General Treatment Options for Common Dermatological Conditions
The most effective treatments for common dermatological conditions involve targeted therapies based on specific diagnosis, with a combination of topical, systemic, and adjunctive approaches tailored to disease severity and presentation.
Acne Vulgaris
- For mild to moderate acne, multimodal topical therapy is recommended combining multiple mechanisms of action 1
- Benzoyl peroxide is a first-line treatment for all acne severities due to its antimicrobial and keratolytic properties 1
- Topical retinoids (tretinoin, adapalene, tazarotene) are strongly recommended for normalizing follicular keratinization and reducing inflammation 1, 2
- Topical antibiotics should never be used as monotherapy but combined with benzoyl peroxide to prevent resistance 1
- For moderate to severe acne, oral antibiotics (doxycycline preferred over minocycline or azithromycin) may be added 1
- For severe, scarring, or psychologically distressing acne, oral isotretinoin is recommended with appropriate monitoring of liver function tests and lipids 1
- For female patients with hormonal acne, combined oral contraceptives or spironolactone are effective options 1
Seborrheic Dermatitis
- The most effective treatment combines topical antifungal medications to reduce Malassezia yeast with topical anti-inflammatory agents 3
- For facial seborrheic dermatitis, avoid alcohol-containing preparations as they increase skin dryness 3
- Gentle skin care with mild, non-soap cleansers and moisturizers is recommended for mild cases 3
- Coal tar preparations can effectively reduce inflammation and scaling in scalp seborrheic dermatitis 3
- Avoid long-term use of topical corticosteroids, especially on the face, due to risk of skin atrophy, telangiectasia, and tachyphylaxis 3, 4
- Secondary bacterial infections should be treated with appropriate antibiotics if present 3
Eczema/Dermatitis
- Use dispersible creams as soap substitutes to cleanse the skin, as soaps remove natural lipids 3
- Apply emollients after bathing to provide a surface lipid film that retards evaporative water loss 3
- Use the least potent topical corticosteroid preparation required to keep the eczema under control 3, 4
- Ichthammol (1% in zinc ointment) or paste bandages may be useful for lichenified areas 3
- Antihistamines with sedative properties can be useful as short-term adjuvants during severe flares with intense pruritus 3
- Avoid greasy products that can inhibit the absorption of wound exudate and promote superinfection 3
Cutaneous T-Cell Lymphomas (including Mycosis Fungoides)
- For early-stage disease, skin-directed therapies including topical corticosteroids, topical retinoids, or phototherapy (PUVA or narrowband UVB) are recommended 1
- Total skin electron beam therapy (TSEBT) can be given at lower doses (10-12 Gy) with fewer side effects 1
- For advanced or refractory disease, systemic options include gemcitabine or liposomal doxorubicin 1
- Multi-agent chemotherapy is only indicated for stage IV disease with lymph node or visceral involvement 1
- Local radiation therapy (8 Gy) can provide palliation for cutaneous and extracutaneous lesions 1
- For Sézary syndrome, extracorporeal photopheresis (ECP) is the treatment of choice, alone or in combination with other modalities 1
Photodynamic Therapy (PDT) for Skin Conditions
- PDT is recommended for actinic keratosis, particularly for cosmetically sensitive sites, multiple lesions, and large-area lesions 1
- For Bowen's disease (squamous cell carcinoma in situ), PDT is effective, especially for poorly healing or cosmetically sensitive skin sites 1
- Daylight PDT is an option for mild to moderate actinic keratosis where pain is likely to be an issue 1
- PDT is not recommended for invasive squamous cell carcinoma 1
- For basal cell carcinoma (BCC), red light should be used rather than shorter wavelength light for enhanced penetration 1
- Consider field PDT as prophylaxis to reduce the emergence of new lesions in people with actinic keratosis or non-melanoma skin cancer 1
EGFR Inhibitor-Induced Skin Reactions
- EGFR inhibitor-induced skin reactions can be effectively treated at all stages and grades, with most reactions being reversible 1
- General recommendations include gentle soaps/shampoos, moisturizers, sun avoidance, and high SPF sunscreen 1
- For acneiform rash (most common reaction):
- Treatment should begin as early as possible after onset of dermatologic reactions 1
Congenital Ichthyoses
- Daily lukewarm baths (30 min or more) are recommended for cleaning the skin and removing scales 1
- Mild soaps or soap-free cleansing bases should be used, followed by gentle rubbing to remove scales 1
- Moisturizing additives, colloidal preparations, baking soda, or saltwater baths can provide additional benefits 1
- Antiseptics should not be used routinely except in specific conditions with recurrent skin infections 1
- Systemic therapy with oral retinoids (primarily acitretin) may be considered when topical therapies are insufficient 1
- Acitretin is especially effective for patients with thick scales (lamellar ichthyosis and harlequin ichthyosis) 1
Common Pitfalls and Considerations
- Undertreatment due to fear of steroid side effects should be avoided 3
- Overuse of non-sedating antihistamines, which have little value in many dermatological conditions, should be avoided 3
- When using retinoids, patients should minimize sun exposure, use sunscreen (SPF 15+), and protect treated areas 2
- Retinoids can cause skin irritation, dryness, and increased sensitivity; starting with lower concentrations and gradually increasing frequency can help minimize these effects 2
- Concomitant use of topical over-the-counter acne preparations containing benzoyl peroxide, sulfur, resorcinol, or salicylic acid with retinoids should be approached with caution 2
- Primary care physicians can effectively manage most common dermatological conditions, but referral to dermatologists should be considered for severe, recalcitrant, or diagnostically challenging cases 5, 6