Common Dermatologic Conditions.

The Medical clinics of North America (Impact Factor: 2.18). 05/2014; 98(3):445-485. DOI: 10.1016/j.mcna.2014.01.005
Source: PubMed

ABSTRACT This review discusses common dermatologic presentations as they would appear in a primary care office, exploring the differential diagnoses for each. Tips are provided on choosing an appropriate topical drug and vehicle and advising patients on its use. Etiology, differential diagnosis, and treatment options are discussed for the following: alopecias including androgenetic alopecia, female pattern hair loss, alopecia areata, and telogen effluvium; facial rashes including acne vulgaris, acne rosacea, periorificial dermatitis, seborrheic dermatitis, erysipelas/cellulitis, and systemic lupus erythematosus; intertriginous rashes including infections, intertrigo, and inverse psoriasis; and the inflamed leg including cellulitis and erysipelas, stasis dermatitis, and contact dermatitis.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Staphylococcus aureus and beta-hemolytic streptococci (BHS) are the 2 main types of bacteria causing soft-tissue infections. Historically, BHS were believed to be the primary cause of diffuse, nonculturable cellulitis. However, with the recent epidemic of community-associated methicillin-resistant S aureus (MRSA) causing culturable soft-tissue infections, it is currently unclear what role either of these bacteria has in cases where the cellulitis is diffuse and nonculturable. This uncertainty has led to broad-spectrum and haphazard use of antibiotics for this infection type, which has led to increased risk of adverse drug reactions, health care costs, and emergence of resistance in bacteria. To investigate this issue, we conducted a prospective investigation between December 2004 and June 2007, enrolling all adult patients admitted to the inpatient service at the Olive View-UCLA Medical Center, a county hospital of Los Angeles, with diffuse, nonculturable cellulitis. Acute and convalescent serologies for anti-streptolysin-O and anti-DNase-B antibodies were obtained. Patient data were analyzed for response to beta-lactam antibiotics. The primary outcome was the proportion of these cases caused by BHS, as diagnosed by serologies and/or blood cultures, and the secondary outcome was the response rate of patients to beta-lactam antibiotics. Of 248 patients enrolled, 69 were dropped from analysis because of loss to follow-up or exclusion criteria. Of the 179 remaining patients, 73% of nonculturable cellulitis cases were caused by BHS. Analysis of outcomes to beta-lactam antibiotic treatment revealed that patients diagnosed with BHS had a 97% (71/73) response, while those who did not have BHS had a 91% (21/23) response, with an overall response rate of 95.8% (116/121). Results of this large, prospective study show that diffuse, nonculturable cellulitis is still mainly caused by BHS, despite the MRSA epidemic, and that for this infection type, treatment with beta-lactam antibiotics is still effective. A cost-effective, evidence-based algorithm can be useful for the empiric management of uncomplicated soft-tissue infections based on the presence or absence of a culturable source.
    Medicine 07/2010; 89(4):217-26. · 4.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rosacea is a common, chronic, cutaneous disorder presenting with recurrent episodes of facial flushing, erythema, papules, pustules and telangiectasias. It is a multifactorial disease and its various clinical presentations probably represent the consequence of combined different triggers upon a specific background. Its management is largely based on long-established treatments empirically tailored to the specific presenting symptoms and no real breakthrough has occurred to date. However, recent insights into the still rather obscure pathophysiology of rosacea seem to open the way for etiologically oriented treatments. These may include, on the one side, the more effective application of traditional drugs, such as tetracyclines and metronidazole, to specifically selected patients or, on the other side, new therapeutic options, such as vitamin D receptor antagonists. It is to be remarked that the quality of most studies evaluating rosacea treatment is rather poor, mainly due to a lack of proper standardization. For a major breakthrough to occur in the management of rosacea, we need both a better understanding of its pathogenesis and the adherence of future clinical trials to clearly defined grading and inclusion criteria, which are crucial for investigators to correctly compare and interpret the results of their work.
    American Journal of Clinical Dermatology 01/2010; 11(5):299-303. · 2.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patterned hair loss in men and women, although medically benign, is a common, albeit unwelcome, event that may cause considerable anxiety and concern. Patterned hair loss is progressive and when untreated leads to baldness. The prevalence and severity of this physiologic process both increase with advancing age. Although androgens play a key role in the pathogenesis of male pattern hair loss (MPHL), the role of androgens in female pattern hair loss (FPHL) is less well established. Satisfactory treatment response to antiandrogen therapy supports the involvement of androgens in the pathogenesis of FPHL. Spironolactone has been used for 30 years as a potassium-sparing diuretic. Spironolactone is a synthetic steroid structurally related to aldosterone. Since the serendipitous discovery 20 years ago that spironolactone given to a woman for polycystic ovary syndrome (PCOS) and associated hypertension also improved hirsutism, it has been used as a primary medical treatment for hirsutism. Spironolactone both reduces adrenal androgen production and exerts competitive blockade on androgen receptors in target tissues. Spironolactone has been used off-label in FPHL for over 20 years. It has been shown to arrest hair loss progression with a long-term safety profile. A significant percentage of women also achieve partial hair regrowth. Spironolactone is not used in male androgenetic alopecia because of the risk of feminization.
    Dermatologic clinics 07/2010; 28(3):611-8. · 1.29 Impact Factor