Yard Rash

70 y old gentleman was performing some yard work over the weekend. Over the next 48 hrs, he noticed a very pruritic rash that spread quickly from his arms to forearms, face and legs. His wife rubbed calamine lotion and OTC hydrocortisone, which provided some relief. His past history is relevant for HTN and BPH, well controlled on metoprolol, Enalapril and doxazosin. On exam, his vital signs are stable, although he looks miserable from extreme pruritus. He has large areas of weeping vesicular eruption on his face, arms and legs, surrounded by erythema and edema.

What is the first line of treatment for his condition?

1. Topical Clobetasol propionate 0.05%
2. Topical Pimecrolimus
3. Avoid contact with vesicles
4. Methylprednisolone dose pack tapered over 1 week
5. Prednisone taper over two weeks starting at 1mg/kg/day (Maximum 60mg/d)

Patchy back

A car mechanic in his early 40’s came to the office complaining of skin rash. He has had the rash for several years with intermittent flare ups during summer months. He has a past history of hypertension, which is well controlled on a combination of metoprolol and hydrochlorothiazide. Exam shows scattered hypo-pigmented, salmon colored coalescing macules on his trunk, back and upper extremities. He lacks health insurance and requests the cheapest treatment option.

Which of the following appropriate treatment option is available for $4?

1. Diflucan 200mg 2 tab po x 1 dose
2. Selenium sulfide 2.5% lotion
3. Ketoconazole 200mg 2 tab po x 1 dose-ANSWER
4. Itraconazole 100mg 4 tab po x 1 dose