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Metronidazole, Topical 385 PART13.MIF Page 385 Friday, October 31, 2003 11:10 AM Metronidazole, topical 385 Methoxsalen. Dermatologic indications and dosage Disease Adult dose Child dose Component of Systemic photochemotherapy – Systemic photochemotherapy – photochemotherapy 0.4–0.6 mg per kg PO 1.5 hours 0.4–0.6 mg per kg PO 1.5 hours – psoriasis; Reiter before exposure to ultraviolet A before exposure to ultraviolet A syndrome; cutaneous light, either via light box, outdoor light, either via light box, outdoor T cell lymphoma sunlight, or photopheresis; topical sunlight, or photopheresis; topical (mycosis fungoides; therapy – 0.1% lotion applied therapy – 0.1% lotion applied Sézary syndrome; 30 minutes before exposure to 30 minutes before exposure to vitiligo; ultraviolet A light ultraviolet A light polymorphous light eruption; solar urticaria; chronic actinic dermatitis; morphea; linear scleroderma; graft versus host disease; lymphomatoid papulosis Component of 0.4–0.6 mg per kg PO 1.5 hours 0.4–0.6 mg per kg PO 1.5 hours photopheresis – T-cell before exposure to ultraviolet A before exposure to ultraviolet A lymphoma (mycosis light light fungoides; Sézary syndrome) M Contraindications/precautions Drug class Hypersensitivity to drug class or compo- Nitroimidazole antibiotic nent Mechanism of action References DNA disruption and inhibition of nucleic Laube S, George SA (2001) Adverse effects with acid synthesis (may not be mechanism in PUVA and UVB phototherapy. Journal of Der- skin disease treatment) matological Treatment 12(2):101–105 Lim HW, Edelson RL (1995) Photopheresis for the Dosage form treatment of cutaneous T-cell lymphoma. He- matology – Oncology Clinics of North America 0.75% cream, gel; 1% cream 9(5):1117–1126 Dermatologic indications and dosage See table Metronidazole, topical Common side effects Cutaneous: burning sensation, erythema, skin eruption Trade name(s) MetroGel; MetroCream; MetroLotion; Nori- Serious side effects tate None Generic available Drug interactions Ye s None PART13.MIF Page 386 Friday, October 31, 2003 11:10 AM 386 Michelin tire baby syndrome Metronidazole, topical. Dermatologic indications and dosage Disease Adult dosage Child dosage Rosacea Apply once daily Apply once daily Contraindications/precautions smooth muscle hamartoma. Pediatric Derma- Hypersensitivity to drug class or compo- tology 6(4):329–331 nent References Cohen AF, Tiemstra JD (2002) Diagnosis and treatment of rosacea. Journal of the American Michelin tire syndrome Board of Family Practice 15(3):214–217 Michelin tire baby syndrome Michelin tire baby syndrome Miescher syndrome 2 Synonym(s) Michelin tire syndrome; Kunze Riehm syn- drome Berardinelli-Seip syndrome Definition Heterogeneous group of disorders charac- terized by ringed creases of the extremities Miescher-Melkersson- Pathogenesis Rosenthal syndrome Autosomal dominant trait; at least two dis- tinct chromosomal abnormalities Cheilitis granulomatosa Clinical manifestation Deep, gyrus-like skin folds on the back; cir- cumferential, deep skin folds of limbs, with spontaneous resolution of skin creases in childhood; loose, thick skin; xanthomas Miescher’s cheilitis and/or lipomas; hypertrichosis with under- granulomatosa lying smooth muscle hamartoma; cleft pal- ate; neuroblastoma; congenital heart defects Cheilitis granulomatosa Differential diagnosis Nevus lipomatosis Therapy None Miescher’s granulomatosis References Glover MT, Malone M, Atherton DJ (1989) Miche- Actinic granuloma lin-tire baby syndrome resulting from diffuse Cheilitis granulomatosa PART13.MIF Page 387 Friday, October 31, 2003 11:10 AM Miliaria 387 rity of the sweat ducts in neonates, lack of Migratory necrolytic acclimitization, occlusive clothing, hot and erythema humid conditions, vigorous exerciose, and bacterial overgrowth Definition Clinical manifestation Miliaria crystallina: usually affects neonates Migratory eruption on face, abdomen, peri- neum, buttocks, or lower extremities, usu- and adults who are febrile or who recently ally associated with underlying glucagon- moved to a tropical climate; asymptomatic, oma clear, superficial vesicles appear in crops, often confluent, and without surrounding Glucogonoma erythema; rupture easily and resolve with superficial, branny desquamation; occur References within days to weeks of exposure to hot Schwartz RA (1997) Glucagonoma and pseudog- weather and disappear within hours to lucagonoma syndromes. International Journal days; in infants, lesions occur on the head, of Dermatology 36(2):81–89 neck, and upper part of the trunk; in adults, lesions appear on the trunk Miliaria rubra: occurs in hot, humid envi- ronments; pruritic or painful, small, dis- Mikulicz disease crete, non-follicular, erythematous papules and vesicles; lesions on the