Acne

Definition

Acne is defined as a skin disorder resulting from the blockage of hair follicles in the skin. Excess cells produced in the follicle combine with sebum, an oily substances secreted by gland connected to the follicle. When a plus forms in the follicles and it is infected with bacteria then a pimple erupts. The bacteria then secret various chemicals than prompt an inflammatory response from the immune system.

Acne commonly associated with teenagers even it can occur in children, adult and women on the time of menopause. It is mostly appear on the parts of the body with the largest number of hair follicles such as face, chest, upper back and upper arms. Some of acne are mild while others are severe.The less severe from consist of comedones, which are hair follicles blocked by plugs of sebum.

Based on the data from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), about 80 percent of United States people develop acne at between the ages of eleven and thirty. Boys are more likely than girls to develop acne during adolescence while among adult, women are more likely than men. Some older women are troubled by acne during menopause.

Cause and Symptoms

• Acne is resulted from the interaction of four factors that are most common in adolescence even they can occur in adult as well. They are:
• Androgens, hormones produced by the adrenal gland present in women and men.
• Propionibacterium acnes, normally live on the skin to grow inside the follicle.
• Chemicals produce by the bacteria that trigger an inflammatory response.
• White blood cells.

Risk Factors:

1. Heredity
2. Changes in the body's hormonal levels such as in pregnant women, early menopause, teenagers, and on menstrual period.
3. Exposure to greasy or oily substances.
4. Clothing or athletic equipment such as backpacks, shoulder straps, helmets, headsets, etc.
5. Climate, especially in humidity or high level of air pollution.

Diagnosis
The diagnose is based on the appearance of the skin.

Treatment

There are one or more of four way for acne treatment:

1. Lowering production of sebum
2. Speeding up the removal of dead skin cells
3. Fighting bacterial infection
4. Reducing skin's inflammatory response to infection

Some medications are topical, applied to the skin, while others are taken by mouth. Some can be purchased over the counter but others require a prescription from medical doctor. The treatments are depend on the severity of the acne, the extend of scarring and the possibility of side effects for specific patients.

Verrucae (warts)

Verrucae (warts) is A flesh-colored growth characterized by circumscribed hypertrophy of the papillae of the corium, with thickening of the malpighian, granular, and keratin layers of the epidermis, caused by human papilloma virus; also applied to epidermal verrucous tumors of nonviral etiology

Treatments:

• Salicylic acid
• Liquid nitrogen

Varicella Zoster

Herpes zoster is an infection caused by a herpes virus (varicella-zoster virus), characterized by an eruption of groups of vesicles on one side of the body following the course of a nerve due to inflammation of ganglia and dorsal nerve roots resulting from activation of the virus, which in many instances has remained latent for years following a primary chickenpox infection; the condition is self-limited but may be accompanied by or followed by severe postherpetic pain. It common occurs in the elderly or immunocompromised person.

Signs and Symptoms:

• Unilateral and painful vesicular eruptions
• Fever
• Dysesthesias
• Malaise
• Headache

Treatments:

1. Antivirals such as acyclovir or valacyclovir within 72 hours of appearance of lesions
2. IV antivirals for patients with immunocompromised

Scabies

Scabies is An eruption due to the mite Sarcoptes scabiei. The female of the species burrows into the skin, producing a vesicular eruption with intense pruritus between the fingers, on the male or female genitalia, buttocks, and elsewhere on the trunk and extremities. It is associated with crowded and dirty living conditions. Mites are passed from person to person.

Etiology:
Sarcoptes scabiei (burrows into the skin to lay eggs)

Signs and Symptoms:

• Pruritus that worsens at night and after hot showers caused by a hypersensitivity reaction to mite feces
• Excoriations, papules, and vesicles on the wrists and between the fingers, elbows, and intertriginous areas

Treatments:

1. 5% permethrin cream
2. Antihistamines for pruritus
3. Wash clothing and bedding to prevent reinfestation
4. Also treat close contacts

Pityriasis Rosea

Pityriasis rosea is a mild and self-limited cutaneous eruption associated with HHV-6

Signs and Symptoms:

• Pruritus
• Diffuse eruption of round to oval erythematous papules and plaques covered with a fine
• Christmas-tree pattern on the trunk with a classic herald patch, a solitary patch that precedes the rest of the rash

Treatments:
Lesion are self-limited but pruritus may require treatment

Necrotizing Fasciiti

Necrotizing fasciitis is infection of skin and fascia caused by group A streptococci, mixed aerobic-anaerobic bacteria, or Clostridium perfringens. It develops rapidly and has high mortality without emergent treatment.

