself

After a case of chickenpox runs its course, the varicella-zoster viruses responsible for the outbreak lie

dormant inside nerve cells near the brain and spinal cord.

Seborrhea

excessive production of sebum (secretion of sebaceous glands) in areas where sebaceous glands are normally found in large numbers, such as on the face, scalp, eye-brows, eyelids, sides of the nose and upper lip, malar regions (cheeks), ears, axillae, under the breasts, in the groin, and in the gluteal crease of the buttocks.

Scabies mites frequently involve the

fingers, and hand contact may produce infection.

Pilar cysts (trichilemmal cysts)

formerly called sebaceous cysts, frequently are found on the scalp. They originate from the middle portion of the hair follicle and from the cells of the outer hair root sheath

Seborrheic dermatitis has a

genetic predisposition. Hormones, nutritional status, infection, and emotional stress influence its course. The remissions and exacerbations of this condition should be explained to the patient. If a person has not previously been diagnosed with this condition and suddenly appears with a severe outbreak, a complete history and physical examination should be considered.

The most important principle of psoriasis treatment is

gentle removal of scales.

Systemic cytotoxic preparations, such methotrexate

have been used in treating extensive psoriasis that fails to respond to other forms of therapy.

Tinea infections affect the

head, body, groin, feet, and nails.

One classic sign of scabies is the

increased itching that occurs during the overnight hours

The viruses causing chickenpox and herpes zoster are

indistinguishable, hence the varicella-zoster virus.

The major cause of death from TEN is

infection, and the most common sites of infection are the skin and mucosal surfaces, lungs, and blood.

Triamcinolone (Aristocort, Kenacort, Kenalog)

injected subcutaneously under painful areas is effective as an anti-inflammatory agent.

psoriasis treatment

involves the commitment of time and effort by the patient and possibly the family. any precipitating or aggravating factors are addressed. assessment is made of lifestyle patient is informed that treatment of severe psoriasis can be time-consuming, expensive, and aesthetically unappealing at times.

Seborrheic dermatitis

is a chronic inflammatory disease of the skin with a predilection for areas that are well supplied with sebaceous glands or lie between skin folds, where the bacteria count is high

Herpes simplex

is a common skin infection.

Calcipotriene 0.05 %

is a derivative of vitamin D. It works by decreasing the mitotic turnover of the psoriatic plaques. Its most common side effect is local irritation.

Pemphigus

is a group of serious diseases of the skin characterized by the appearance of bullae (blisters) of various sizes apparently normal skin and mucous membranes.

Exfoliative dermatitis

is a serious condition characterized by progressive inflammation in which generalized erythema and scaling occur. It may be associated with chills, fever, prostration, severe toxicity, and pruritic scaling of the skin.

Lentigo-maligna melanoma

is a slowly evolving, pigmented lesion that occurs on exposed skin areas, especially the sum of the hand, the head, and the neck in elderly people. Often, the lesion is present for many years before it is examined by a provider. It first appears as a tan, flat lesion, but in time it undergoes changes in size and color

Nodular melanoma

is a spherical, blueberry-like nodule with a relatively smooth surface and a relatively uniform, blue-black color It may be dome-shaped with a smooth surface. It may have other shadings of red gray, or purple. Sometimes, appear as irregularly shaped plaques. invades directly into adjacent dermis (ie, vertical growth) and therefore has a poorer prognosis.

Ultraviolet-B (UVB) light therapy

is also used to treat generalized plaques. UVB light ranges from 270 to 350 nm.

Bullous pemphigoid

is an acquired disease of flaccid blisters appearing on normal or erythematous skin.

Herpes zoster, also called shingles

is an infection caused by the varicella-zoster virus, a member of a group of DNA viruses.

Scabies

is an infestation of the skin by the itch mite Sarcoptes scabiei.

Etretinate

is especially useful for severe pustular or erythrodermic psoriasis. is a teratogen with a very long half-life; it cannot be used in women with childbearing potential.

nonprimary initial episode

is the initial episode of either type 1 or type 2 in a person previously infected with the other type.

True primary infection

is the initial exposure to the virus.

Exposure to the sun

is the leading cause of skin cancer

Skin cancer

is the most common cancer in the United States. is the most successfully treated type 1of cancer.

seborrheic dermatitis goal

is to keep it under control. Patients need to be encouraged to adhere to the treatment program.

