Rash

Rash:

  • Hydrocortisone 2.5% topical cream – apply qd (avoid face and genitalia)
  • Prednisone 60mg PO bid
  • Benadryl 50mg PO q6hr PRN pruritus
  • Hydroxyzine pamoate (Vistaril) 50mg PO q8hr PRN pruritus
  • Triamcinolone 0.1% ointment – apply topically q12hr
    • If inpatient:
      • Patient has a history of MRSA: Vancomycin (pharm to dose)
      • Lortab 5 q4hr PRN pain – Note: Lortab can cause pruritus.
      • Consult Wound Care.
    • Once Discharged:
      • Follow up outpatient with Dermatology.
      • Prednisone taper.
      • Bactrim DS PO [Could also consider Doxycycline or Clindamycin.]
    • Also consider Scabies: Permethrin or Ivermectin.

Rash: steroid course may be beneficial

  • Contact dermatitis: Started on Zyrtec Allergy 10mg PO qd, Hydroxyzine 25mg PO tid, and Triamcinolone Acetonide 0.1% external lotion – Apply 2-3 times a day to affected areas.
  • Hydroxyzine (Atarax: HCl itching) (Visteril: Pamoate anxiety) 25mg PO tid OR Hydroxyzine (Vistaril): antihistamine (Tx: anxiety, tension, nervousness, N/V, allergies, skin rash, pruritis, hives) (do NOT use in elderly)
    1. Start: 25mg PO qd (start only in the evening as may cause drowsiness)
    2. Other: 50mg IM/PO
  • Zyrtec (Cetirizine): antihistamine
    1. Treats hay fever and allergy symptoms, hives, and itching.
      1. Also consider adding Famotidine.
  • Triamcinolone Acetonide 0.1% external lotion – Apply 2-3 times a day to affected areas.
    1. Rash with uticaria on back, abdomen, arms, and legs: Started Cetirizine 10mg PO qd and started Triamcinolone external cream today. The patient is recommended to not use harsh soaps and to pay attention to her diet and her environment to determine whether there is something new in her diet or new in her environment that is causing this skin reaction.
    2. Eczema: (or Psoriasis)
      1. Triamcinolone acetonide 0.1-0.5% external ointment to be applied tid
      2. Hydrocortisone Valerate 0.2% external ointment.
  • Betamethasone Dipropionate 0.05 % External Ointment; APPLY SPARINGLY TO AFFECTED AREA(S) TWICE DAILY
  • Clobetasol propionate is a corticosteroid of the glucocorticoid class used to treat various skin disorders including eczema and psoriasis. It is also highly effective for contact dermatitis caused by exposure to poison ivy/oak.
    1. Clobetasol Propionate 0.05% external ointment
    2. Poison ivy:
      1. Tx: Dexamethasone 4-8mg (1-2ml) IM, Prednisone 20mg PO qd for 5 days, and Clobetasol Propionate 0.05% external ointment.
  • Benadryl
  • Consider whether Tinea corporis: anti-fungal needed.
  • Z-pack (Azithromycin – antibacterial)
  • Aquaphor (petrolactum topical)
  • Prednisone 20mg PO qd for 5 days
    1. Referral to Allergist and/or Dermatologist if rash persists despite treatment.

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