Acne, Scabies and Eczema

Dr Han Yung Wen

• A 22-year-old woman presents with the following facial lesions for the
past 2 weeks.
• What are your differential diagnosis?
Acne
• Acne is a disease of pilosebaceous units in the skin.
• Colonization of Propionibacterium acnes

• Classification: mild, moderate and severe

• Classified by type of lesion—comedonal, papulopustular, and
nodulocystic. Pustules and cysts are considered inflammatory acne.
• Different classification system – follow CPG Malaysia 2012
Aims of management
• To induce clearance
• To maintain remission and prevent relapse
• To prevent physical and psychological complications
Induce clearance
• Topical agents • Systemic agents
• Topical benzoyl peroxide (BPO) • Oral antibiotics
• Topical retinoids • Tetracycline
• Topical tretinoin • Doxycycline
• Topical adapalene • Erythromycin
• Topical isoretinoin • Clindamycin
• Topical tazarotene • Minocycline
• Topical antibiotics - erythromycin • Co-trimoxazole/ trimethoprim alone
• Topical Azelaic acid • Oral hormonal treatment
• COCs
• Topical salicylate acid
• Spironolactone
• Topical sulphur and its combination • Other antiadrogenic agents - flutamide
• Topical Dapsone • Isoretinoin
• Topical Fixed combination
Maintainence
• Cleaniness
• Topical agents
• Comedone extraction – not widely recommended
• Others - Chemical peel, phototherapy, photodynamic therapy
• Don’t forget psychological well-being
References
• Pochi PE, Shalita AR, Strauss JS, Webster SB, Cunliffe WJ, Katz HI, et al.
Report of the Consensus Conference on Acne Classification.
Washington, D.C., March 24 and 25, 1990. J Am Acad Dermatol.
1991;24:495–500.
• Management of Acne, Clinical Practice Guidelines, Malaysia 2012
• A 10-year-old boy was brought to you by his parents because of the
itchy rashes over his hands for the past 2 weeks.
Burrows
Management
• Diagnosis under microscope – fix with oil
• Education – explain to patient about scabies
• Treat all close contacts
• If the medication is wipe off e.g. during hand washing, make sure
reapply
• Need to get rid of all scabies hiding areas – all clothings, bed linens
etc either boil (>50ᴼC), or keep in plastic bag >72 hours (scabies can’t
live separated from human host for >72 hours
• Apply the medication neck down (except babies), including all skin
folds
• Choice of meds: Permethrin 5%; Benzyl benzoate 10-25%; Precipitate
sulphur 6-10%; crotamiton 10%; Lindane 1%; Ivemectin (oral)
References
• Guideline for management of scabies in adult and children, Clinical
Practice Guidelines Malaysia 2015
• A 70-year-old man presents with persistent itchiness over both his
legs for the past 6 months. He has seen various GPs and
dermatologists, given topical medication, resolved temporarily but
recur. He is keen to know his condition.
• What are your differential diagnosis?
Types of eczema
• Endogenous • Exogenous
• Atopic or IgE • Allergic
• Seborrheic • Toxic irritant contact
• Discoid or nummular • Photosensitive
• Pompholyx
• Venous
• Asteatotic
• Juvenile plantar
• Erythroderma
Management
• MOISTURISE, MOISTURISE, MOISTURISE
• Prevent further dryness – avoid hot shower, avoid strong soap,
use mild soap or soap substitute
• Apply moisturiser after shower on soften keratin layer
• Use liberally, apply as often as needed
• May use with steroids cream
• Avoid the itch-scratch-itch-scratch cycle
• May need to add antihistamine
• Wet wrap
• Use cotton undergarments, avoid synthetic materials
• Avoid perfumes/ cosmetics especially if it worsens the eczema
References
• Guidelines for the care of the management of atopic dermatitis,
American Academy of Dermatology 2014
Thank you