Inflammation of the pilosebaceous glands form papules, nodules, and cysts
on the face, neck, shoulders, and back as a result of keratin plugs at the base of
the pilosebaceous oil glands near the hair follicles.
The increase in androgen production that occurs during adolescence increases
the production of sebum, an oily skin lubricant. Sebum combines with keratin to
form a keratin plug. An individual has little control over acne except to eat a
nutritionally healthy diet and practice good hygiene. Acne is significantly influ-
enced by age, heredity, stress, hormonal changes, and onset of puberty. All of
these are beyond the patient’s control.
Acne is treated by gently applying a cleansing agent several times a day to the
skin. Vigorous scrubbing should be avoided. In addition, the patient can admin-
ister topical anti-acne medication such as keratolytics. These include benzoyl
peroxide, resorcinol, and salicylic acid that dissolves keratin, the outer layer of
the epidermis.
The patient should undergo systemic treatment if he or she has a severe case
ofacne vulgaristhat results in scarring, has persistent hyperpigmentation, or
when topical treatment fails (see Table 20-1).
A list of drugs utilized in the treatment of skin disorders is provided in the
Appendix. Detailed tables show doses, recommendations, expectations, side
effects, contraindications, and more; available on the book’s Web site (see URL
in Appendix).
PSORIASIS
Psoriasis is a chronic skin disorder characterized by erythematous papules and
plaques covered with silvery scales appearing on the scalp, elbows, palms of the
CHAPTER 20 Skin Disorders^375
Non-Hormonal Treatment Hormonal Treatment
Antibiotics, oral Corticosteroids
Tetracycline Anti-inflammatory actions: high dose
Erythromycin Androgen suppressant action: low dose
Minocycline Sex hormones (for women only)
Trimethoprim-sulfamethoxazole Estrogen (oral contraceptive medication)
Isotretinoin, oral AntiandrogensTable 20-1. Medication for systemic therapy.