COMMON SKIN PROBLEMS IN GENERAL PRACTICE

Dr. Rajesh Sankar, Consultant Dermatologist, Cochin Hospital, Ernakulam

 

Skin disease accounts for a good 20% of patients seen in general practice, and the common conditions seen in our population are listed here. 1. Infections and infestations: a) Bacterial infections: These include folliculitis, furunculosis, echthyma, erysipelas and cellulites, caused usually by Staphylococcus aureus, or by
Group Ab hemolytic streptococci, responding to appropriate antibiotics, viz., Cephalexin, or Amoxycillin – Clavulanate. b) Viral infections: These include Herpes simplex, which may affect the oral area, genital area, or otherwise, and Varicella zoster virus, causing Chicken pox and Herpes Zoster, both treated with varying doses of Aciclovir, or the newer Valaciclovir. Human papillomaviruses, causing warts, and Molluscum contagiosum virus, causing the disease by the same name, are the other common viral infections, and respons to ablative therapy, or the new medication, imiquimod. c) Fungal infections: Ermatophytoses (the Tineas), Tinea versicolor, and Candidiasis are the fungal infections, responding well to topical azoles like Clotrimazole and Miconazole, or newer drugs like Terbinafine and Butenafine, although susceptibilities vary. Widespread or chronic infections are treated with Griseofulvin ( in dermatophytoses only), and oral triazoles like Fluconazole or Itraconazole, and allylamines like Terbinafine. d) Infestations: Scabies and Pediculosis, both capitis and corporis are common infestations, and respond to oral Ivermectin or topical Permethrin or Lindane (which is used less nowadays) 2. Eczemas: a) Atopic Dermatitis: This eczema is on the rise following
industrialization and environmental changes, and is associated with asthma and allergic rhinitis and conjunctivitis. Treated with topical corticosteroids, topical immunomodulators, and oral antihistamines and antibiotics, depending on the extent and severity. b) Seborrheic Dermatititis: A common eczema affecting the
seborrheic areas, this has the fungus Malassezia furfur as one of the etiological factors. Responds to antifungals and topical corticosteroids, but is notoriously recurrent. c) Gravitational eczema: Seen in people with varicose veins. Topical neomycin is contraindicated here. d) Allergic and Irritant contact dermatitis and Nummular eczema are the other eczemas. e) Pityriasis alba, a common hypopigmentary disorder of childhood is now considered a variant of eczema. 3. Acne and its variants, a common disorder affecting the 15-45 age group, more so in the adolescents, is a disorder of the pilosebaceous apparatus, and is treated according to its grade and severity with topical retinoids, keratinolytics or antibiotics, or systemic antibiotics or retinoids, or a combination of both. 4. Psoriasis is a hyperproliferative disorder of the skin, resulting from a T helper cell imbalance, characterized by scaly plaques, with nail changes, and sometimesarthritis. Treatment varies from the basic topical applications like tar, to the latest modalities like Narrow bandUVB, and the “biologicals”. 5. Vitiligo is a disorder resulting from the destruction of melanocytes, probably of autoimmune etiology, and is a disorder which causes extreme emotional distress. Treatments include PUVA, and NBUVB, and topical corticosteroids and immunomodulators. 6. Urticaria, a very common disorder, results from mast cell degranulation by a variety of factors, treated with antihistamines, mast cell stabilizers, and oral contricosteroids, occasionally in severe cases, with angioedema. 7. Pityriasis rosea, a seasonal disorder, which is characterized by a herald patch, followed subsequently by daughter patches arranged in a fir tree pattern on the trunk, responding to UVB and topical corticosteroids. 8. Dermatitis medicamentosa, or simply drug eruptions can occur in myriad forms ranging from a localized fixed drug eruption to the severe toxic epidermal necrolysis, treated by withdrawal of the offending drug and supportive measures. 9. Lichen planus, which si a not so uncommon papulosquamous
disorder, which affects the skin and mucosa, characterized by intensely pruritic violaceous papules, resistant to a veriety of treatments. 10. Alopecias, or hair loss, which affect the cosmesis of the individual, result from different causes, more common ones being androgenic alopecia, and alopecia areata. Treatmetnt in androgenic alopecia ranges from topical minoxidil and systemic finasteride, to hair grafts.