Upon completion of the chapter, the reader will be able to:
Describe the pathophysiology of common skin disorders.
Assess the signs and symptoms of common skin disorders in a presenting patient.
List the goals of treatment for patients with common skin disorders.
Select appropriate nonpharmacologic and pharmacologic treatment regimens for patients presenting with common skin disorders.
Identify adverse effects that may result from pharmacologic agents used in the treatment of common skin disorders.
Develop a monitoring plan that will assess the safety and efficacy of the overall disease state management of common skin disorders.
Create educational information for patients about common skin disorders, including appropriate self-management, available drug treatment options, and anticipated therapeutic responses.
Several thousand skin disorders are currently documented, and many patients seek the assistance of a health care provider when a complication with their skin develops. Others will utilize self-care to effectively treat their symptoms.
This chapter discusses acne vulgaris, contact dermatitis (irritant and allergic), and diaper dermatitis; other common skin and soft tissue infections and superficial fungal infections are discussed in Chapters 73 and 83, respectively. Providing patients with appropriate therapy options, as well as patient education on treatment and prevention, will assist the successful management of many common skin disorders.
Acne vulgaris is an inflammatory skin disorder of the pilosebaceous units of the skin. Although most commonly seen on the face, acne can also be present on the chest, back, neck, and shoulders (Figure 65–1).1 Acne is not just a self-limiting disorder of teenagers. The clinical course of acne can be prolonged or recur, resulting in long-term physical complications such as extensive scarring and psychological distress.2
Twenty-year-old man. In this case of papulopustular acne, some inflammatory papules become nodular and thus represent early stages of nodulocystic acne. (From Wolff K, Johnson RA. Disorders of sebaceous and apocrine glands. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. 6th ed. New York: McGraw-Hill; 2009: 3.)
EPIDEMIOLOGY AND ETIOLOGY
With an estimated 40 to 50 million people affected, acne vulgaris is the number one skin disease in the United States.3 Acne affects approximately 85% of adolescents and adults aged 12 to 25 years, with severity of acne correlating with pubertal maturity.3,4 Additionally, acne may persist beyond puberty and has been found to affect 64% and 43% of individuals into the 1920s and 1930s, respectively. Acne is more likely to occur in males during adolescence and females during adulthood. Individuals with a positive family history of acne have been shown to develop more severe cases of acne at an earlier age. Prevalence of acne among ethnic groups is similar.4