Dermatology Basics for Primary Care Professionals
In primary treatment, skin disorders are among the most commonly treated cases. This article reviews the aetiology, pathophysiology, clinical features, and suggestions for differentiating between the most common dermatological problem. The treatment strategy is explored for each cutaneous condition, including topical and systemic medical treatments, and which cases need a systemic workup to be addressed. Facial dermatitides and common generalised eruptions will be the subject of this first section.Patients and perplexed clinicians may be bothered by skin issues, from rashes to bumps. There is at least 1 skin issue with as many as 1 in 3 patients presented to their primary care doctor. This article reviews common dermatological disorders, focusing on identifying entities and describing therapeutic strategies for various symptoms to help guide physicians through the field of cutaneous disease.
The Facial Dermatids
Patients also lodge symptoms of facial eruptions to the primary care provider, which are more worrisome to patients because of the high visibility.
Dermatological Problem: Acne vulgaris is a widespread pilosebaceous condition arising from follicular orifice obstruction, increased development of sebum, Propionibacterium acnes bacteria overgrowth, and inflammation. The disease affects about 85 percent of teenagers, and for many, it persists into adulthood. Gathering a comprehensive history is important for clinicians. In general, note to ask female patients whether lesions escalate during menstruation, as this may occur in 40% of females. It is also important to rule out underlying causes. Corticosteroids, progestin, lithium, phenytoin, and iodides contain drugs that may exacerbate acne. Endocrine disorders may also lead to acne, especially if the onset of acne is sudden or early. Normally, mild acne does not need systemic treatment, although both topical and oral therapy is also required for moderate to serious acne situations.
A doctor should address fertility safety with female patients before initiating any procedure since certain topical and oral therapies (eg, tetracyclines) are contraindicated during pregnancy or lactation. In addition, all therapies require 6-12 weeks to heal, but patients should be aware that acne sometimes worsens until it is affected.
Dermatological Problem: Rosacea is a facial disease characterised by frequent flushing, erythema, papules, pustules, and telangiectasiasis episodes. The rosacea aetiology remains unknown; however, several prevalent hypotheses and clinical subtypes are available. Patients should be asked about flushing and blushing, as well as signs of itching and skin or eye pain, suggesting an underlying condition of rosacea. Rosacea, although a benign disease, frequently reduces the quality of life of a patient, leading to poor self-esteem and humiliation. A number of topical and systemic rosacea therapies are effective; patient education and regular skincare, however, are main stones of therapy. In the prevention of transepidermal water loss and regeneration of the skin barrier to avoid exacerbations, moisturisers are especially important. Sunscreen helps minimise inflammatory molecules and blocks the development of reactive oxygen species, particularly physical blockers such as zinc oxide or titanium dioxide.
A variety of products intended for the treatment of rosacea, such as oral or topical antibiotics and anti-inflammatory agents have been recently approved by the FDA in addition to the core therapies, such as oral or topical antibiotics. Brimonidine tartrate, 0.5 percent, is a topical alpha-adrenergic receptor agonist that for 6 to 7 hours after treatment decreases chronic facial erythema by vasoconstriction. Ivermectin cream, 1 percent, is beneficial in the management of inflammatory papular or pustular rosacea and has been found to be equivalent to metronidazole cream in trials, 0.75 percent, an existing pillar of rosacea treatment. While expensive, as part of a combined strategy, these new drugs can be effective in select rosacea patients.
Dermatological Problem: Adults are also afflicted by seborrheic dermatitis, which favors the scalp, ears, face, central chest, and intertriginal regions. The aetiology is likely to be linked to active sebaceous glands with Malassezia (formerly known as Pityrosporum) yeast reaction, Malassezia furfur, which is part of the resident skin flora. Patients display red, orange, or pink, greasy, scaly spots or plaques that are sharply demarcated. The path is persistent and relapsing, which could include the use of topical antifungal shampoos and creams regularly at intervals. Oral antifungals like fluconazole or itraconazole are seldom required. Patients should be referred for refractory patients to a dermatologist for management.
Dermatitis of the Eyelids
Dermatological Problem: Eyelid dermatitis, which can occur secondary to a variety of underlying conditions, including irritant dermatitis, atopic dermatitis, seborrheic dermatitis, blepharitis rosacea or allergic contact dermatitis, is often present in patients. Because it may be difficult to discern the aetiology, practitioners can compile a comprehensive background, including the following: asking questions regarding the usage of soaps, shampoos, cosmetics, hair dyes, or moisturisers to test for irritant or allergic components; collecting details concerning an atopic personal or family history; asking questions about dandruff elsewhere; and researching the celestial history.
Studies investigating the cause of eyelid dermatitis have shown that allergic contact dermatitis is the most widespread, accounting for about 30% to 70% of cases, accompanied in more than 10% of patients by atopic dermatitis and, less commonly, by irritant dermatitis and seborrheic dermatitis. The experience and analysis can require patch checking.
Popular remedies, irrespective of the underlying cause, include cold moist compresses accompanied by the application of petroleum jelly; topical ointment-shaped corticosteroids of class 5 to 7 containing fewer preservatives and supplying more hydration; discontinuation of some products, including make-up and washing agents; and avoidance of preservatives or fragrances. In a number of eyelid dermatides, topical calcineurin inhibitors are prescribed because they do not thin or lighten the skin in the way a corticosteroid can over time.
Dermatological Problem: Heterogeneous communities of inflammatory skin conditions that share common epidermal inflammation hallmarks are included in the word eczema. That includes atopic dermatitis, contact dermatitis, stasis dermatitis, dyshidrotic eczema, seborrheic dermatitis, and asteatotic eczema, for instance. Eczema may occur acutely, marked by swollen, weeping, draining, blistered skin, or may occur regularly, with dried, thickened, scaly, pigment-altered skin looking either hyperpigmented or depigmented at times. Extrinsic causes, such as irritant dermatitis or allergic contact dermatitis, or intrinsic causes, such as atopic or dyshidrotic eczema, are common causes.