1) Acne – Tx – Local applications – Adapalene gel, cream, solution 0.1% OD, bd or every other day application, Tazarotene gel or cream 0.05-0.1% OD, Tretinoin cream 0.1%, 0.05%, 0.025%, gel 0.01%, 0.025%, solution 0.05% OD, Clindamycin gel 1%, lotion 1%, solution 1% or swab 1% bd application, Erythromycin gel 2%, solution 2%, bd application, Azelaic acid cream 20% cream bid application, Benzoyl peroxide 2.5%,5%,10% gel, 2.5%, 5%, 10% wash OD-bid application, Drugs - Doxycyline 50-100 mg daily, Tetracycline 250-500 mg qid, Minocycline 50-100 mg OD-bd, Erythromycin 250-500 mg bd. Treatment algorithm – mild acne use topical retinoids, benzoyl peroxide, topical antibiotics in that order until improvement, moderate acne – oral antibiotics for 12/52, add benzoyl peroxide or topical antibiotic, on failure switch onto hormonal therapy, severe acne – topical antibiotic and hormonal therapy OR dermatologist referral for isotretinoin therapy, maintenance therapy – benzoyl peroxide OR topical antibiotics, -
2) Folliculitis in the face -
3) Rosacea – earliest features are central facial erythema and telangiectasis, next stage central facial papules (rarely pustules) with erythema, chronic stage of rhinophyma with papules and telangiectasis, never itchy, lesions only in the face, never in the chest or back, common in adults than in teen like in acne, associated flushing episodes triggered by sun exposure, cold weather, hot beverages, emotions, associated eye changes (conjunctivitis which is itchy, burning, dry, gritty conjunctivitis, episcleritis, iritis) positive, Mx – avoidance of triggers, topical metronidazole, topical clindamycin, if no response dermatologist referral for further management with isotretinoin therapy
4) Seborrheic dermatitis -
5) Herpes simplex primary infection – severe pain and tenderness prior to the appearance of the mucosal lesion, tenders cervical lymphadenopathy, multiple small vesicles, clusters of vesicles, perioral areas, lesions mostly in the gum, inside the mouth causing an acute gingivostomatitis (common in children) or acute pharyngotonsillitis (common in adults), symptoms last 5-7 days, unable to eat and drink, high fever, vesicles, erosions, and maceration in the buccal mucosa, erythematous and edematous gum margin, tender submandibular lymphadenopathy, Mx – Valacyclovir 1000 mg bid for 10 days OR Acyclovir 400 mg tid for 10 days
6) Herpes simplex recurrent infection – herpes labialis – prodrome of tingling and burning at the site of rash, usually around lips, perioral area, cheeks, nose, neck, lesion progression in the following sequence, erythema, clear fluid vesicles, purulent vesicles, crusting and healing, vesicle clustering seen, tender lymphadenopathy, Mx – Valacyclovir 2000 mg bid for 1 day OR Famciclovir 500 mg tid for 5 days OR Acyclovir 800 mg tid for 5 days AND topical 1% penciclovir cream applied every 2 hourly for 4 days.