Skin

Question 1

Acne treatment

Answer 1

Treatment Plan

Topical retinoids are first-line treatment therapy for comedonal acne.
Topical retinoids (e.g., retinol, tretinoin, adapalene, tazarotene) are effective in both noninflammatory (comedones) and inflammatory (papules, pustules) acne. They come in cream, gel, or solution.

Topical retinoids can be used alone in mild acne.
-With inflammatory acne, a topical retinoid can be used with a topical antimicrobial (benzoyl peroxide, erythromycin, clindamycin).
-If no improvement, add oral antibiotics (tetracycline, minocycline, doxycycline, erythromycin) at a limited duration of 3 to 4 weeks. Use with topical benzoyl peroxide to increase effectiveness.
Tetracyclines can be given for acne from age 13, as growth of permanent teeth is finished except wisdom teeth (or third molars), which erupt between the ages of 17 and 25 years; tooth discoloration is not a consideration.
Tetracyclines (Category D): Cause permanent discoloration of growing tooth enamel. Not given during pregnancy or to children younger than age 13.
-Certain oral contraceptives (Desogen, Yaz) are indicated for acne.
Role of diet: Limited evidence that some types of dairy (e.g., skim milk) may affect acne.

Question 2

well-demarcated, verrucous, flat -topped brown or pink papule (rubbery texture) with a stuck-on appearance, usually asymptomatic but can be pruritic or tender when irritated

Answer 2

seborrheic keratosis

Question 3

scaly papule with erythematous base

Answer 3

actinic keratosis

Question 4

slow growing papule or nodule with pearly rolled boarder and overlying telangiectasia, ulceration is common as is bleeding following minor trauma

Answer 4

basal cell carcinoma