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🩺 Dermatology OPD Survival Guide - Kal ke liye Ready Ho Ja!

Yeh guide tujhe OPD mein sabse common dermatology cases ke liye tayar karti hai - presentation, diagnosis, aur prescription kaise likhni hai sab cover hai.

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PEHLE SAMAJH - OPD mein Kya Hoga?

1. Chief complaint sunna hai (itching, rash, hair fall, etc.)
2. Lesion dekh ke identify karna hai (macule? papule? vesicle?)
3. Diagnosis bolni hai
4. Parchi likhni hai - drugs + instructions

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PART 1: SKIN LESIONS KI ABC (Morphology)

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PART 2: TOP 8 CONDITIONS - OPD Mein Sabse Zyada Aate Hain

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1. TINEA (Fungal Infection) - Daad/Khaaj

• Tinea corporis - body pe ring worm
• Tinea cruris - groin/thigh area (dono side symmetric)
• Tinea pedis - paon ke fingers ke beech (athlete's foot)
• Tinea versicolor - back/chest pe light/dark patches (Malassezia - technically not tinea but)
• Tinea capitis - scalp pe (children mein zyada)
• Tinea unguium (Onychomycosis) - nail mein

• Ring-shaped lesion with raised scaly border
• Central clearing
• Itching zyada
• Active margin at periphery

Rx
1. Tab. Fluconazole 150 mg        - 1-0-0  (weekly x 4 weeks)
                        OR
   Tab. Itraconazole 200 mg       - 0-0-1  (x 2-4 weeks)

2. Clotrimazole 1% cream / Luliconazole 1% cream
                                   - Apply BD on lesion (x 4 weeks)
                                   
3. Tab. Cetirizine 10 mg          - 0-0-1  (for itching, if needed)

Advice: Dry skin, loose cotton clothes, don't share towels

Rx
1. Ketoconazole 2% shampoo        - Apply on wet skin 10 min, wash off - daily x 2 weeks
2. Tab. Fluconazole 400 mg        - Single dose (severe cases)
   OR Tab. Itraconazole 200 mg    - OD x 5-7 days

Rx
Tab. Itraconazole 200 mg - BD x 1 week, then 3 week gap (Pulse therapy)
Total: 3-4 pulses for fingernails, 5-6 pulses for toenails

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2. SCABIES - Khujli

• Nocturnal itching (raat mein zyada - hallmark)
• Burrows between fingers, wrists, genitals, areola
• Family members bhi affected hote hain

Rx
1. Permethrin 5% cream (Lyclear/Scaboma)
   - Neck se neeche poore body pe lagao raat ko
   - Subah dholo
   - 1 week baad repeat karo
   
2. Tab. Cetirizine 10 mg - 0-0-1 x 2 weeks (itching ke liye)
   (Post-scabetic itch 2-4 weeks tak reh sakti hai)

Advice: Saare kapde, bistar 60°C pe dhoo ya 3 din bahar rakh do.
        Ghar ke sabhi members ko treat karo.

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3. URTICARIA (Hives/Pitti) - Chambal

• Wheals - raised, itchy, erythematous
• Transient (< 24 hrs ek jagah)
• Dermographism ho sakta hai
• Acute < 6 weeks | Chronic > 6 weeks

Rx
1. Tab. Cetirizine 10 mg          - 0-0-1 x 2 weeks
   OR Tab. Levocetirizine 5 mg    - 0-0-1 x 2 weeks
   OR Tab. Fexofenadine 180 mg    - 0-0-1 (non-sedating, good choice)

2. (Severe/Angioedema mein)
   Tab. Prednisolone 20-40 mg     - 1-0-0 x 5 days (taper)
   
Advice: Trigger dhundho - food (fish, egg, nuts), medicines (NSAIDs, ACE-I),
        infections, stress

Rx
Tab. Fexofenadine 180 mg - OD (first line)
Titrate up to 4x dose if inadequate response (modern guideline)

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4. ACNE VULGARIS - Muhase

• Grade 1 (Comedonal): Blackheads + whiteheads only
• Grade 2 (Mild-Moderate): Comedones + papules/pustules
• Grade 3 (Moderate-Severe): Papules + pustules + nodules
• Grade 4 (Severe/Nodulocystic): Cysts + risk of scarring

Rx
1. Benzoyl Peroxide 2.5-5% gel     - Apply BD (thin layer on affected area)
2. Adapalene 0.1% gel (Adaferin)   - Apply OD at night
3. Tab. Doxycycline 100 mg         - 0-0-1 x 6-8 weeks (if papulopustular)

Advice: Oil-free, non-comedogenic moisturizer & sunscreen use karo.
        Face zyada mat dhoo (drying se acne bhadta hai).
        Squeeze mat karo.

