Acne vulgaris
Presentation
- Widespread distribution in sebum-rich areas
- Onset usually with puberty but may start later in life
- Comedones (open and closed), pustules and cysts may be seen
- In females, it may be exacerbated by menses
- Condition usually improves with sun exposure
Management
- Treatment depends on severity
- Topical antibiotics, benzoyl peroxide and topical zinc helpful
- Oral antibiotics may be required
- Topical isotretinoin is excellent for comedones and in more severe cases, an oral version may be required
- Five per cent of cases will continue and may be life long
Rosacea
Presentation
- Affects the face in adults and is more common in women
- A chronic condition
- Comedones are not a feature
- Often associated with a past history of facial flushing
- Most cases are made worse by exposure to sunlight
- May be exacerbated by spicy food, heat and alcohol
- In some cases, rhinophyma can also be a late feature
Management
- In mild cases, a topical antibiotic, such as metronidazole, is helpful
- In more persistent cases, oral antibiotic may be required
- Oral isotretinoin can help where rhinophyma is present
Folliculitis
Presentation
- Usually an acute condition affecting hair-bearing areas
- In men, it may be associated with a shaving rash
- May occur all over the body after swimming or hot tub use
- In recurrent cases, nasal carriage of Staphylococcus aureus may be a factor
Management
- A short course of oral antibiotics usually works well
- If nasal Staph aureus detected, topical antibiotic can be helpful
- If associated with shaving, avoid use of multi-blade razors
- Emollients containing antiseptic can help to reduce the bacterial load on the skin
Perioral dermatitis
Presentation
- Rash localised to the mouth
- Usually only seen in females, especially those aged 20-45
- Usually follows the use of topical steroids, especially fluorinated preparations
- Rash has a tendency to recur
- Usually exacerbated by soaps, facial washes and cream
Management
- Stopping steroid cream advisable and usually helps
- Topical antibiotics may be all that is required in mild cases
- Oral tetracyclines usually help, but long courses of treatment may be required
- Education about irritant effect of soaps and washes is important
- Dr Stollery is a GP in Kibworth, Leicestershire