Signs and Symptoms:

• Pain and unexplained fever
• Swelling, tenderness, induration, or bullae
• Extending of infection to fascia and spreads rapidly
• Predisposing factors: DM, peripheral vascular disease, breaches in the skin or mucosa, and surgery
• Necrotizing fasciitis of the perineal region is called Fournier's gangrene

Treatments:

1. Surgery
2. Antibiotic therapy after gram stain and culture of tissue

Molluscum contagiosum

Molluscum contagiosum is an infection caused by a poxvirus. It is commonly found in young children and AIDS patients

Signs and Symptoms:

• Discrete, dome shaped, and shiny papules (2-5 mm) with central umbilication
• The lesions are asymptomatic unless inflamed or irritated
• In adult: lesions on the perianal and perigenital areas
• In child: lesions on the trunk, extremities, and face

Treatments:

1. The lesions resolve (months to years) spontaneously
2. Liquid nitrogen cryotherapy
3. Curettage
4. Trichloroacetic acid

Lice

Types of Lice:

1. Pediculus capitis - infection of the scalp
2. Pediculus corporis - infection of the body
3. Phthirus pubis - infection of the pubic area

Signs and Symptoms:

• Pruritus
• Nits fluoresce blue under Wood's lamp

Treatments:

• Permethrin shampoo or cream
• Sources of reinfection (such as combs, bed sheets, clothing) should be decontaminated

Lyme Disease

Lyme Disease:

• "Bull's eye" erytheuma
• Occurs in moist and warm areas of the body (axillae, behind the knees, inguinal area) where the tick initially bites
• Fatigue
• Malaise
• Arthralgias
• Headache
• Lymphadenopathy
• Neurologic deficits
• History of tick bite

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever:

• Rash on the palms and soles then spreads to the trunk and face
• High fever
• Chills
• Headache
• History of tick bite

Scarlet Fever

Scarlet Fever:

• Rash on the trunk as sandpaper-like
• Strawberry tongue
• Circumoral pallor
• Most occurs in untreated streptococcal pharyngitis
• Penicillin is drug of choice to prevent rheumatic fever

Chickenpox (varicella)

Chickenpox (varicella):

• Macules on the trunk cause papules and vesicles, ruptured and crusting
• Crops of lesions
• Dewdrop on a rose petal: a clear vesicle on an erythematous base
• Fever
• Risk for bacterial superinfection of lesions

Fifth Disease

Fifth Disease (Erythema infectiosum):

• Caused by parvovirus B19
• Slapped-cheek rash over the cheeks
• Maculopapular rash on the trunk and extremities 1-2 days later
• Malaise
• Low-grade fever

Infectious Rashes: Rubella

Rubella (German measles):

• Maculopapular rash (spreading from the head downward)
• Suboccipital swelling
• Postauricular nodes
• Low-grade fever
• Malaise
• Arthralgias

Infectious Rashes: Measles / Rubeola

Measles / Rubeola:

• Koplik's spots (white spots on buccal mucosa) usually occurs 3 days after a high fever
• Maculopapular rash (spreading from the head downward)
• Cough
• Coryza
• Conjunctivitis

Impetigo

Impetigo is a contagious and autoinoculable skin infection caused by staphylococci or streptococci. It commonly in children than adults

Signs and Symptoms:

• Pruritus with honey-colored crusts on the face, neck, and extremities
• Nonbullous impetigo: superficial pustules with surrounding erythema
• Bullous impetigo: erythematous macules as thin-walled vesicles or bullae on an erythematous base.

Treatments:

1. Mild soap for washing the lesions
2. Topical mupirocin
3. Systemic antibiotics
4. Patient's towels and washcloths should be segregated

Herpes Simplex

Herpes simplex is a recurrent vesicular eruption of mucocutaneous surfaces due to HSV infections. It is a painful eruption.

Signs and Symptoms:

• First outbreaks are longer and more sever than recurrent eruptions
• Prodromal tingling, burning, or frank pain with lymphadenopathy
• Fever, discomfort, malaise, and edema on involved area
• Grouped vesicles on erythematous base
• Recurrent infections are limited to mucocutaneous areas

Treatments:

1. Acyclovir ointments
2. Oral or IV acyclovir
3. Daily acyclovir therapy for patient with more than 6 outbreaks per year

Fungal Infections: Tinea Corporis/Capitis

Tinea corporis / capitis is an infection of the body/scalp caused by fungus

Signs and Symptoms:

• Pruritus
• Ring-shaped (ringworm)
• Erythematous
• Scaling plaques

Treatments:

1. Tinea corporis: topical anti-fungal
2. Tinea capitis and tinea unguium (nail infection): oral anti-fungals

Fungal Infections: Pityriasis versicolor

Pityriasis versicolor is also named by tinea versicolor. It is caused by Malassezia furfur.

Signs and Symptoms:

• Small, scaling, hyper or hypopigmented macules
• Lesions: asymptomatic or mild itching
• Chest and back is the common site of infections

Diagnosed by:

• KOH
• Wood's light examination

Treatments:

1. Topical anti-fungal agents
2. Selenium sulfide shampoo

Cellulitis

Cellulitis or folliculitis is skin infections due to streptococci or staphylococci.

Signs and Symptoms:

• Folliculitis: hair follicles infection commonly on facial hair
• Cellulitis: red, hot, and swollen skin lesions, fever and chills

Treatments:

1. Oral antibiotics such as cephalexin or dicloxacillin for mild to moderate cases
2. In cases of systemic toxicity, comorbid condition, DM, extremes of age, or hand or orbital involvement, patient should be hospitalized and give IV antibiotics