Workshop: Facial Eruptions

Question 1

• Acne Vulgaris
• Rosacea • Folliculitis
• Peri-orificial
Dermatitis • Lupus
Erythematosus
LM Parsons ©

Answer 1

see some pustules and comedones. blockages in pores definitely seen. • Acne Vulgaris

Question 2

comedones: blockages in pores in ____ that is full of:

Answer 2

blockages in pores in osteum, full of sebum, keratin, and bacteira

Question 3

how is acne vulagris classified?

Answer 3

1. sebaceous/comedonal
2. papulo/pustular
3. cystic
4. nodular

Question 4

what major sequelae of acne vulgaris is illustrated here?

Answer 4

scarring– dimpling and dells seen.

Question 5

what are your initial treatment recommendations

Answer 5

1. topical: retinol, possible lifestyle modification
2. systemic therpay: would help the cysts but not the blackhead
3. oral tetracycline 6-12 weeks

Question 6

t/f systemic therapy like abx will help with comedones

Answer 6

false. wont help the blackheads but woould hlep the cystic/nodulese

Question 7

a patient with the first picture was given oral tetracyclie for 3 months. afterwards, it looks like the below picture. what are reasonable “next steps” for therapeutic recommendations?

Answer 7

it looks worse– there are more pustules and there for it’s likely oral tetracycline has not helped.

two choices:

1. oral isotretinoid/accutaine
2. 2nd antibiotic with erythromycin, but theres a lower chance of success.

Question 8

what is your most likely diagnosis?

• Atopic Dermatitis

• Seborrheic Dermatitis
• Psoriasis
• Lupus erythematosus
• Allergic Contact Dermatitis

Answer 8

• Seborrheic Dermatitis

Question 9

What is your most likely diagnosis?

Where else might you look for clues to the diagnosis?

Answer 9

could be seborrheic dermatitis or psoriasis. there are erythematous plaques with scale and scalp involvemnet– very like psoriasis or “sebo psoriasis”

I would look at the nails to see if oil drop sign, hyperkeratosis, pitting or onycholysis is happening. also would look to see if there was nasolabila fold involvement (THE MOST COMMON SEBORRHEIC DERMATITIS SITE), as well as extensor surfaces of elbows or knees.

Question 11

what is the most likely diagnosis? Why is it not lupus?

Answer 11

psoriasis.

not seb derm because there is decreased oil production in the eyelid. it’s not lupus because upper eyelid is photoprotected.

Question 12

Where else might you look for clues to the diagnosis?

Answer 12

CHRONIC LUPUS WITH CLASSIC DISCOID LESIONS. htere is a loss of hair and scarring, the only thing that scars spontaenously is lupus.

Question 13

the only lesion that scars spontaenously is :

Answer 13

, the only thing that scars spontaenously is lupus

Question 14

What is your description of this lesion?

Answer 14

erythematous annular plaques with raised borders. rolled up edges with a bit more central of a clearing. hyper pigmentation noted. looks like a tinea infection or psoriasis. do a fungal scraping.

Question 15

Which clinical photo best represents Rosacea?

Answer 15

The last picture

the first is acne vulgaris

the second is peri-orificial dermatitis (note the lip sparing)

Question 16

List 3 clinical features of Rosacea seen here

Answer 16

1. plaque
2. telangiectasia
3. conjunctival involvement
   - there is also soft tissue sebaceous hyperplasua (common in the nose)

Question 17

List 3 conditions in the differential diagnosis of this condition

Answer 17

small raised erythematous papules, possibly pruritic and become erosion.

• peri-orificial dermatitis rosacea

Question 18

Which stage of Rosacea is represented
by each photo?

Answer 18

A. papulopustular acnerosacea

B. ocular

C. phymatous

D. erythematotelangiectasia