The Curbsiders Internal Medicine Podcast #285 Common Skin Complaints in Primary Care (Dermsiders)
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Jul 19, 2021 
Dr. Helena Pasieka, Chief of Dermatology at Kashlak, discusses common skin complaints in primary care, including tinea versicolor, skin tags, generalized pruritus, venous insufficiency, and onychomycosis. Also mentioned are treatment options such as creams with steroids, non-steroidal creams, and topical anti-fungal nail lacquers.
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Why Versicolor Appears Pale
- Tinea versicolor yeast is ubiquitous and host response determines disease.
- The yeast can produce an enzyme that inhibits pigment, making lesions appear paler with tanning.
Topical First-Line For Versicolor
- Advise ketoconazole shampoo or selenium sulfide as topical first-line therapy for tinea versicolor.
- For maintenance, recommend using the shampoo two to three times weekly to reduce recurrences.
Old Ketoconazole Sweating Trick
- Older practice: oral ketoconazole plus sweating to concentrate drug on skin could clear tinea versicolor.
- Dr. Pasieka stopped recommending it after safety warnings on oral ketoconazole emerged.