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Acne Rosacea

• Chronic inflammation can cause skin disorder with immune and vascular dysfunction
• Does not involve comedones, also known as blackheads or whiteheads

Symptoms of Acne Rosacea

• Facial flushing occurs independently of temperature changes
• Persistent redness and visible blood vessels, known as telangiectasia
• Possible history of acne or sensitivity to skincare products
• Presence of fluid-filled bumps also known as papules and pustules on the face

Objective Findings of Acne Rosacea

• Facial erythema often has looks like a butterfly pattern
• Inflammatory papules and pustules are present without comedones
• Watery, irritated eyes indicate potential ocular rosacea

Risk Factors for Acne Rosacea

• Individuals with fair skin types, Fitzpatrick I-II
• Individuals of Asian descent
• Genetic predisposition or family history

Differential Diagnoses for Acne Rosacea

• Adult acne vulgaris
• Seborrheic dermatitis
• Photodermatitis

Treatment and Management of Acne Rosacea

• Goal is reduce inflammation and manage symptoms
• Follow a gentle skincare routine
• Avoid known triggers like spicy foods, hot beverages, and sun exposure

Pharmaceutical Interventions for Acne Rosacea

• Topical medications used are prescribed such as metronidazole (0.75% gel, cream, or lotion) or azelaic acid (15% gel, 20% cream), brimonidine (.33% gel), sulfacetamide sodium/sulfur (sulfacetamide 10% with sulfur 5-10% in creams, lotions, or washes)
• Oral medications used are ABX: erythromycin, clindamycin, doxycycline, minocycline
• Accutane is only prescribed by dermatology, teratogenic

Preventative Care for Acne Rosacea

• Consists of trigger avoidance
• Adherence to treatment plans
• Routine follow-ups

Related Information for Acne Rosacea

• Ocular rosacea causes symptoms involving the eyes, leads to redness, irritation, and blurred vision, refer patients to ophthalmology and untreated ocular rosacea can lead to vision loss
• Rosacea can significantly affect self-esteem and mental health, so consider referring patients to mental health providers

Acne Vulgaris

• Inflammatory disorder of the pilosebaceous follicles, hair follicles with associated oil glands

Symptoms of Acne Vulgaris

• Bumps on the face, chest, back, and shoulders
• Lesions that range from blackheads and whiteheads to painful cystic nodules

Objective Findings of Acne Vulgaris

• Comedones, papules, pustules, and nodules are often found on the face, back, and shoulders
• Scarring can occur, especially with cystic lesions

Risk Factors for Acne Vulgaris

• Genetic predisposition
• Hormonal changes like during puberty, menstruation

Other Factors for Acne Vulgaris

• Certain medications such as steroids or lithium
• Environmental factors like less sunlight exposure, stress
• Facial products, such as comedogenic makeup and skincare

Differential Diagnoses for Acne Vulgaris

• Milia with small cysts
• Sebaceous hyperplasia
• Rosacea note no comedones
• Folliculitis
• Fungal infections

Treatment and Management of Acne Vulgaris

• Topical treatments for mild to moderate acne includes salicylic acid, benzoyl peroxide, retinoids tretinoin, adapalene, ABX clindamycin, erythromycin, azelaic acid finacea, Azelex
• Oral treatments for moderate to severe acne involves ABX for inflammatory acne doxycycline, minocycline, clinda, contraceptives, hormonal acne, estrogen and progesterone combo needed
• The progesterone would only make symptoms worse
• Isotretinoin for severe, cystic acne like accutane is teratogenic and only prescribed by dermatology only

Preventative Care for Acne Vulgaris

• Consistency is crucial, acne treatment takes time often weeks or months
• Identify triggers, such as stress, diet, and product choices, affects acne severity
• Avoid picking or squeezing, this can worsen inflammation and lead to scarring
• Follow-up visits are essential to adjust treatments and prevent complications

Complications of Acne Vulgaris

• Scarring and Keloids are common to severe or untreated cases
• Medication side effects
• Oral antibiotics can cause GI issues or photosensitivity
• Hormonal treatments have a risk of DVT or hyperkalemia

