Infectious Disease, Dermatology, and Common Ambulatory Presentations
Common ambulatory problems
Acne vulgaris is treated with benzoyl peroxide, topical retinoids, and topical antibiotics; oral antibiotics are adjuncts. Isotretinoin is for severe or refractory disease and requires pregnancy prevention and monitoring. Atopic dermatitis improves with emollients and topical corticosteroids; use the lowest effective potency. Tinea corporis and pedis respond to topical antifungals; tinea capitis needs oral therapy. Molluscum and warts are often self-limited.
Infectious and dermatologic traps
Infectious mononucleosis causes fever, pharyngitis, lymphadenopathy, and fatigue; avoid contact sports for about 4 weeks or until symptoms resolve because of splenic rupture risk. Amoxicillin in EBV can cause a rash. Group A streptococcal pharyngitis requires testing and penicillin or amoxicillin. Herpes simplex presents with grouped vesicles. MRSA abscesses require drainage.
Rule of thumb
For mild acne, start benzoyl peroxide plus a topical retinoid. For suspected mononucleosis with splenomegaly, restrict contact sports. For a well-appearing adolescent with a viral upper respiratory infection, avoid antibiotics.
Traps
Do not use tetracyclines under age 8. Do not prescribe isotretinoin without pregnancy testing and contraception counseling. Do not treat molluscum aggressively by default.