PUVA

it has been associated with long- term risks of skin cancer, cataracts, and premature aging of the skin

prescription scabicide,

lindane (Kwell), crotamiton (Eurax), 5% permethrin ( Elimite )

Exfoliative dermatitis management

maintain fluid and electrolyte balance prevent infection. Medications implicated discontinued Temp maintained Plasma volume expanders

systemic corticosteroids

may cause rapid improvement of psoriasis, their usual risks and the possibility of triggering severe flare-up on withdrawal limit their use

The psoriatic epidermal cell

may travel from the basal cell layer of the epidermis to the stratum corneum and be cast off in 3 to 4 days, which is in sharp contrast to the normal 26 to 28 days.

Oral retinoids (ie, synthetic derivatives of vitamin A and its metabolite, vitamin A acid)

modulate the growth and differentiation of epithelial tissue.

seborrhea treatment

no known cure the objective of therapy is to control the disorder and allow the skin to repair itself.

Epidermal cysts (epidermoid cysts)

occur frequently, are slow-growing, firm, elevated tumors frequently noted on the face, neck, upper chest, and back.

TEN and SIS Risk Factors

occur in all ages and both genders. incidence is increased in older people People who are immunosuppressed

Superficial Spreading Melanoma

occurs anywhere on the body and is the most common form of melanoma.

Acral-lentiginous melanoma

occurs in areas not excessively exposed to sunlight and where hair follicles are absent. It is found on the palms of the hands, on the soles, in the nail beds, and in the mucous membranes in dark-skinned people. These melanomas appear as irregular, pigmented macules that develop nodules. They may become invasive early

herpes simplex type 2

occurs in the genital area

herpes simplex type 1

occurs on the mouth

The patches of grouped vesicles appear

on the red and swollen skin.

PSORIASIS

one of the most common skin diseases affects approximately 2% of the population appearing more often in people of European ancestry. Onset may occur at any age, most common in people between 15 and 35 years of age. has a tendency to improve and then recur periodically throughout life

Pemphigus Symptoms

oral lesions appearing as irregularly shaped erosions that are painful, bleed easily, and heal slowly Skin bullae that rupture Offensive odor from bullae Bacterial superinfection is common

Shingles eruption is usually accompanied or preceded by

pain, which may radiate over the entire region supplied by the affected nerves. pain may be burning, lancinating (tearing or sharply cutting), stabbing, or aching. Some patients have no pain, but itching and tenderness the area. Sometimes, gastrointestinal (GI) disturbances precede the eruption.

shingles characterized by

painful vesicular eruption along the area of distribution of the sensory nerves from one or more posterior ganglia.

Exfoliative dermatitis symptoms

patchy or a generalized erythematous eruption fever malaise occasionally GI symptoms skin color changes from pink to dark red. exfoliation (ie, scaling) begins Hair loss Relapses are common. high-output heart failure intestinal disturbances breast enlargement elevated levels of uric acid in the blood (ie, hyperuricemia) temperature disturbances.

There is an increased frequency of herpes zoster infections among

patients with weakened immune systems and cancers (especially leukemias and lymphomas), those on chemotherapy, and in HIV-affected individuals.

8-methoxypsoralen

photosensitizing medication

In older patients, the pain from herpes zoster may persist as

postherpetic neuralgia for months after the skin lesions disappear.

Systemic corticosteroid

prednisone

Exfoliative dermatitis Pathophysiology

profound loss of stratum corneum (ie, outermost layer of the skin), which causes capillary leakage, hypoproteinemia, and negative nitrogen balance. large amounts of body heat are lost

mainstay of dandruff treatment

proper, frequent shampooing (at least three times weekly) with medicated shampoos.

Instructions for using medicated shampoos are

reinforced for people with dandruff who require treatment. Frequent shampooing is contrary to some cultural practices; nurse should be sensitive to these differences when teaching the patient about home care.

Seborrheic keratoses Treatment

removal of the tumor tissue by excision, electrodesiccation, and curettage, or application of carbon dioxide or liquid nitrogen

Tazarotene

retinoid, causes sloughing of the scales covering psoriatic plaques. As with other retinoids, it causes increased sensitivity to sunlight by loss of the outermost layer of skin, so the patient should be cautioned to use an effective and avoid other photosensitizers Side effects include burning, erythema, or irritation at the site of application and worsening of psoriasis

Antiseborrheic shampoos include those containing

selenium sulfide suspension, zinc pyrithione, salicylic acid or sulfur compounds, and tar shampoo that contains sulfur or salicylic acid.

glucocorticoids

should be used with caution near the eyelids, because it can induce glaucoma and cataracts in predisposed patients.

