cellulitis,acne and rosacea Flashcards
(18 cards)
what is and symptoms of cellulitis?
Cellulitis - Acute bacterial infection of dermis & Subcutaneous tissue
Symptoms
Pain, warmth, swelling, redness of infected area
Possible blisters
Fever, malaise, nausea, rigors
Tracking
diagnosis of cellulitis?
History
Symptoms – Duration & severity
Recent trauma to skin?
Comorbidities?
Predisposed conditions?
Examination
Assessment of area
Observation & vital signs
Skin breaks/wounds
Assess for risk factors
Investigations
Skin swab
Skin biopsy
Ultrasonography
WCC
ESR
CRP
differential diagnosis of cellulitis?
DVT
Septic arthritis
Gout
Thrombophlebitis
Cutaneous abscess
Drug reaction
Erythema nodosum
Pyoderma gangrenosum
Cancer
categorisation of cellulitis?
Class I – No systemic illness or comorbidity
Class II – Systemically unwell or well with comorbidity
Class III – Significant systemic illness/upset
Class IV – Sepsis or severe life threatening illness
management of cellulitis?
hospital admission for:
class 3 or IV suspected
class 2 + serious illness
rapid deterioration
young or frail patient
facial cellulitis
Antibiotic treatment
Flucloxacillin – 1st line
Clarithromycin – 1st line in pen. Allergy
Doxycycline
Erythromycin
Metronidazole – If anaerobic cause suspected, avoid alcohol
Co-amoxiclav - Avoid due to high risk c.diff…but 1st line in facial cellulitis
About acne
Chronic, inflammatory skin condition
Blocked, inflamed pilosebaceous unit
Affects areas with high amounts of pilosebaceous units
Face, back, chest
Peaks in adolescence but can affect any age
Non-inflammatory comedones
Whiteheads (open) & blackheads (closed)
Papules, pustules, nodules & cysts
Categorisation of acne
Mild – Predominantly non-inflamed lesions & some inflammatory lesions
Moderate – More widespread, more inflamed papules & pustules
Severe – widespread inflammatory papules, pustules, nodules & cysts with scarring
Conglobate acne – Rare & severe. Extensive inflammatory papules, nodules, cysts on trunk & upper limbs
Acne fulminans – Rare. Severe inflammatory reactions, deep ulcerations & erosions. Fever & joint stiffness
Management of acne
- Severity any: Combination
topical adapalene & benzoyl
peroxide (Epiduo)
Apply OD in the evening - Severity any: Combination
topical tretinoin & clindamycin
(Treclin)
Apply OD in the evening - Severity mild - moderate:
Combination benzoyl peroxide
& clindamycin (DUAC)
Apply OD in the evening - Severity moderate - severe:
Combination topical
adapalene & benzoyl peroxide
OD
Plus oral
lymecycline/doxycycline OD* - severity moderate - severe:
Combination Azelaic acid BD
Plus oral lymecycline/doxycycline OD*
About rosacea and symptoms?
Also termed Acne Rosacea
Chronic inflammatory skin condition
Affects convexities of centrofacial region
Symptoms
Facial flushing
Erythema
Papules
Pustules
Telangiectasia
diagnosis of rosacea
1 diagnostic or 2 major clinical symptoms
Diagnostic = Facial skin thickening, rhinophyma, persistent erythema
Clinical = Flushing, inflammatory papules/pustules, telangiectasia, ocular symptoms
Ocular Rosacea
Eye discomfort/irritation
Tearing, foreign body sensation
Dryness & itching
Photophobia, blurred vision
Telangiectasia on eyelids
differential diagnosis of rosacea
Differential diagnoses
Acne
Seb. dermatitis
Contact dermatitis
Photodermatitis/damage
Peri-oral or peri-ocular dermatitis
Mastocytosis
Steroid induced dermatitis
Folliculitis
Lupus
Erysipelas
Keratosis pilaris
Sarcoidosis
management of rosacea
Persistent erythema– Topical Brimonidine gel once daily PRN
Mild-Moderate papules and/or pustules – Topical Ivermectin OD 8-12 weeks
Or topical metronidazole 0.75% BD or Azelaic Acid 15% BD
Moderate-Severe papules and/or pustules – Topical Ivermectin and Doxycycline MR 40mg OD for 8-12 weeks
Alternative topical Metronidazole or Azelaic Acid
Alternative abx – Oxytetracycline or Tetracycline 500mg BD or Erythromycin 500mg BD
Clinically inflamed phymatous disease – Doxycycline MR 40mg OD for 6 weeks
Pathophysiology of acne (stage 1)
Keratin and sebum clog the hair follicles -> microcomedone
Further hyperkeratinisation, and sebum production enlarge the follicle -> microcomedone evolves into comedomes
Whitehead (closed comedomes) -> below the skin surface not exposed to the air
Blackheads (open comedones) clog on the surface -> air oxides sebum turning dark
Pathophysiology of acne (stage 2-4)
Clogged follicle ruptures (dermis) -> Triggers inflammatory response
Sebum overproduction → fuels Cutibacterium acnes overgrowth (a normal follicle resident)
C. acnes digest sebum triglycerides -> releases pro-inflammatory free fatty acids -> worsen inflammation, redness, and lesion
Mechanism of Benzoyl Peroxide (for acne)
Penetrates the epidermis converted into benzoic acid and hydrogen peroxide
Benzoic acid has comedolytic and anti-inflammatory effects
Hydrogen peroxide releases free radicals, damaging and killing C. acnes cells
Mechanism of Retinoids (for acne)
Penetrates epidermis and slightly the dermis
Enters keratinocytes binds to intracellular retinoic acid receptors acts as a transcription factor modulating gene expression to:
- normalises keratinisation
- reduces inflammation
- comedolytic action
sebum reduction
mechanism of topic/oral antibiotics (for acne)
Protein synthesis inhibition – targeting bacterial ribosomes
Bacteriostatic effect Reduce C. acnes colonisation
mechanism for azelaic acid (for acne)
Normalise keratinisation -> inhibiting 5α-reductase (reduced DHT conversion)
Antimicrobial activity against C. acnes
Modest anti-inflammatory -> inhibits neutrophil activation
