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Dermatologic Possible therapeutic alternatives
Phthiriasis (pubic lice, crabs)



 Common pathogens
Permethrin (Elimite ®, Rid ®, A200 ® )
Scabies: ELIMITE® (permethrin) 5% Cream is indicated for the treatment of infestation with Sarcoptes scabiei (scabies).

DOSAGE AND ADMINISTRATION: Adults and children: Thoroughly massage ELIMITE® into the skin from the head to the soles of the feet. Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in infants and geriatric patients. Usually 30 grams is sufficient for an average adult. The cream should be removed by washing (shower or bath) after 8 to 14 hours. Infants should be treated on the scalp, temple and forehead. ONE APPLICATION IS GENERALLY CURATIVE.
Patients may experience persistent pruritus after treatment. This is rarely a sign of treatment failure and is not an indication for retreatment. Demonstrable living mites after 14 days indicate that retreatment is necessary.

Head Lice (Nix rinse, lotion - Permethrin 1%): After hair has been washed with shampoo, rinsed with water and towel dried, apply a sufficient volume of creme rinse to saturate the hair and scalp. Also apply behind the ears and at the base of the neck. Leave on hair for 10 minutes before rinsing off with water. Remove remaining nits. May repeat in 1 week if lice or nits still present. In areas of head lice resistance to 1% permethrin, 5% permethrin has been applied to clean, dry hair and left on overnight (8-14 hours) under a shower cap.

Supplied: Cream: Elimite®: 5%. Liquid creme rinse: (Nix®): 1% (60 ml). Lotion: 1% (59 ml). Spray [for bedding and furniture]: A200® Lice: 0.5% (180 ml). Nix®: 0.25% (148 ml). Rid®: 0.5% (150 ml).

Lindane (Kwell):NO LONGER RECOMMENDED BASED ON TOXICITY. Scabies: apply 30-60 ml of lotion/cream in a thin layer from the neck to the toes. Bathe and remove after 8-12 hours. Repeat treatment in 7 days if still present. Pediculosis, lice: 15-30 ml of shampoo-lather for 4-5 minutes. Rinse hair thoroughly and comb with a fine tooth comb to remove nits. May repeat in 7 days is still present.
RID, A-200 (pyrethrins, piperonyl butoxide):  Lice: Apply shampoo, wash after 10 minutes. Re-apply in 5-7 days.
Crotamiton (Eurax):  Scabies: apply cream/lotion from chin to feet. Repeat In 24hrs. Bathe after 48 hours. Pruritus: massage as needed. [cream/lotion 10%]
Nail Infections  
Terbinafine (Lamisil) 250 mg PO qd x 6weeks (fingernails) or x 12 weeks (toenails)
Itraconazole (Sporanox) 100mg PO bid or 200mg PO qd x 8 weeks (fingernails) or x 12 weeks (toenails). Pulse regimen: 200mg PO bid x 1w, for 2 consecutive months (fingernails) or 3 consecutive months (toenails)
Fluconazole (Diflucan) 150-300mg PO weekly x 6-12 months (until complete nail growth)
Tinea corporis/tinea cruris Trichophyton rubrum
 ciclopirox (Loprox ®): Apply cream or lotion twice daily  [cream/lotion 1%]
butenafine (Mentax ®): Apply cream once or twice daily. [cream 1%]
clotrimazole (Lotrimin ®): Apply twice daily.   Supplied:  [1% cream /solution /lotion]
enconazole (Spectazole ®): Tinea: apply once daily. Candida: apply twice daily.   Supplied:[1% cream]
ketoconazole: (Nizoril ®) Tinea/candida: apply once a day  Supplied: [2% cream]. Seborrheic dermatitis: apply shampoo/cream  once or twice daily. Dandruff: shampoo 2 times per week.
Miconazole: Tinea/candida: apply twice a day.  Supplie:  [2% cream/powder/spray]
naftifine (Naftin ®): Tinea: apply once daily (cream) or  twice a day- (gel)
terbinafine (Lamisil ®): Tinea: apply once or twice daily.   Supplied: [cream 1%]
tolnaftate (Tinactin ®): Apply twice a day.  Supplied:  [1% cream /powder/ gel /solution]
Dermatologic infections