Operational Dermatology
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Objectives Discuss common skin conditions Basic management You as a primary care provider Highlight patient education Pitfalls & Mismanagement Recognize skin cancers When to refer to dermatology Recommended References Clinical Dermatology, 4th ed Thomas P. Habif ISBN: 3323013198 Color Atlas & Synopsis of Clinical Dermatology Thomas B. Fitzpatrick, et al. ISBN: 0071360387 Acne Disease of the pilosebaceous units Hormonally influenced Disfiguring Acne Classification Comedonal Non-inflammatory Whiteheads Blackheads Inflammatory Red papules Pustules Nodulocystic Comedonal acne Inflammatory acne – Mild Inflammatory acne – Moderate Nodulocystic acne Other involved areas Treatment Good MILD skin care mild soaps gentle washing No facial scrubs – BAD, BAD, BADAcne comes from within Not from dirt Not from foods Comedonal Acne Start with low dose retinoidRetin-A 0.05% cream Switch to Retin-A micro 0.04% after several weeks or when adjusted Benzoyl peroxide 5% gel/wash +/- topical antibiotics Cleocin T lotion or gel Retinoids Reduces keratinocyte cohesion Opens plugged pores Prevents plugging Problems Irritating Photosensitizing |
Retinoids To avoid irritation: Go easy in the beginning Use lower strength to start (creams, low %) Use 2 nights per week Increase as tolerated to nightly use Apply on very dry face Wash face, then wait 15-20 minutes Avoid moist areas nasal folds, periorbit, oral commissures Retinoids Apply only at night Photosensitivity Use mild non-comedogenic moisturizer in the morning with SPF 15-30 Patient education Acne will get worse before it gets better Should continue even though face clears Retinoids Retin A Cream 0.025%, 0.05%, 0.1% Gel 0.01%, 0.025% Micro 0.04%, 0.1% Differin gel Tazorac This is KEY to long term acne tx! Benzoyl Peroxide Antibacterial Minimizes bacterial resistance Mild peeling effect Bleaches colored cloth 5% wash or gel Inflammatory acne – Mild Dry face with topical antibiotics first Cleocin T gel/lotion x 2-3 weeks Introduce retinoids Retin-A 0.05% cream Switch to Retin-A micro 0.04% after several weeks or when adjusted Continue topical antibiotics Benzoyl peroxide 5% wash |
Lecture by LCDR Will Lumbang
2006 Surface Warfare Medical Officer Indoctrination Course
Naval Operational Medicine Institute
340 Huise Road
Pensacola FL 32508-1092
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Operational Dermatology |