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S2 E040 Derm Part 3

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Acne Vulgaris

  • Obstruction and inflammation of hair follicles and sebaceous glands
  • The most common skin disease affecting 80% of the US population
  • Sebum is an oily secretion from the sebaceous glands
  • How it happens
    • Follicles get clogged with sebum and keratinocytes
    • Follicles are colonized by Propionibacterium acnes which is a normal human anaerobe
    • Inflammation occurs

Clinical Presentation

  • Comedones
    • Blackheads ( open comedones)
    • Whiteheads (closed comedones)
  • Papules
  • Pustules
  • Cysts

Labs
Typically it is not necessary, but the following hormone levels might be useful.

  • Testosterone
  • FSH
  • LH
  • DHEA

Diagnosis

  • The diagnosis is made clinically

Treatment

  • Consider oral contraceptives
  • Mild cases
    • Keep skin clean, but not dried out. Wash twice a day but avoid over washing
    • Some data shows worsening symptoms with a diet high in sugar and milk products
  • Moderate cases
    • Topical retinoids
    • Topical azelaic acid
    • Topical benzoyl peroxide
    • Topical antibiotic
  • More severe cases
    • The addition of an antibiotic may be necessary
      • Tetracycline is the historical favorite
      • Erythromycin
      • Clindamycin
    • Isotretinoin (Accutane)
      • May only be prescribed by a dermatologist with special approval due to the possibility of severe side effects. These Include dry eyes and mouth, mood swings, joint pains, visual changes, leukopenia. Accutane is teratogenic..

Acne Rosacea

  • A chronic inflammatory skin issue typically affecting caucasian female between 30 and 50.
  • Males are less likely to get it, but have worse symptoms when they do.
  • Periods of outbreaks and remission

Clinical Presentation

  • Face appears flushed
  • Small papulopustules
  • Facial telangiectasia
  • Rhinophyma (enlarged nose) may be seen

Diagnosis
Diagnosis is made clinically

Treatment

  • Step one is to remove aggravating events which include
    • Sun exposure
    • Emotional stress
    • Heat both weather and food
    • Heavy exercise
    • Alcohol consumption
  • For a more severe case
    • Topical antibiotics
      • Clindamycin, erythromycin
    • Topical Metronidazole
  • Very severe cases
    • Oral antibiotics
      • Doxycycline
      • Tetracycline
    • Isotretinoin (Accutane)

Folliculitis

  • Infection of the hair follicle by any number of different pathogens
    • Bacterial
      • Staph Aureus is the most common cause
      • Pseudomonas
    • Viral
    • Fungal
    • Parasite

Clinical Presentation

  • Pustule
  • Perifollicular inflammation

Treatment

  • Often self limiting
  • Clindamycin lotion
    • Treats Staph infection

**Actinic Keratosis (Solar Keratosis) **

  • A premalignancy left untreated 20% will go on to squamous cell carcinoma
  • Associated with sun exposure

Clinical Presentation

  • 2–10 mm macules or papules
  • Pink or hyperpigmented
  • Feels like sandpaper

Labs and Studies
– A biopsy may be necessary for diagnosis but this is usually done after treatment fails

Treatment

  • Prevention
    • Avoid over sun exposure
  • Cryotherapy or electrocautery
  • Phototherapy
  • Topical 5-FU

Seborrheic Keratosis*

  • A benign, usually brown pigmented lesion
  • Numbers increase with age
  • Variable size and slow growing
  • The lesions have a WAXY STUCK ON appearance
  • No treatment is necessary, but they bay be removed

Study tip
Know your key terms

 

<< Click here to get 26 Derm questions straight from my book, The Final Step >>