The other day I happened to freeze my hands. Yes, not that frostbite, and not frostbite at all, but so, slightly freeze. All right, all right-my gloved fingers froze, so I remembered a story told by a patient at the reception.
By the way, that is why the heading is called – "Jungle dermatology", being in which we all need guidance ways – diagnostic and therapeutic.
So, therapeutic tactics depends on the observed manifestations of the disease. Conditionally highlighting the last time the stages of inflammation, we focus on the so-called limit of therapy – something that can be used on the principle of sufficiency.
I note that all my arguments do not contradict the clinical recommendations, and based on them, only clarify the meaning of the appointment on the basis of the observed clinical manifestations.
Transient spontaneous erythema of the face, transient swelling, periodic and mild itching will make us more carefully identify and offer the patient to eliminate the factors that influenced its appearance:
- environmental influence;
- excess consumption of alcohol, hot and carbonated beverages;
- traumatizing the psyche of the situation;
- climacteric syndrome and neuroendocrine disorders;
- application of cosmetics with irritating effect;
- other Exo - and andfactory causing erythema of the face, including some drugs.
Visible stagnant erythema of a spilled nature – a pathognomonic symptom of the disease implies the mandatory use of external (including laser) and systemic effects in the aggregate:
External therapy:
- metronidazole, gel 0,75%, cream 1% 2 times a day, morning and evening, up to 4 months or
- azelaic acid, cream 15% or gel 2 times a day (morning and evening) 3-4 months;
- benzoyl peroxide 2,5–5–10% gel 2 times a day;
- adapalen, 0.1% cream, gel apply 1 time a day to clean, dry skin.
Systemic therapy:
- xanthinol nicotinate 300 mg orally 2 times a day for 4 weeks;
- trental 100 mg orally 3 times a day, for 4 weeks.
Laser and physiotherapy technologies:
- IPL, diode, KTR, alexandrite, long-pulse neodymium laser on aluminum-yttrium garnet – Nd:YAG;
- microcurrent therapy
The appearance of papules (of course against the background of erythema), says about infiltration of the dermis, and therefore proposes to break the treatment into stages:
Decontaminations:
- sulfur ointment simple on the face, 1 time per day, at least 20 days in a row or
- metronidazole 1.0—1.5 g per day orally for 4-8 weeks or
- Ornidazole 0.5 g per day orally for 10 days;
- klindamitinom, gel 1% to 8 weeks.
Reduce inflammation, normalize blood circulation:
- azelaic acid, cream 15% or gel 2 times a day (morning and evening) 3-4 months;
- xanthinol nicotinate 300 mg orally 2 times a day for 4 weeks.
Application of lymphatic drainage measures:
- microcurrent therapy.
The presence of pustules, papulo-pustules causes joining the previous list:
- course doxycycline 100—200mg per day orally for 21-28 days + maintenance dose — 100 mg per day for 12 weeks or
- erythromycin 0.25 mg 4 times a day orally for 14-28 days (especially in the treatment of pregnant women);
- isotretinoin 0.1-0.3 mg per kg of body weight orally once a day after meals for 4-6 months.
The presence of bugorkova infiltration and granulomatous inflammation (Atofina, rhinophyma, gnathophyma, metafile) will give us all reason to use:
- isotretinoin 0.3 mg per kg body weight orally 1 time per day after meals for 4-6 months;
- surgical excision or laser dermabrasion (which is preferable).
Treat consciously!