Tab. Isotretinoin 0.5-1 mg/kg/day - (Roaccutane) - Sr. doctor likhte hain
Female mein: Pregnancy test mandatory, contraception required

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5. ECZEMA / ATOPIC DERMATITIS

• Dry, itchy skin
• Children: face, antecubital fossa, popliteal fossa
• Adults: hands, face, neck
• Lichenification (skin thickening) in chronic cases

Rx
1. Moisturizer (Cetaphil / Vaseline / Coconut oil) - Apply generously 2-3x/day
2. Hydrocortisone 1% cream         - Apply BD on affected areas x 1-2 weeks
   OR Betamethasone 0.1% cream     - BD on body (NOT face)
   OR Mometasone 0.1% cream        - OD on body
3. Tab. Cetirizine 10 mg           - 0-0-1 x 2 weeks (itching)

Advice: Mild soap use karo, long bath avoid, cotton clothes pehno.
        FACE pe potent steroid mat lagao.

• Face/Intertriginous areas: Hydrocortisone 1% (weakest) ya Desonide
• Body: Betamethasone 0.1% / Mometasone 0.1%
• Palms/Soles: Clobetasol 0.05% (strongest)

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6. PSORIASIS - Safed Daag (NOT vitiligo!)

• Well-defined plaques with silvery scales
• Extensor surfaces: elbows, knees, scalp, lower back
• Auspitz sign - pinpoint bleeding on removing scale
• Candle sign - scale comes off like candle wax

Rx
1. Coal tar 2-5% ointment          - Apply OD/BD (scalp + body plaques)
   OR Salicylic acid 3-6% ointment - Apply BD (descaling)
2. Betamethasone 0.1% + Salicylic acid (Betasalic ointment) - OD/BD
3. Calcipotriol 0.005% cream       - Apply BD (Vit D analog)
4. Tab. Cetirizine 10 mg           - 0-0-1 (if itchy)

Note: Severe/extensive - Refer for Methotrexate / Biologics

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7. CONTACT DERMATITIS

• Irritant CD: Chemical se (soap, detergent, cement) - most common
• Allergic CD: Allergen se (nickel jewellery, hair dye - PPD)

• Redness, vesicles, weeping at contact site
• Housewife's hands - classic

Rx
1. Avoidance of allergen/irritant  - Most important!
2. Betamethasone 0.1% cream        - BD x 1-2 weeks (wet/oozing: lotion form)
   (Oozing lesion mein: Normal saline wet dressing first)
3. Tab. Cetirizine 10 mg           - 0-0-1 x 2 weeks
4. Bland moisturizer               - liberally after resolution

Advice: Rubber gloves pehno kaam karte waqt, mild soap use karo

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8. VITILIGO - Safed Daag (autoimmune)

• Well-defined chalk-white patches (milk-white)
• Wood's lamp pe brilliant white fluorescence
• NO scaling, NO itching
• Any body part - lips, genitals, around eyes (perilesional areas first)

Rx
1. Betamethasone 0.1% cream        - Apply OD (on patches, NOT face)
   OR Mometasone 0.1% cream        - OD
2. Tacrolimus 0.1% ointment        - BD (for face/genitals - steroid sparing)
3. Tab. Levamisole 150 mg          - 2 days/week (immunomodulator - often used in India)
4. Sunscreen SPF 30+               - Apply on patches before going out

Advice: Ye ek autoimmune disease hai. Slow response hoti hai (months).
        PUVA/NB-UVB phototherapy refer karo for extensive cases.

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PART 3: PARCHI LIKHNE KA FORMAT

Pt. Name: _______     Age/Sex: ___     Date: ___
D/O: _______________  (diagnosis)

Rx
1. [Drug name + strength]    [Route]    [Dose timing]    [Duration]
2. [Drug name + strength]    [Route]    [Dose timing]    [Duration]
...

Advice:
- _______
- _______

Follow-up: ___ weeks / Review if worsening

                                        Signature

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PART 4: SIR POOCH SAKTE HAIN YEH QUESTIONS - READY RAH

• "Yeh lesion primary hai ya secondary?"
• "Distribution kya hai? Bilateral symmetric hai?"
• "Lesion ke border sharp hain ya ill-defined?"
• "Scale hai? Hain toh silvery hai ya fine?"
• "Wood's lamp use karte hain kyun?"

• Tinea = Active elevated border + central clearing
• Psoriasis = Auspitz sign, extensor surface, well-defined
• Vitiligo = No itching, milk-white, Wood's lamp brilliant white
• Scabies = Nocturnal itch, family members affected, burrows in web spaces
• Pityriasis versicolor = Pale/hypopigmented patches on back/chest, young adults, KOH shows "spaghetti and meatballs"

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PART 5: QUICK DRUG REFERENCE CARD

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QUICK TIPS - LAST MIN REVISION

1. Topical steroid FACE pe potent wala mat lagao - sir zaroor poochha karte hain
2. Scabies mein poore body pe lagao (neck se neeche), sirf rash pe nahi
3. Tinea aur Eczema alag hote hain - tinea mein active border, eczema mein ill-defined
4. Urticaria transient hoti hai - ek jagah se 24 hrs mein hat jaati hai (key feature)
5. Acne mein antibiotics ke saath topical retinoid dono milao for best results
6. Vitiligo ko Leucoderma bhi bolte hain - autoimmune, curable nahi easily

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