The skin

There is 2 types of acne:

1. Acne Vulgaris
   
2. Acne Rosacae

Acne Vulgaris

Symptoms

• Seborrhoea ( too much oil on the skin)
  
• Comedones ( blackheads)
  
• inflammation
  
• papules. ( small inflamed elevation of skin) . pustules or nodules
  
• Tenderness
• scaring
  

Cause

• at puberty: pilsoebaceoous gland increase sebum in response to testosterone ( males and female do produce testosterone but males produce more - so it effects more in men)
  
• flow of shedding.
  

- increased keratin and sebum production during adolescence are thought to be important contributory factors

- the increased amount of keratin leads to blockages of the follicles and the formation of microcomedones.

- the microcomedones can develop into a non-inflammatory lesion (comedone) , which may be open (blackhead) or closed ( whitehead) or into an inflammatory lesion( papule, pustule or nodule) .

- excess sebum encourages the growth of bacteria , particularly propionibacterium acnes, which are involved in the development of inflammatory lesions.

Management

- The general aim of therapy are to remove follicular plugs so that sebum is able to flow freely and to reduce the number of bacteria on the skin.

- therefore reduce comedone formation

- lotions, creams and gels ( gels with an alcoholic base dry quickly but can be irritating. those with aqueous base dry shower but are less likely to irritate the skin.) comedogenic moistuiser.

Benzoyl peroxide (BP)

• has both antibacterial and anticomedogenic actions and is the 1st-line OTC treatment for inflammatory and no inflammatory acne.
  
• Antiflammatory action occurs at all strengths but anticomedogenic action is low and has the greatest effect at higher strengths.
  
• it has a keratolytic action, which increases the turnover of skin cells, helping the skin to peel.
  
• Regular application can result improvement of mild acne.
  

1. BP is very like to produce reddening and soreness of the skin. and patient should be warned of this.
   
2. so, treatment should start with a 2.5 or 5%product. moving gradually to 10% strength if needed.
   
3. Oily skin: Gels
   
4. Dry skin: Creams
5. Washing the skin with a mild soap or cleansing help by reducing the amount of sebum on the skin.
   
6. BP prevents new lesions forming rather than shrinking existing area. Therefore it needs to apply on the whole of affected area. and it is best to apply after washing.
7. first use: the skin is like to redden and sore. Stinging, drying and peeling to occur. - lowest strength preparation to begin and to apply cream, lotion...on the first week of treatment.
   
8. Application once daily or on alternate day could be tried for a week and then frequency of use increased to twice daily. After 2 or 3 weeks, a higher strength preparation may be introduced. if irritant affects do not improve after 1 week or are severe. Discontinued.

Acne rosacae

- over 40s
-broken blood vessels


Fungal skin infection

- caused by Tinea

Types:

1. T.Pedis
   
2. T.cruris
   
3. T. corporis
   
4. T. unguium
   
5. T. capitis
   

- Dermatophytes invade stratum corneum ( not living tissus)
- Intertrigo ( rash in skin fold)

T.Corporis : anywhere on the body. Red edge , satellite spots surrounding and clearance in the middle.

T. pedis : affects toe webs- bits in between the toes.

T. Cruris: Affects the groin.

Treatment

• Benzoic acid ( + salicylic acid= Whitefield's ointment)
• Undecanoates
  
• tolnaftate -less evidence
  
• imidazoles
  
• Allyamines
  
• Canesten HC ( with hydrocortisone 1%)
  
• Griseofulvin (1%) spray
  

Onychomycosis

• Amorolfine (OTC)
  
• use weekly
• take 8-12 weeks
  
• Curanail - 3 months treatment and 2 nails only
  

Dry skin

• use emolients
• Apply 4 times a day + after bathing
  

Eczema

• Irritant contact dematitis
  
• Allergic contact dermatitis
  
• Atopic eczema

Treatment

Hydrocortisone ( 0.1 and 1% OTC and 0.25% with crotamiton)

• mild topical steroid
  
• over 10 years of age only
• contact and allergic dermatitis and mild to moderate eczema
  
• Apply sparingly once or twice a day
  
• Max 7 days
  

Clobetasone

• NB Chobetasone butyrate 0.05%
  
• Moderately potent steroid
  
• over 12 years of age only
  
• contact and allergic dermatitis and mild to moderate eczema
• Apply sparingly twice a day
  
• Max 7 days
  

Warts / verrucae
- Growths of the skin caused by human papilloma virus (HPV)
- Verrucae: warts on the foot. Plantar warts

Refer:

• Eczema or broken skin
  
• facila or anogenital
• Diabetic / poor circulation
  
• large area affected
  

Treatment

• 1st line: Salicylic acid for 12 weeks
  
• 2nd line: Gluteraldehyde. formaldehyde

Corns ( Helomas ) and calluses
- caused by friction and pressure ( hyperkeratoses )
- corns: against bony prominences
- hard corns : top tops
- soft corns: between toes, macerated

Calluses: Flattened yellowed white hardened skin

Treatment

• relieve pressure and friction
• shoes that fit
  
• cushioning
  
• Keratolytics
  

Bunions
- caused by inappriate footwears ( sky-high heels etc)

Cold Sores

- infection caused by herpes simplex virus type 1 ( HSV)
- after primary contact virus lays dormant in root nerve
Triggers:
- sunlight
- cold weather
- infection
- menstruation

• start as burning, pricking, tingling
  
• then a painful blisters develop
  
• scab over in a couple of days
  

Treatment

Aciclovir 2% cream
Penciclovir 1% ( fenistill )

• they inhibit HSV DNA polymerase
  
• if applied at prodromal stage can reduce healing time by day.
  

Aciclovir

• apply 5 times a day for 5 days
  

Penciclovir :

• 2 hourly for 4 days