Module 1 Flashcards
most common skin condition in USA
acne vulgaris
Acne vulgaris has the highest incidence among individuals aged
12 to 25 years, with incidence peaking at 15 years of age.
closed comedones
(“whiteheads”
open comedones
blackheads
Although androgen excess may lead to acne formation
, most individuals with acne do not overproduce androgens. However, their pilosebaceous glands are likely hypersensitive to these hormones and more prone to retention hyperkeratosis
mild acne
, lesions are primarily noninflammatory comedones with occasional small papules.
face, chest, neck
moderate acne
, lesions are mainly inflammatory lesions such as papules and pustules. The papules range in size from a few millimeters to one-half centimeter. The color of the acne papules in light-skinned patients ranges from light pink to bright red.
Scarring is more likely with
larger and deeper pustules
severe acne
severe acne, or nodulocystic acne, lesions are mainly nodules and cysts. This form of acne always results in scar formation
more common in males
acne conglobat
a is severe cystic acne in which nodules, cysts, and abscesses develop; lesions are predominantly located on the trunk area instead of the face. Females with acne conglobata should be evaluated for polycystic ovary syndrome (PCOS)
acne fulminan
s is rare and is seen in young adolescent males. This condition is characterized by acute onset of multiple painful, ulcerated acne lesions, along with systemic symptoms such as fever, chills, malaise, and generalized joint and muscle aches.
rosacea
Rosacea, previously termed “acne rosacea,” should be ruled out. Rosacea is more common in adults and older patients and is located more centrally on the face, cheeks, chin, and nose. Comedones are never found in rosacea. There is a tendency for easy flushing in response to alcohol or heat. Telangiectasias (dilations of small groups of superficial blood vessels) may be present at the skin surface. Rosacea can be accompanied by eye complaints such as excessive dryness and irritation, and it is more common in patients of Irish, Scottish, or English descent.
hot tub folliculitis
“hot tub folliculitis” (folliculitis lesions caused by Staphylococci), which appears within 1 to 4 days after hot tub use, due to insufficient temperature and inadequate chlorination of the water. Patients will complain of small red pustules that are occasionally pruritic. Folliculitis is located on the areas of the body that were immersed in the water, such as the lower torso, buttocks, and legs.
primary goal of acne treatment
is to prevent and/or minimize scarring and permanent pigmentation changes
topical tx for comedonal acne
topical retinoids (Retin-A)
dryness, erythema, scaling
topical tx inflammatory acne
topical abx
applied once-twice daily, refrigerate when stored
Systemic Antibiotic and Hormonal Treatment of Moderate to Severe Acne
if have not responded to topical meds x2-3 months
moderate-severe
doxycycline, minocycline
doxycycline
take with full glass of water
se: photosensitive, GI upset
do not take with antacids, dairy product, iron vitamins
severe acne tx
derm referral
tretinoin tx
0.5mg/kg daily in two divided doses, increase gradually
SE: dry skin, hypertriglyceridemia
acne f/u
every 4-6 weeks to evalaute response
Rosacea is characterized by flare-ups that include three cutaneous components
the first component is vascular in nature, with persistent erythema that primarily involves the central face
he second component is cutaneous and involves the development of recurrent acneiform, erythematous papules and pustules around the central face. The third component consists of connective tissue hyperplasia around the central face with discrete sebaceous gland hyperplasia, consisting of persistent yellow papules particularly around the nose
rosacea tx
metronidazole cream, may take 6-8 weeks to work
ABX if flare (tetracycline, minocycline, doxycycline)
Seborrheic keratosis
is one of the most common noncancerous skin growths seen in older adults. It is characterized by benign, warty-appearing growths that are usually found on the trunk, but they may also be seen on the hands and face. They develop in both sun-exposed and sun-protected areas