IV acyclovir

started early, is effective in significantly reducing the pain and halting the progression of shingles

Treatment of skin tumors

surgical excision, Mohs' micrographic surgery, electrosurgery, cryosurgery, and radiation therapy.

Keloid Treatment

surgical excision, intralesional corticosteroid therapy, and radiation.

Scabies Medical and Nursing Management

take a warm, soapy bath or shower, dry thoroughly & allow skin to cool Perscription scabicide applied thinly to entire skin

Scabies Clinical Manifestations and Assessment

takes approximately 4 weeks from the time of contact for the patient's symptoms to appear. patient complains of severe itching caused by a delayed type of immunologic reaction to the mite or its fecal pellets. burrows may be multiple, straight or wavy, brown or black, thread-like lesions

The blisters are usually confined to a narrow regiom of

the face or trunk

If an ophthalmic nerve is involved in shingles

the patient may have eye pain.

Psoriasis sites of the body that tend to be affected most are

the scalp, the extensor surface of the elbows and knees, the lower part of the back, and the genitalia. Bilateral symmetry is a feature In approximately one-fourth to one-half of patients, the nails are involved

The goals of herpes zoster management are

to relieve the pain and to reduce or avoid complications, which include infection, scarring, and postherpetic neuralgia and eye complications.

The goals of management of the psoriatic lesions

to slow the rapid turnover of epidermis, to promote resolution and to control the natural cycles of the disease. There is no known cure.

Bullous Pemphigoid Treatment

topical corticosteroids for localized eruptions systemic corticosteroids for widespread involvement.

Herpes simplex infection is classified as a

true primary infection, a nonprimary initial episode, or a recurrent episode.

The shingles inflammation is usually

unilateral, involving the thoracic, cervical, cranial nerves in a bandlike configuration.

cause of psoriasis

unknown cause Possible combination of specific genetic makeup and environmental stimuli may trigger the onset of disease. Current evidence supports an immunologic basis for the disease Periods of emotional stress and anxiety aggravate the condition. Trauma, infections, seasonal and hormonal changes also trigger factors.

early vesicles

which contain serum, later may become purulent, rupture, and form crusts.

polymorphic light eruption

(a rash related to photosensitivity that can take on many forms);

guttate psoriasis

(in the shape of a drop) because the lesions remain about 1 cm wide and are scattered like raindrops over the body. This variation is believed to be associated with a recent streptococcal throat infection.

teratogenic

(produces physical defects in the fetus)

Topical Corticosteroids Over - the - counter Lowest

0.5 % to 1.0 % hydrocortisone Dexamethasone 0.1 % ( Decaderm ) Alclometasone 0.05 % ( Aclovate ) Hydrocortisone 2.5 % ( Hytone )

TEN and SIS are triggered by

a reaction to medications. Antibiotics, especially sulfonamides, antiseizure agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and sulfonamides are the most frequent medications implicated

Seborrheic dermatitis of the body and face may respond to

a topically applied glucocorticoid cream or low-potency topical steroids (eg, desonide), which allays the secondary inflammatory response

Removal of Scales can be accomplished with

Baths, Oils (eg, olive oil, mineral oil, Aveeno Oilated Oatmeal Bath) coal tar preparations (eg, Balnetar) can be added to the bath water and a soft brush used to scrub the psoriatic plaques gently. After bathing, the application of emollient creams containing alpha-hydroxy acids (eg, Lac-Hydrin, Penederm) or salicylic acid continues to soften thick scales.

TEN & SJS fluid replacement

Because an indwelling IV catheter may be a site of infection, fluid replacement is carried out by nasogastric tube and then orally as soon as possible

Clinical Manifestations Tinea corporis (body)

Begins with red macule, which spreads to a ring of papules or vesicles with central clearing. Lesions are found in clusters. Many spread to the hair, scalp, or nails. Very pruritic An infected pet may be the source.

Clinical Manifestations Tinea cruris (groin area; "jock itch")

Begins with small, red scaling patches, which spread to form circular elevated plaques. Very pruritic Clusters of pustules may be seen around borders.

oral antiviral agents,

acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir)

Superficial Spreading Melanoma risks and symptoms

affects middle-aged people occurs most frequently on the trunk and lower extremities. lesion tends to be circular, with irregular outer portions. margins of the lesion may be flat or elevated and palpable may appear in a combination of colors, with hues of tan, brown, and black mixed with gray, blue-black, or white. Sometimes a dull pink rose color seen within the lesion.

Clinical Manifestations and Assessment psoriasis.

