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Chronic erythematous rash on the face
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Rosacea needs to be distinguished from acne, seborrhoeic eczema and perioral dermatitis. Acne occurs at a younger age and there should be comedones present as well as papules and pustules. Seborrhoeic eczema may be confused with rosacea. Seborrhoeic eczema is scaly, there are no pustules and the nasolabial folds rather than cheeks are affected; scaling will also be present in the scalp and possibly elsewhere (see p. 62). Perioral dermatitis (p. 91) occurs around the mouth in young adults. Systemic lupus erythematosus (p. 86) causes redness of the face but there are no papules or pustules and the patient is usually unwell.
Medical therapy
Published in Dimitris Rigopoulos, Alexander C. Katoulis, Hyperpigmentation, 2017
Alexander C. Katoulis, Efthymia Soura, Antigone Alevizou, Dimitris Rigopoulos
The topical use of corticosteroids has been associated with various adverse events. Steroid-induced acne is not uncommon and is characterized by the appearance of a rosacea-like eruption with persistent erythema, pustules, and papules, distributed in a centrofacial manner. This type of acne may flare if the corticosteroids are withdrawn abruptly, but usually improves after 1–3 months. Perioral dermatitis, seen predominately in adult women, is also possible. Another possible adverse event of topical corticosteroids, which are often used to treat allergic disorders, is allergic contact dermatitis. This adverse event has been observed with most topical corticosteroids.61 Skin atrophy may also be observed after long-term use. The skin becomes thinner and underlying vessels may become apparent. Telangiectasias may also be observed.61 For instance, in a study by Kanwar et al., a number of patients had to cease treatment after 4 weeks of treatment with clobetasol propionate 0.05% owing to local atrophy and appearance of telangiectasias.17 At this point, corticosteroids are not recommended as monotherapy for the treatment of melasma. However, when used in combination therapy, fluorinated steroids have been found to be superior to nonfluorinated steroids, both in efficacy and in safety.6
Papulopustular (Subtype 2) Rosacea
Published in Frank C. Powell, Jonathan Wilkin, Rosacea: Diagnosis and Management, 2008
Frank C. Powell, Jonathan Wilkin
Perioral dermatitis can usually be distinguished from PPR by its distribution on the face and the morphology of the skin lesions. As the name implies, the typical distribution of this eruption of fine vesicles, pustules, and papules is in a symmetrical fashion encircling the mouth with a zone of normal skin separating the eruption from the vermillion border of the lips (Figure 17). Sometimes the eruption can occur around the eyes when the term periocular dermatitis is used, and lesions can occur in the perinasal region. Occasionally the vesicles, papules, and pustules may be distributed in an asymmetrical fashion. Smaller and more superficial than the papules and pustules of PPR, the lesions, (firm erythematous papules, papulovesicles, and papulopustules), are often grouped (“agminated”). They are typically all in the same stage of evolution, in contrast to the inflammatory lesions of PPR that may be more variable in their stages of development. Erythema and scaling are two other constant findings, and the patient often complains of intolerance to sunlight and to local applications (including cosmetics and hot water). It is thought that bacterial or yeast overgrowth may give rise to the inflammatory lesions in patients with perioral dermatitis. Patients (females are most often affected) often give a history of having used topical corticosteroid creams before the onset of the eruption. Occasionally inhaled corticosteroids are responsible for this eruption (11). Discontinuation of the use of the topical corticosteroid and a systemic antibiotic (tetracyclines, minocycline, or erythromycin) taken over a sixweek period usually results in a complete clearance of the eruption. Subsequent relapse of perioral dermatitis is uncommon when the treatment is discontinued (unlike PPR when such relapse is frequent). It should be remembered, that the lesions of PPR may occur in a perioral distribution as shown in Figure 18(A) and a periocular distribution as shown in Figure 18(B). The papules in patients with PPR are usually larger than those seen in perioral dermatitis and vesiculation is not a feature.
Evaluation of the changes in sebum, moisturization and elasticity in acne vulgaris patients receiving systemic isotretinoin treatment
Published in Cutaneous and Ocular Toxicology, 2021
Güllü Gencebay, Özge Aşkın, Server Serdaroğlu
Thirty-five adult patients (20 female, 15 male) who were diagnosed with acne vulgaris and who received systemic isotretinoin treatment for 6 months in Cerrahpaşa Medical Faculty Department of Dermatology between June 2012 and May 2017 were included in this study. The ages of the patients ranged from 16 to 32 years. Patients under the ages of 16 years were excluded. The other exclusion criteria were pregnancy, lactation, use of other systemic drugs for comorbid diseases, use of other topical or systemic drugs for acne vulgaris and hormonal irregularities. Patients with other dermatological diseases on the face (such as herpes infection, impetigo, perioral dermatitis, seborrhoeic dermatitis, lupus erythematosus) were excluded in the study because they may affect the parametres.
Investigational drugs for atopic dermatitis
Published in Expert Opinion on Investigational Drugs, 2018
Kam Lun Hon, Alexander K.C. Leung, Theresa N. H. Leung, Vivian W. Y. Lee
Successful treatment of AD requires a systematic multipronged approach that consists of avoidance of triggering factors, optimal skin care, pharmacotherapy during acute exacerbations, and education of patients/caregivers [1,8]. Topical corticosteroids are the mainstay of pharmacotherapy for AD, with the choice of potency depending on the severity, site, and extent of the outbreak [8]. Corticosteroids mediate their anti-inflammatory effects through binding to a cytoplasmic glucocorticoid receptor in the target cells and forming complexes that enter the nucleus of the cell. The risk of side effects depends on the potency of the corticosteroid, concomitant use of occlusion, the area being covered, skin integrity, and duration of treatment. Compared with adults, children are at higher risk of both local and systemic effects. Local adverse effects particularly on delicate skin areas include skin atrophy, striae, depigmentation, telangiectasia, decreased subcutaneous adipose tissue, rosacea, perioral dermatitis, folliculitis, and steroid acne. Among systemic side effects are Cushing’s syndrome, adrenal suppression, cataracts, glaucoma, osteopenia/osteoporosis, and growth retardation. Rebound flares may occur following discontinuation of therapy. Tachyphylaxis may occur with prolonged treatment [36,37]. There is scanty evidence that growth retardation can also occur from inadequate control of severe eczema [38]. A new autosomal recessive entity has also been reported that severe pre- and postnatal growth retardation and developmental delay is associated with eczema [36-39]. Meanwhile, appropriate usage of topical corticosteroids for AD has been demonstrated to be associated with therapeutic efficacy without any adverse effects [40].
Review of international psoriasis guidelines for the treatment of psoriasis: recommendations for topical corticosteroid treatments
Published in Journal of Dermatological Treatment, 2019
Elise C. Kleyn, Elaine Morsman, Lizelle Griffin, Jashin J. Wu, Peter Cm van de Kerkhof, Wayne Gulliver, Joelle M. van der Walt, Lars Iversen
It is advised that the potency of steroid should be considered depending on the site of treatment, but specific details are not given. Local side effects of skin atrophy and telangiectasia in relation to prolonged therapy and use on sensitive sites are stated (7). Other local adverse effects are mentioned in brief, including perioral dermatitis, striae, hypertrichosis and infections. In agreement with the NICE guidelines (2), systemic adverse effects are not included (7).