Some Otitis Externa Reminders

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As usual, as the weather warms and swimming increases, otitis externa ramps up. The above is an excellent article updating suggestions for otitis externa. The article is from the American Family Physician. Some pearls are:
1. While rare, always be on the lookout for malignant otitis externa, which is a medical emergency and needs the hospital/emergency room. The "prototype" patient is a middle aged poorly controlled type 2 diabetic. However, be on the alert for any immunosupressed, febrile patient with a "severe" otitis externa. In cases where you judge the issue to not need ER evaluation and CT scan, consider documenting in your note "no tenderness on mastoid palpation."
2. Don't forget the aural cotricosteroids (along with the appropriate antibiotics) to lessen pain and inflammation.
3. I also suggest reminding concerned parents they can assist with acetaminophen or ibuprofen.
4. On your discharge instructions, remind the patient to use a cotton ball/ear plugs to keep the ear totally dry- except for your prescription drops- to speed healing.
  

A Practical Derm Pearl

     Make no mistake, steroid creams of varying potency are a mainstay in urgent care rash treatment. Knowing the exact amount of cream/ointment to prescribe for though, can be a bit of a 'guessing game."  Too much, and you risk an overzealous patient using the cream 6 months later on their jock itch (We have met the enemy-it is ourself.). Too little leads to needless patient suffering, extra trips to the pharmacy, and even more copays. Below is a table, based on body region, estimating the necessary amount of topical steroid needed to cover a 2 week period. ENJOY!

Estimating the Necessary Amount of Topical Corticosteroid for Adults

                        Area                                            Amount Needed for BID dosing x 2wks 

                Face and Neck                                                       36g

                Trunk (front and back)                                        186g

                One Arm                                                                48g

                One Hand                                                               17g

                One Leg                                                                  81g

                One Foot                                                                25g

(Source:Long CC, Finlay AY. The Finger Tip Unit-A New Practical Measure. Clinical Exp Dermatology 1991; 16(6):444-447.)