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Treatment of lesions of digital dermatitis is done by topical application of agents to the affected skin. The skin should be cleaned and kept dry prior treatment. Topical oxytetracycline (OTC) is often referred as the most reliable treatment as cows treated with OTC have a good recovery rate. Bandaging the lesion is often undertaken but there is no evidence of any benefit and bandaging can provide the anaerobic environment which supports the spirochaetes.. Systemic antibiotics are not needed.
Control and prevention of digital dermatitis relies on prompt detection, isolation and treatment of affected cattle. Group hoof disinfection can be achieved via the passage of the cows through footbaths of antimicrobial solutions. Slurry build-up should be avoided since organic matter can impair the antimicrobial efficacy of the footbath solutions. Regular footbaths should be organised, using formalin, copper sulphate or a thymol-based disinfectant. While regular footbathing can help prevent hoof infections, occasional flare-up of active M2 lesions can happen.
The skin should be cleaned and kept dry, and topical antibiotics can be applied to the area. Systemic antibiotics are not needed.
Control relies on prompt detection, isolation and treatment of affected cattle. Footpaths should be kept as dry as possible and slurry build-up should be avoided. Regular footbaths should be organised, using formalin, copper sulphate or a thymol-based disinfectant. In 2013, a safer and alternative to chemicals for hoof baths called Thymox Technology was proven, through field testing, to kill the main bacteria causing digital dermatitis.
There are many topical antifungal drugs useful in the treatment of athlete's foot including: miconazole nitrate, clotrimazole, tolnaftate (a synthetic thiocarbamate), terbinafine hydrochloride, butenafine hydrochloride and undecylenic acid. The fungal infection may be treated with topical antifungal agents, which can take the form of a spray, powder, cream, or gel. Topical application of an antifungal cream such as terbinafine once daily for one week or butenafine once daily for two weeks is effective in most cases of athlete's foot and is more effective than application of miconazole or clotrimazole. Plantar-type athlete's foot is more resistant to topical treatments due to the presence of thickened hyperkeratotic skin on the sole of the foot. Keratolytic and humectant medications such as urea, salicyclic acid (Whitfield's ointment), and lactic acid are useful adjunct medications and improve penetration of antifungal agents into the thickened skin. Topical glucocorticoids are sometimes prescribed to alleviate inflammation and itching associated with the infection.
A solution of 1% potassium permanganate dissolved in hot water is an alternative to antifungal drugs. Potassium permanganate is a salt and a strong oxidizing agent.
Initial treatments for minor erythrasma can begin with keeping the area clean and dry and with antibacterial soaps. The next level would be treated with topical fusidic acid, miconazole cream, and antibacterial solution such as clindamycin HCL to eradicate the bacteria. For aggressive types of Erythrasma, oral antibiotics like macrolides(erythromycin or azithromycin)can be prescribed. Below is a figure showing the different types and subtypes of therapies.
There is no current agreement on the most optimal treatment for this disease. There are plenty of limitations on these treatments such as more irritation, possible allergic reactions, and ulcerations. These treatments are suitable for most ages, but for young children it should be monitored very closely. Erythrasma if treated and found early on, is not fatal and the patient will live a full life. In more severe cases, it can be an indicator for another disease such as diabetes.
Various moisture-absorbing powders, such as talcum or starch, reduce moisture but may introduce other complications. Airborne powders of any sort can irritate lung tissue, and powders made from starchy plants (corn, arrowroot) provide food for fungi and are not recommended by the American Academy of Dermatology.
In persistent or especially bad rashes, an antifungal cream often has to be used. In cases that the rash is more of an irritation, a "mild" topical corticosteroid preparation, e.g. hydrocortisone cream, is used. As it is often difficult to tell a fungal infection apart from a mere skin irritation, many physicians prefer an corticosteroid-and-antifungal combination cream such as hydrocortisone/miconazole.
Athlete's foot resolves without medication (resolves by itself) in 30–40% of cases. Topical antifungal medication consistently produce much higher rates of cure.
Conventional treatment typically involves thoroughly washing the feet daily or twice daily, followed by the application of a topical medication. Because the outer skin layers are damaged and susceptible to reinfection, topical treatment generally continues until all layers of the skin are replaced, about 2–6 weeks after symptoms disappear. Keeping feet dry and practicing good hygiene (as described in the above section on prevention) is crucial for killing the fungus and preventing reinfection.
Treating the feet is not always enough. Once socks or shoes are infested with fungi, wearing them again can reinfect (or further infect) the feet. Socks can be effectively cleaned in the wash by adding bleach or by washing 60 Celsius. Washing with bleach may help with shoes, but the only way to be absolutely certain that one cannot contract the disease again from a particular pair of shoes is to dispose of those shoes.
