What are the treatment plans for common dermatological conditions like acne, eczema, and psoriasis?

Treatment Plans for Common Dermatological Conditions

Acne Treatment

For acne vulgaris, the first-line treatment is a combination of topical retinoids and topical antimicrobials, with adapalene being a preferred topical retinoid that should be applied once daily to the entire affected area. 1

Treatment Algorithm for Acne:

1. Mild Acne:

   • Topical retinoid (adapalene) once daily 1
   • Can be combined with benzoyl peroxide or topical antibiotics for inflammatory lesions
   • For occasional stubborn cystic lesions, intralesional triamcinolone acetonide (10 mg/mL) can flatten most nodules within 48-72 hours 2

2. Moderate Acne:

   • Combination therapy with topical retinoid plus antimicrobial
   • Chemical peels may be considered:
     • Glycolic acid (30-70%) applied every 15 days for 4-6 months 2
     • Salicylic acid (20-30%) for comedonal acne 2

3. Severe Acne:

   • Consider oral antibiotics, hormonal therapy (in females), or isotretinoin
   • Note: Avoid intralesional steroid injections at sites of active infections 2

Important Considerations:

• Applying more adapalene than directed will not provide faster results but may worsen skin irritation 1
• Intralesional steroids should be avoided in patients with active infections, hypersensitivity to triamcinolone, or uncontrolled systemic conditions 2
• Chemical peels are contraindicated in patients on isotretinoin therapy within the last 6 months 2

Psoriasis Treatment

Treatment Algorithm for Psoriasis:

1. First-Line Treatment:

   • Topical corticosteroids combined with vitamin D analogs 3
   • For maintenance: reduce corticosteroids to weekends and vitamin D analogs to weekdays 3

2. Treatment by Body Location:

   • Face, intertriginous, and genital areas: Low-potency corticosteroids or calcineurin inhibitors (tacrolimus 0.1%) 3
   • Scalp and ear canal: Topical corticosteroids (potency based on severity) 3

3. Moderate-to-Severe Psoriasis (>5% BSA):

   • Narrowband UVB phototherapy 3
   • Systemic treatments:
     • Methotrexate (10-15 mg weekly) 3
     • Cyclosporine (2.5-5 mg/kg/day) for rapid control but limited to short-term use 3
     • Biologics (TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors) for inadequate response to traditional systemics 3

Special Considerations:

• Pediatric patients should use lower potency corticosteroids 3
• Acitretin is contraindicated in women of childbearing potential due to teratogenicity 3
• Regular monitoring for adverse effects is necessary, especially with systemic treatments 3
• Disease severity classification: mild (<3% BSA), moderate (3-10% BSA), severe (>10% BSA) 3

Eczema (Atopic Dermatitis) Treatment

Treatment Algorithm for Eczema:

1. Basic Therapy:

   • Appropriate basic therapy is crucial for chronic dermatoses to prevent symptom onset 4
   • Long-term basic therapy serves as preventive therapy and improves quality of life 4

2. Topical Treatments:

   • Topical corticosteroids based on severity and location
   • Topical calcineurin inhibitors for sensitive areas
   • Regular moisturizing with emollients

3. For Moderate-to-Severe Cases:

   • Phototherapy
   • Systemic immunosuppressants
   • Newer biologics for severe cases

Common Pitfalls and Caveats:

1. For Acne:

   • Overuse of topical treatments can worsen irritation 1
   • Local overdose of intralesional steroids can result in atrophy, pigmentary changes, and telangiectasias 2
   • Chemical peels should be avoided in patients with active infections or open wounds 2

2. For Psoriasis:

   • Avoid high-potency corticosteroids in children aged 0-6 years due to risk of HPA suppression 3
   • Cyclosporine should be limited to short-term use due to nephrotoxicity 3
   • Regular monitoring is essential for patients on systemic treatments 3

3. For All Conditions:

   • Skin conditions significantly affect quality of life and often lead to high consumption of dermatological drugs 5
   • Less than 50% of people with skin conditions seek advice from medical practitioners 6
   • Many patients use complementary and alternative medicine (CAM) therapies, particularly those with acne who report greater confidence in CAM efficacy 7

Monitoring and Follow-up:

• Evaluate response after 4 weeks for topical therapy 3
• Regular monitoring for adverse effects is necessary, especially with systemic treatments 3
• Consider combination therapy to enhance efficacy and reduce side effects 3