Bacterial Infection, Cellulitis

• Acute, spreading infection of dermal subcutaneous tissues
• Commonly caused by streptococcus bacteria, specifically group A or B hemolytic streptococci

Symptoms of Cellulitis

• Redness, pain, swelling, and warmth in affected area
• May experience fever, chills, and general malaise if the infection becomes systemic
• Inquire about recent injuries, cuts, or other skin breaches that could've allowed bacteria to enter

Objective Findings of Cellulitis

• Unilateral one-sided involvement, most commonly on a limb
• Redness also known as erythema , warmth, swelling, and tenderness
• Drainage from the area or the skin could appear shiny and tight due to swelling, in some cases
• Patients may present with a fever, indicating systemic involvement
• Assess for signs of a deeper injection, like abscess formation or necrotizing fasciitis

Risk Factors for Cellulitis

• Immunocompromised, such as diabetes, HIV, or on immunosuppressive therapy
• Obesity
• Any condition causing for circulation, hardware in the body, like plates or screws

Differential Diagnoses for Cellulitis

• Deep vein thrombosis DVT, both conditions can cause redness, swelling, and pain, especially in the legs
• Superficial venous thrombosis
• Osteomyelitis bone infection, the go big or go home infection to the bone
• The plastic disease, skin cancers or other growths could present similarly
• Contact dermatitis is sometimes confused with cellulitis due to similar erythema and swelling

Treatment and Management of Cellulitis

• Systemic abx are the mainstay of therapy, cephalexin, keflex for mild to moderate cellulitis, clindamycin for underneath MRSA abscess, augmentin
• Non-Pharmaceutical for rest, elevation of affected limb, applying compression if appropriate to reduce swelling

Patient Education for Cellulitis

• Emphasize the importance of completing the full course of antibiotics, even if symptoms improves, otherwise, client risks recurrence
• Teach about how to recognize warning signs of worsening infection, critical to refer the patient to a specialist if symptoms don't improve or worsen

Preventative Care for Cellulitis

• Complete the entire course of antibiotics, even if symptoms improve, stopping early can lead to recurrence Keep affected area clean and elevated, reduces swelling Monitor for signs of worsening infection; if the redness spreads and the swelling increases or fever develops, seek immediate care
• Prevents future skin infections like proper wound care and managing underlying conditions like diabetes and obesity that might predispose them to cellulitis

Complications of Cellulitis

• Systemic sepsis; Infection spreads to the bloodstream, potentially life-threatening conditions
• Osteomyelitis; Infection spreads the bone Periorbital cellulitis; cellulitis occurs, leading to blindness/brain damage, requiring immediate referral

Dermatitis Allergic, Rhus Dermatitis, Irritant

• Occurs when the skin reacts to a specific allergen like poison ivy, resulting in a localized reaction only where the allergen contacted the skin

Symptoms of Dermatitis

• Intense pruritus
• Severe reactions leads to stinging/pain

Objective Findings of Dermatitis

• Well-demarcated erythema, edema with superimposed closely spaced papules nonumbilicated vesicles
• Severe reactions; bullae, confluent erosions exuding serum, crusts
• Plaques of mild erythema showing small, dry scales
• Small, red, pointed, rounded erythematous firm papules and scales

Risk Factors for Dermatitis

• Differential diagnoses: atopic dermatitis, seborrheic dermatitis, psoriasis, epidermal dermatophytosis, fixed drug eruption, phytophotodermatitis

Treatment and Management of Dermatitis

• Identify and remove the etiologic agent
• Topical glucocorticoid ointments/gels classes I-III
• Larger vesicles may be drained, BUT TOPS SHOULD not be removed
• Wet dressings cloths soaked in Burow's solution changed every 2-3 HOURS

Further Treatments for Dermatitis

• Glucocorticoids are indicated If severe and in airborne ACD
• Prednisone beginning at 1 mg/kg, tapering over 2-3 week period
• Allergen avoidance through preventative care

Dermatitis Atopic, Eczema

• Chronic inflammatory skin condition causes cycles of exacerbations and remissions Mediated condition primarily driven by a histamine response

