Skin is the largest organ of the body and is fast becoming one of the important domains in physician’s daily practise. Acne , infections – bacterial fungal and viral , hair and nail disorders are not only areas of concern for the patient but also warrant the correct diagnosis and treatment by the physician.
Eczema, psoriasis, atopic dermatitis, vitiligo are common skin conditions encountered in our population and their occurrence is growing at a fast pace thanks to our changing lifestyle.
Treating skin conditions is not just about prescribing a cream containing a steroid, or an antifungal or an antibiotic. Ill treatment and injudicious use of topical steroids and various other combinations has led to resistance of various infections to common antibiotics and antifungals.
A physician today also has to deal with cosmetically conscious patients asking for a remedy to their conditions like hair fall, melasma, acne etc. An attempt has been made to simplify and help the physician diagnose and treat effectively the common skin conditions encountered in their day to day practice.
This presentation will help the physician add to their practice and give them an edge above others for not only beauty is skin deep, pathologies are even deep seated and require an in depth knowledge about the subject for an effective treatment.
Various skin conditions seen in our daily practice and their treatment are as follows:
a. Bacterial Infections-
i. I. Pyoderma: One of the commonest skin infections encountered in our day to day practice. Pyoderma is usually caused by staph species. The treatment involves application od topical antibiotics like mupirocin, fusidic acid and nadifloxacin. Oral antibiotics and anti inflammatory drugs should be restricted to severe conditions only.
ii. Impetigo: Another commonly encountered bacterial infection esp in children, Impetigo is characterised by bullous lesions esp in exposed areas like face. The lesions rapture to form crust which is golden in color. Treatment includes topical antibacterials and oral antibiotics for multiple lesions. Patient should be advised to apply the antibiotic cream inside nose also to prevent further spread of the infection as the bacteria harbours and grows at such areas.
iii. Folliculitis: Bacterial infections of the hair follicles are common in adults esp in females after waxing etc. If not treated properly this can result in formation of cysts at time and repeated infections at the same site may warrant surgical removal of the cyst. Treatment include topical GEL based antibiotics as ointments and creams can lead to worsening of the lesions at times.
b. Viral Infections:
i. Herpes Zoster: One of the most common viral infection seen in the physician’s office is herpes zoster . The condition is caused by the herpes zoster virus which lies dormant in the dorsal root ganglion post varicella zoster infection , which usually occurs in the childhood. The activation of the virus in adulthood leads to the condition in times of stress.
The times tested treatment includes oral acyclovir in the dose of 800 mg five times a day alongwith symptomatic treatment for the pain relief but with the introduction of valacyclovir beter patient compliance is being seen. The post hepetic neuralgia resulting out of herpes episode is treated with drugs like gabapentin.
ii. Herpes labialis: Recureent episodes of herpes labialis are seen in many patients who complain of fluid filled vesicles starting with burning near their mouth. The infection can occur as a result of HSV-1 or HSV-2. The treatment includes oral acyclovir 200 mg five times a day or 400 mg three times a day. Topical acyclovir gel is also used locally.
iii. Molluscum contagiosum: Another viral infection commonly encountered in children results from transmission of the virus from one to another. Children are often at risk to get the condition from friends etc in schools. In adults molluscum lesions usually occurs in genital area as a result of unprotected sexual exposure and is catagorised as an STI. Extraction of the molluscum body through a fine bore needle or Phenol application are common treatment modalities to get rid of the condition.
i. Tinea Cruris: Tinea cruris/corporis is one of the most common dermatological infections treated by the OTC medicines. The rampant use of topical combinations containing antifungals, steroids and antibacterials has led to emergence of resistance as well as spread of the diseased condition in the general population.
The condition is common in those who work in hot and humid climate and hence is mostly seen during the monsoon season.
The treatment incudes oral fluconazole or terbinafine but with the emergence of resistance to these widely used drugs, Oral Itraconazole is fast becoming the drug of choice for resistant cases. Even in topical preparations resistance is observed with clotrimazole and hence newer preparations containing luliconazole, sertaconazole are emerging as an alternative.:
ii. Tinea Capitis:
The fungal infection of the scalp is mostly seen in the children and griseofulvin remains the drug of choice or treating such a condition.
Griseofulvin should be be given with fatty food like milk to increase the drug absorption and give better results. Shampoos containg ketoconazole can be used as additional treatment for clearing the scalp.
iii. Onychomycosis: Fungal infection of the nail is called Onychomycosis and is one of the most resistant fungal infection to treat.
The treatment needs to be given till the whole nail is cleared of the infection. A novel concept in treating such cases is to treat the condition using a terbinafine pulse, where oral terbinafine 250 mg is given twice a day for one week every month and the pulse is repeated till all the infected nails are cleared of the infection.
Oral itraconazole is also used for treating the condition.
Acne is almost synonymous with the branch – Dermatology. The condition is a chronic , relapsing one and is a big embarrassment in adolescence. The skin condition can be completely cured with topical preparations containing clindamycin, benzoyl peroxide, azaelic acid, retinoids etc.
Oral antibiotics used for treating acne include azithromycin, doxycycline, minocycline etc.
In severe cases oral isotretinoin has emerged as a wonder drug which controls the excessive sebum secretion and cures acne.
Fractional resurfacing with the help of Er: Yag or CO2 laser can help in clearing the scars while the post inflammatory hyperpigmentation can be taken care with procedues like glycolic acid peeling.
Eczema means “eruption” while dermatitis means “ disease of skin” in the greek language. It is characterized by itchy, erythematous, vesicular and crusted papules or plaques.
Eczema might be dry or wet. Dry eczema can get transformed into wet by constant friction due to scratching by the patient therby leading to the loss of skin barrier and leading to oozing.
Treatment incudes application of topical preparations containing mild to moderate steroids, topical moisturising creams and anti oral antihistaminic drugs. Oral antibiotics are required when the condition is secondarily infected and in rare cases of wet eczema oral steroids are required to control oozing. Topical steroids should not be prescribed in wet eczemas till they turn dry.
Urticarial rash are seen as erythematous macula-paular skin lesions and occur as a result of an allergic reaction . The rash can result from food allergy, inhalation of air borne allergen, allergy to drug intake or at times because of any disease condition . Rash cdue to fever is a common phenomenon.
The treatment plan includes oral antihistaminics like fexofenadine, cetrizine, hydoxyzine etc alongwith topical soothing agents like calamine lotion in summers and moisturising lotions in winters, Topical steroidal lotions can be added in severe cases.