Lesions appear as red, raised patches of skin covered with silvery scales. If the scales are scraped away, the dark-red base of the lesion is exposed, patches are not moist and may be pruritic.

Tinea corporis (body) Treatment

Mild: topical antifungal creams Severe: Griseofulvin or Terbinafine

Tine cruris (groin area; "jock itch") Treatment

Mild: topical antigungal creams Severe: grisefulvin or terbinafine

Treatment Angiomas

Most patients use masking cosmetics (ie, Covermark or Dermablend) to camouflage the lesions. The argon laser is being used on various with some success. Treatment of strawberry ___________ is more successful if undertaken as soon after birth as possible

Clinical Manifestations Tinea unguium (toenails; affects about 50 % of adults )

Nails thicken, crumble easily, and lack luster. Whole nail may be destroyed.

Medicated shampoos

Neutrogena T-Gel, T-Sal, Zetar Head & Shoulders Desenex Selsun Blue Bakers P&S (emulsifying agent with phenol, saline solution, and mineral oil)

Photochemotherapy

Oral gold (auranofin) etretinate methotrexate UVA or UVB light with or without topical medications PUVA (combines UVA light with oral psoralens, or topical Trisoralen)

herpes zoster management

Pain controlled with analgesics Systemic corticosteroids reduce the incidence and duration of postherpetic neuralgia

Hydroxyurea (Hydrea)

also inhibits cell replication by affecting DNA synthesis. The patient is monitored for signs and symptoms of bone marrow depression.

Preventing Skin Cancer

Remind patients that up to 50 % of ultraviolet rays can penetrate loosely woven clothing Remind patients that ultraviolet light can penetrate cloud cover Teach children to avoid all but modest sun exposure and to use a sunscreen regularly Avoid tanning if their skin burns easily, never tans, or tans poorly Avoid unnecessary exposure to the sun, especially during the time of day when ultraviolet radiation (sunlight) is most intense (10 AM to 3 PM) Avoid sunburns. Apply a sunscreen daily to block harmful sun rays Use a sunscreen with an SPF of 15 or higher that protects against both ultraviolet-A (UVA) and ultraviolet-B (UVB) light Reapply water-resistant sunscreens after swimming if heavily sweating, and every 2 to 3 hours during prolonged periods of sun exposure Avoid applying oils before or during sun exposure Use a lip balm that contains a sunscreen Wear protective clothing Avoid using sun lamps avoid commercial tanning booths.

Treatment Epidermal cysts

Removal of the cysts provides a cure

Tinea pedis (foot; athlete's foot") Treatment

Soak feet in vinegar and water solution Resistant infections: griseofulvin or terbinafine Terbinafine (Lamisil) daily for 3 months

Clinical Manifestations Tinea pedis (foot; athlete's foot")

Soles of one or both feet have scaling and mild redness with maceration in the toe webs. More acute infections may have clusters of clear vesicles on dusky base.

Melanoma treatment

Surgical excision for small, superficial lesions Lymph node dissection (Sentinel nody biopsy first) Immunotherapy Chemotherapy Regional perfusion

Psoriasis Pathology

The cells in the basal layer of he skin divide too quickly, and the newly formed cells move rapidly to the skin surface that they become evident as profuse scales or plaques of epidermal tissue.

TINEA , also called ringworm

The most common fungal skin infection

Treatment Genitalia and perianal warts (condylomata acuminata.)

They are treated with liquid nitrogen cryosurgery, electrosurgery, topically applied trichloroacetic acid, and curettage

Treatment Actinic keratoses

They are usually removed by cryotherapy or shave excision

Genitalia and perianal warts (condylomata acuminata.)

They may be transmitted sexually. affect the uterine cervix predispose the patient to cervical cancer

Treatment Warts

They may be treated with locally applied laser therapy, liquid nitrogen salicylic acid plasters, or electrodesiccation

Treatment Pilar cysts

Treatment is surgical removal

Topical Corticosteroids Medium - High

Triamcinolone acetonide 0.1 % to 0.5% ( Aristocort ) Fluocinonide 0.05 % ( Lidex ) Desoximetasone 0.05 % to 0.25 % (Topicort) Fluocinolone 0.2 % ( Synalar ) Diflorasone diacetate 0.05 % (Psorcon)

palmar pustular psoriasis.

When psoriasis occurs on the palms and soles, it can cause pustular lesions

One treatment for severely debilitating psoriasis is

a psoralen (phototoxic) medication (eg, methoxsalen) combined with ultraviolet-A (PUVA) light therapy.