The Skin Barrier During Eczema

• Impaired, allowing allergens and irritants to penetrate more easily, that leads to inflammation, itching, and rash Found in areas where the skin folds, such as elbows, knees, under the breasts

Symptoms of Dermatitis, Eczema

• Dry, itchy patches on the skin are accompanied by crusting or oozing
• Chronically affected can develope thicken skin
• Often severe and can disrupt sleep

Objective Findings of Dermatitis, Eczema

• Diffuse rashes
• Linear excoriations and scaling or crusting in affected areas are found on the upper extremities

Risk Factors for Dermatitis, Eczema

• Asthma
• Food allergies
• Frequent exposure to irritants

Differential Diagnoses for Dermatitis, Eczema

• Fungal infections
• Parasitic infections like scabies
• Immune deficiencies

Treatment and Management of Dermatitis, Eczema

• Topical steroids low and high potency, oral steroids

Preventative Care for Dermatitis, Eczema

• Avoid triggers
• Use gentle moisturizers regularly
• Start treatment at the first sign of a flare up

Irritant Dermatitis

• Caused by substances that break down the skin's protective barrier, like harsh detergents/ frequent handwashing

Symptoms of Irritant Dermatitis

• Burning, stinging, smarting, and itching Pain occurs as fissures develop

Objective Findings of Irritant Dermatitis

• Dryness, chapping
• Erythema
• Hyperkeratosis and scaling
• Fissures and crusting
• Sharp margination gives way to ill-defined borders/lichenification

Risk Factors Irritant Dermatitis

• Atopy
• Fair skin
• Low temp
• Low humidity climate Occulsion
• Mechanical irritation
• Individual engaged medical, dental, cleaning floral, working,engineering

Differential Diagnoses of Irritant Dermatitis

• Allergic contact dermatitis Palmoplantar psoriasis Photoallergic contact dermatitis

Treatment and Management of Irritant Dermatitis

• Identify and remove the etiologic agent
• Apply wet dressings with burow's solution, changed every 2-3 hours
• Topical class I-II blucocorticoid preparations
• In severe cases, systemic glucocorticoids may indicated
• prednisone taper over 2-3 weeks, starting at 1 mg/Kg

Preventative Care for Irritant Dermatitis

• Avoid irritant/caustic chemical(s) by wearing protective gear
• Wash with water or weak neutralizing solution, if contact occurs

Herpes Oral

• Double STRANDED DNA virus
• HSV-1 is responsible for cold sores

HSV

• HSV-2 is associated with herpes, both can affect either the oral or genital areas Patient Feels that telling signs or itching before the blisters appear crust and scales • PAINFUL, Weepy BLISTErs

Risk Factors of Herpes Oral

women have a higher seroprevalence than men HSV-2 antibodies start to develop during puberty and correlate with the onset of sexual ACTIVITY

Differential Diagnoses of Herpes Oral

• Erythema multiforme • IMPETIGO • varicella • Herpes zoster • acyclovir or helps reduce and severity

Herpes Zoster, Shingles

• Dermatologic eruption caused by the Reactivation of the VZV THAT FOLLOWS, sometimes by decades, a primary varicella-zoster (CHICKENPOX) INFECTION
• PAINFUL, ITCHY rash with clusters of Blisters • Burning, stabbing, or aching pain • rash is unilateral and Follows a dermatoме • Fever WITH INITIAL OUTBreak

Objective Findings of Herpes Zoster

• CLUSTERS OF Clear vesicles • Tender To The TOUCH • FOLLOWS THE Path of a single dermatome WHAT ARE RISK FACTORS? • Younger people are prone to reactivation • IMMUNOSuppression: CONDITIONs Like HIV or diabetes • Treatment may more likely History of varicella Infection priors

Differential Diagnoses of Herpes Zoster

• Allergic DermailITIS • Dermatitis HerpetIFORMIS • contact dermatitis • coxsackievirus INFECTION

Dermatitis Treatment and Management of Herpes Zoster

• Antiviral medications ACYCLovir or valacyclovir First-Line Treatments, Pain Medication or other Treatments as needed It's very important to educate Early Prevention