To be effective, treatment includes all infected areas (such as toenails, hands, torso, etc.). Otherwise, the infection may continue to spread, including back to treated areas. For example, leaving fungal infection of the nail untreated may allow it to spread back to the rest of the foot, to become athlete's foot once again.
Allylamines such as terbinafine are considered more efficacious than azoles for the treatment of athlete's foot.
Severe or prolonged fungal skin infections may require treatment with oral antifungal medication.
One of the keys to treatment and prevention involves keeping the skin moisturized. Lotions, creams, and bath oils may help prevent an outbreak. If the condition flares up, a common treatment involves the application of topical corticosteroids. Oral antihistamines may help lessen itching. Avoidance of irritants is a common strategy. More severe cases sometimes respond to ultraviolet light treatment.
Id reactions are frequently unresponsive to corticosteroid therapy, but clear when the focus of infection or infestation is treated. Therefore, the best treatment is to treat the provoking trigger. Sometimes medications are used to relieve symptoms.These include topical corticosteroids, and antihistamines. If opportunistic bacterial infection occurs, antibiotics may be required.
A number of medications speed up recovery including: tetracycline, doxycycline, and erythromycin. Erythromycin may be used as a cream. Doxycycline is most often the first antibiotic drug choice, given at a daily dosage of 100 mg for upto a month before considering tapering off or stopping. Sometimes, longer duration of low doses of doxycycline are required.
Metronidazole is less effective, is available in a gel and can be applied twice daily. If the perioral dermatitis was triggered by a topical steroid then pimecrolimus cream has been suggested as effective in improving symptoms. However, this has also been documented to cause the condition.
Antifungal drugs are used to treat mycoses. Depending on the nature of the infection, a topical or systemic agent may be used.
Example of antifungals include: fluconazole which is the basis of many over-the-counter antifungal treatments. Another example is amphotericin B which is more potent and used in the treatment of the most severe fungal infections that show resistance to other forms of treatment and it is administered intravenously.
Drugs to treat skin infections are the azoles: ketoconazole, itraconazole, terbinafine among others.
Yeast infections in the vagina, caused by "Candida albicans", can be treated with medicated suppositories such as tioconazole and pessaries whereas skin yeast infections are treated with medicated ointments.
Oatmeal contains avenanthramide (anthranilic acid amides), which can have an anti-inflammatory effect.
There is little evidence for antihistamine; they are thus not generally recommended. Sedative antihistamines, such as diphenhydramine, may be tried in those who are unable to sleep due to eczema.
Multiple treatment regimes are available and treatment algorithms have been proposed.
Perioral dermatitis will usually resolve within a few months without medication and by limiting the use of cosmetics. This is called zero treatment. Topical corticosteroids should be stopped entirely if possible. If the flare proves intolerable, temporary use of a less potent topical corticosteroid can often be helpful.
Topical corticosteroids, such as hydrocortisone have proven themselves effective in managing AD. If topical corticosteroids and moisturisers fail, short-term treatment with topical calcineurin inhibitors like tacrolimus or pimecrolimus may be tried, although they are usually avoided as they can increase the risk of developing skin cancer or lymphoma. Alternatively systemic immunosuppressants may be tried such as ciclosporin, methotrexate, interferon gamma-1b, mycophenolate mofetil and azathioprine. Antidepressants and naltrexone may be used to control pruritus (itchiness). In 2016 crisaborole was approved as a topical treatment for mild-to-moderate eczema. In 2017, the biologic agent dupilumab was approved to treat moderate-to-severe eczema.
The aim of treatment is to relieve the allergy-induced itch and to remove the fleas from the pet and its home environment. In some cases, secondary bacterial or yeast infections will also need treatment before the itching subsides. Environmental flea control includes using flea foggers or bombs, vacuuming, and treating pet bedding by washing on a hot cycle (over 60 degrees Celsius) in the washing machine. The current on-pet treatment recommended by veterinary dermatologists is spinosad (Comfortis) monthly and nitenpyram (Capstar or generics) every 48 hours until improvement.
Many pets with FAD may also have other allergies, such as allergies to food, contact allergies, and atopic dermatitis.
Keeping the skin clean and dry, as well as maintaining good hygiene, will help larger topical mycoses. Because fungal infections are contagious, it is important to wash after touching other people or animals. Sports clothing should also be washed after use.
Treatment may include corticoids, astringents, and keratolytics. Dermatoses tend to be recurrent unless the use or contact can be avoided. Discontinuation of the instrument is curative in almost all cases, but usually impractical.
A more novel form of treatment involves exposure to broad or narrow-band ultraviolet (UV) light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares. In particular, the usage of UVA1 is more effective in treating acute flares, whereas narrow-band UVB is more effective in long-term management scenarios. However, UV radiation has also been implicated in various types of skin cancer, and thus UV treatment is not without risk.