neck and in the groin and axillae; lesions on covered skin Rhinoscleroma subject to friction, such as the neck, scalp, upper part of the trunk, and flexures in M adults Miliaria profunda: occurs in those in a trop- Miliaria ical climate who have had repeated epi- sodes of miliaria rubra; asymptomatic, firm, flesh-colored papules, usually on the Synonym(s) trunk, developing within minutes or hours Prickly heat; sudamina; heat rash; lichen after the stimulation of sweating and tropicus; tropical anhidrosis resolves quickly after removal of stimulus that caused sweating; increased sweating in Definition unaffected skin; lymphadenopathy; hyper- Disorder of the eccrine sweat glands often pyrexia and symptoms of heat exhaustion, occurring in conditions of increased heat including dizziness, nausea, dyspnea, and and humidity, caused by blockage of the palpitations sweat ducts that results in the leakage of eccrine sweat into skin Differential diagnosis Folliculitis; milia; viral exanthem; cutane- Pathogenesis ous candidiasis; erythema toxicum; insect Occlusion of the skin, due to clothing or bite reaction; scabies; foreign body reac- bandages, resulting in pooling of sweat on tion; drug eruption; cholinergic urticaria the skin surface and overhydration of the stratum corneum; in susceptible persons, Therapy including infants, with relatively immature Miliaria crystallina: no therapy indicated eccrine glands, stratum corneum overhy- Miliaria rubra: removal of occlusive cloth- dration causes transient blockage of the ing; limiting of activity; air conditioning acrosyringium, resulting in leakage of Miliaria profunda: removal of occlusive sweat; other contributing factors: immatu- clothing; limited activity; air conditioning; PART13.MIF Page 388 Friday, October 31, 2003 11:10 AM 388 Miliaria cystallina anhydrous lanolin lotion applied 2–3 times secondary milia result from damage to daily and before activity that may produce pilosebaceous unit after skin trauma excess sweating Clinical manifestation References Uniform, pearly-white to yellowish, small, Wenzel FG, Horn TD (1998) Nonneoplastic disor- domed papules, often in groups; primary ders of the eccrine glands. Journal of the Amer- milia: usually on the face of newborns; seen ican Academy of Dermatology 38(1):1–17 around the eye in children and adults; sec- ondary lesions: arise after blistering or trauma, including bullous pemphigoid, inherited and acquired epidermolysis bul- Miliaria cystallina losa, bullous lichen planus, porphyria cuta- nea tarda, and burns Miliaria Differential diagnosis Acne vulgaris; flat wart; syringoma; trich- oepithelioma; xanthoma Miliaria profunda Therapy Incision and drainage; light hyfrecation Miliaria References Touart DM, Sau P (1998) Cutaneous deposition diseases. Part I. Journal of the American Acad- Miliaria pustulosa emy of Dermatology. 39(2 Pt 1):149–171 Miliaria Minocycline Miliary tuberculosis of the Trade name(s) skin Minocin; Dynacin; Vectrin Generic available Cutaneous tuberculosis Ye s Drug class Tetracycline Milium Mechanism of action Antibiotic activity: protein synthesis inhibi- Synonym(s) tion by binding to the 30S ribosomal subu- None nit; anti-inflammatory activity: unclear mechanism Definition Small, benign, keratin-filled cyst Dosage form 50 mg, 75 mg, 100 mg tablets Pathogenesis Derived from the pilosebaceous follicle; pri- Dermatologic indications and dosage mary lesions arise from vellus hair follicles; See table PART13.MIF Page 389 Friday, October 31, 2003 11:10 AM Minocycline 389 Minocycline. Dermatologic indications and dosage Disease Adult dosage Child dosage Acne vulgaris 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice daily Atrophoderma of 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice Pasini-Pierini daily Bullous pemphigoid 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice daily Confluent and 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice reticulate daily papillomatosis of Gougerot and Carteaud Dermatitis 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice herpetiformis daily Folliculitis 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice daily Linear IgA bullous 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice dermatosis daily Mycobacterium 100 mg PO twice daily for 4–6 weeks > 8 years old – 50–100 mg PO twice marinum infection after clinical resolution daily for 4–6 weeks after clincial resolution Nocardiosis 100-200 mg PO daily for 2–4 weeks > 8 years old – 100-200 mg PO daily M for 2–4 weeks Pemphigus foliaceus 50–100 mg PO twice daily > 8 years old – 50–100 mg PO twice daily Perioral dermatitis 50–100 mg PO twice daily for at > 8 years old – 50–100 mg PO twice least 30 days daily for at least 30 days Rosacea 50–100 mg PO twice daily for at > 8 years
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