Common Skin Conditions and Management in Adults
Most Prevalent Skin Conditions
The most common skin conditions affecting the general adult population are warts (41.3%), acne (19.2%), contact dermatitis (15.0%), atopic dermatitis (13.8%), psoriasis (13.3%), and urticaria (11.0%), with approximately 60% of middle-aged adults having at least one skin disease requiring treatment. 1, 2
Epidemiological Patterns
- Women are more frequently affected by most skin diseases compared to men, with the exception of skin cancer which shows slightly higher prevalence in males 1
- Northern European countries (Germany, Netherlands, Sweden) demonstrate higher prevalence of skin diseases compared to southern European countries (Italy, Portugal) 1
- Skin infections and eczemas occur more commonly in populations with lower educational attainment 2
- Males (70%) have more skin diseases requiring treatment than females (52%) in middle-aged populations 2
Acne Vulgaris Management
All acne patients should begin with topical retinoid (adapalene 0.1-0.3% or tretinoin 0.025-0.1%) combined with benzoyl peroxide 2.5-5% as foundational therapy, escalating based on severity by adding topical or oral antibiotics for moderate-to-severe disease, always with concurrent benzoyl peroxide to prevent resistance. 3, 4, 5
Severity-Based Treatment Algorithm
Mild Acne:
- Start with topical retinoid + benzoyl peroxide as first-line treatment 3, 4
- Adapalene 0.1% is preferred due to superior tolerability, lack of photolability, and over-the-counter availability 3, 4
- Alternative options include azelaic acid for patients with post-inflammatory dyspigmentation 4
Moderate Acne:
- Use fixed-dose combination of topical retinoid + benzoyl peroxide 3, 4
- Add topical antibiotics (clindamycin 1% or erythromycin 3%) combined with benzoyl peroxide for inflammatory lesions, never as monotherapy 4, 5
- Fixed-combination products (erythromycin 3%/BP 5%, clindamycin 1%/BP 5%, clindamycin 1%/BP 3.75%) enhance treatment compliance 4
Moderate-to-Severe Acne:
- Initiate triple therapy: oral antibiotics + topical retinoid + benzoyl peroxide 3, 4
- Doxycycline 100 mg once daily is strongly recommended as first-line oral antibiotic for patients ≥9 years 3, 5
- Minocycline 100 mg once daily is conditionally recommended as an alternative 4, 5
- Limit systemic antibiotics to 3-4 months maximum to minimize bacterial resistance 3, 4, 5
Severe or Recalcitrant Acne:
- Isotretinoin is indicated for severe nodular acne, treatment-resistant moderate acne after 3-4 months of appropriate therapy, or any acne with scarring or significant psychosocial burden 3, 4
- Standard dosing is 0.5-1.0 mg/kg/day targeting cumulative dose of 120-150 mg/kg 3
- Monitor liver function tests and lipids; routine CBC monitoring is not needed in healthy patients 4
- Mandatory pregnancy prevention through iPledge program for persons of childbearing potential 3, 4
Hormonal Therapy for Female Patients
- Combined oral contraceptives reduce inflammatory lesions by 62% at 6 months and are conditionally recommended 3, 4
- Spironolactone 25-200 mg daily is useful for hormonal acne patterns, premenstrual flares, or those who cannot tolerate oral antibiotics 3, 4
- No potassium monitoring needed in healthy patients without risk factors for hyperkalemia 4
Adjunctive Treatments
- Intralesional triamcinolone acetonide 10 mg/mL for larger nodules provides rapid pain relief within 48-72 hours and prevents scarring 3, 5
- Topical clascoterone is a newer antiandrogen conditionally recommended based on high certainty evidence 3, 4
Maintenance Therapy
- Continue topical retinoid monotherapy indefinitely after achieving clearance to prevent recurrence 3, 4
- Benzoyl peroxide can be continued as maintenance therapy 4
Critical Pitfalls to Avoid
- Never use topical or oral antibiotics as monotherapy—resistance develops rapidly without concurrent benzoyl peroxide 3, 4, 5
- Never extend oral antibiotics beyond 3-4 months without re-evaluation, as this dramatically increases resistance risk 3, 4, 5
Atopic Dermatitis Management
Atopic dermatitis affects 13.8% of the general adult population and requires awareness of associated comorbidities including other atopic conditions, infections, autoimmune diseases, mental health disorders, metabolic conditions, and cardiovascular disease. 6
Key Clinical Considerations
- Atopic dermatitis is a chronic, pruritic inflammatory skin disease that follows a relapsing course 6
- Often associated with personal or family history of allergic rhinitis and asthma 6
- Treatment typically consists of topical emollients and corticosteroids; phototherapy is reserved for refractory cases 7
Contact Dermatitis Management
Contact dermatitis affects 15.0% of the general adult population and presents as scaling patches and plaques. 6, 1
Treatment Approach
- Therapy typically consists of topical emollients and corticosteroids 7
- Phototherapy is reserved for refractory cases 7
- For generalized drug eruptions, eliminate the inciting agent, use topical antipruritics, and systemic corticosteroids for severe reactions 7
Psoriasis Management
Psoriasis affects 13.3% of the general adult population and presents as scaling patches and plaques. 6
Treatment Considerations
- Therapy typically consists of topical emollients and corticosteroids 7
- Phototherapy is reserved for refractory cases 7
- Topical calcipotriene may be used but can cause transient irritation of lesions and surrounding skin; discontinue if irritation develops 8
- Patients using calcipotriene should avoid excessive exposure to natural or artificial sunlight, as it may enhance UVR-induced skin tumor formation 8
Urticaria Management
Urticaria affects 11.0% of the general adult population. 6
Infectious Skin Conditions
Bacterial Infections
Skin infections affect 44% of middle-aged adults and are more common in populations with lower educational attainment. 2
Impetigo:
- May present as bullous eruption or erosion with honey-colored crust 7
- Treatment involves topical or systemic antibiotics depending on extent 7
Cellulitis:
Folliculitis:
- Bacterial infection of hair follicles 7
Fungal Infections
Tinea infections:
- Usually treated with topical antifungals 7
- If infection is located in hair-bearing area, systemic antifungals are necessary 7
Candidiasis:
- Common fungal infection requiring antifungal therapy 10
Viral Infections
Warts (Verruca):
- Most common skin disease affecting 41.3% of the general adult population 1
- Treatment varies from observation to cryosurgery and topical imiquimod 7
Herpes Simplex and Herpes Zoster:
Molluscum Contagiosum:
Ectoparasitic Infections
Scabies:
Pediculosis (Lice):
Sebaceous Gland Diseases
Sebaceous gland diseases affect 27% of middle-aged adults. 2
Seborrheic Dermatitis:
Eczematous Conditions
Eczemas affect 27% of middle-aged adults and are more common in populations with lower educational attainment. 2
Asteatotic Eczema:
- Common in hospitalized older adults due to drier and less elastic skin with declining sebum levels 9
- Comprehensive skin assessments help diagnose and commence management 9
Vascular and Venous Conditions
Venous Ulcers:
Skin Cancers
Melanoma and keratinocyte cancers have disproportionately greater clinical practice guideline representation compared to disease burden, particularly in high-income countries. 6
- Skin cancer has slightly higher prevalence in men compared to women 1