A full recovery is expected with treatment. Recurrent id reactions are frequently due to inadequate treatment of the primary infection or dermatitis and often the cause of recurrence is unknown.
If the rash does not improve or continues to spread after 2–3 of days of self-care, or if the itching and/or pain is severe, the patient should contact a dermatologist or other physician. Medical treatment usually consists of lotions, creams, or oral medications.
- Corticosteroids. A corticosteroid medication similar to hydrocortisone may be prescribed to combat inflammation in a localized area. It may be applied to the skin as a cream or ointment. If the reaction covers a relatively large portion of the skin or is severe, a corticosteroid in pill or injection form may be prescribed.
In severe cases, a stronger medicine like halobetasol may be prescribed by a dermatologist.
- Antihistamines. Prescription antihistamines may be given if non-prescription strengths are inadequate.
Recent research for Erythrasma is mainly focused on the treatments and which methods work best to treat the patient depending on the severity of the condition. In a 2016 study performed by Prathyusha Prabhakar and H. Hema, they looked into comparing 2% clotrimazole cream and 2% Fusidic cream in treating erythrasma. This was a one year long hospital based study in South India that resulted in stating that the groin was the most common site for the symptoms of itching and discloloration being predominant and also mostly in men. The general conclusion made was that topical 2% fusidic acid cream was found to be more effective than 2% clotrimazole cream in patients with erythrasma. The topical 2% clotrimazole cream was more effective only when an associated fungal infection was present.
Another study performed in early 2017 by Tanya Grewal and Philip Cohen looked directly at mupirocin 2% ointment monotherapy. This study was done with nine males who showed a presence of erythrasma at bilateral inguinal folds, medial thighs, and axillae. After initial diagnosis by Wood lamp's examination to confirm the diagnosis, the antibiotic cream was distributed. Mupirocin is a topical antibiotic that is usually used to treat Streptococcus and Staphylococcus infections. After 2-4 weeks of use, the erythrasma seemed to clear up. They were able to conclude that the application of 2% Mupirocin ointment monotherapy twice a day, everyday is a great consideration for a first line of treatment for erythrasma.
A study done in 2011 by M. Inci and G. Serarslan revolved around detecting the frequency and risk factors of interdigital erythrasma in patients who were possibly diagnosed with Tinea pedis. The study was done with 122 people who had a confirmed diagnoses of erythrasma through the Wood's lamp method. The results showed that erythrasma was more prevalent in males who were over the age of 40 years. Their conclusions were that erythrasma is a common condition and can also easily mimic other infections such as tinea pedis and that gram staining is a better tool to differentiate the bacteria and it's mechanism than the Wood's lamp method.
Generous application of bland emollients can improve the rash. However, complete resolution will not occur until the lip licking stops. Breaking the cycle of dryness then licking followed by more dryness is key to treatment. Sometimes, unlike in perioral dermatitis, topical steroids may be used for few days only.
Cattle infested with bovine pediculosis are generally treated chemically, by drugs like ivermectin and cypermethrin.
The clinical expression of the dermatitis can be mitigated by avoidance of the allergen. Through compliance with avoidance measures, the immune system can become less stimulated. The key to avoidance is proper evaluation and detection of the inciting allergen. However, once the immune system registers the allergen, the recognition is permanent.
The first step in treating the condition is appropriate recognition of the clinical problem, followed by identification of the culprit chemical and the source of that chemical. Corticosteroid creams should be used carefully and according to the prescribed directions because when overused over longer periods of time they can cause thinning of the skin. Also, in some instances such as poison ivy dermatitis calamine lotion and cool oatmeal baths may relieve itching.
Usually, severe cases are treated with systemic corticosteroids which may be tapered gradually, with various dosing schedules ranging from a total of 12 – 20 days to prevent the recurrence of the rash (while the chemical allergen is still in the skin, up to 3 weeks, as well as a topical corticosteroid. Tacrolimus ointment or pimecrolimus cream can also be used additionally to the corticosteroid creams or instead of these. Oral antihistamines such as diphenhydramine or hydroxyzine may also be used in more severe cases to relieve the intense itching. Topical antihistamines are not advised as there might be a second skin reaction (treatment associated contact dermatitis) from the lotion itself.
The other symptoms caused by allergic contact dermatitis may be eased with cool compresses to stop the itching. It is vital for treatment success that the trigger be identified and avoided. The discomfort caused by the symptoms may be relieved by wearing smooth-textured cotton clothing to avoid frictional skin irritation or by avoiding soaps with perfumes and dyes.
Commonly, the symptoms may resolve without treatment in 2 to 4 weeks but specific medication may hasten the healing as long as the trigger is avoided. Also, the condition might become chronic if the allergen is not detected and avoided.