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DR. ITCHY'S TIPS

1. Assume everything has folliculitis (pyoderma, Demodex, dermatophytosis) until proven otherwise.
   1. Skin scrape every case.
   2. DTM culture almost every case.
   3. Is it oozes, do cytology.
2. Lichenified skin on the ventral neck, axilla, and ventrum is caused by Malassezia dermatitis until proven otherwise.
3. Atopy, food allergy, and scabies can look exactly alike and should be considered as a group.
4. If you diagnosis Malassezia dermatitis, recurrent pyoderma, or recurrent otitis identify and control the primary underlying disease (allergy, endocrine, etc.)
5. Biopsy to diagnosis neoplasia, deep infections, autoimmune skin diseases, or when the dermatitis is severe or you are unsure of the etiology. Use a dermatohistopathologist or someone who is interested in skin.
6. if in doubt use antibiotics and use more antibiotics than steroids.
7. Use steroids only when you have a tentative diagnosis, not  just for "itch".
8.  When you get stuck ask someone (a dermatologist or a colleague) or refer.
9. Recognize lesions and disease patterns. Most of dermatology is using clues from the history and pattern of lesions to form a rule-out list which you can work through.

Suggestions:

Make all dermatology appointments for 1 hour. It is impossible to do good skin work-ups in 15 minutes.

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