Cosmetic Dermatology in Primary Care

Cosmetic Dermatology in Primary Care
by: Jenifer Hammond MD

What is Skin?
* A protective, yet permeable barrier for the human body
* Body’s largest organ
* Most essential source of sensory stimulation

Three layers of skin
* Epidermis
* Dermis
* Subcutaneous fat (hypodermis)

Facts of Aging Skin
Clinical Signs of Aging Skin
Clinical Signs of Photoaging Skin
FACTS about PhotoAging
Photodamaged Skin
What is the treatment for Photoaging Skin?
You Are What You Eat!
What is Good Skin Care?
Exfoliate
Microdermabrasion
Hydrate
Protect
Skin Cancer Facts 2007
Topical C
Prevage MD
UVB Protection
Sun Protection Tips
UVA protection “What’s New”
Sunscreen
Retinoids
Rejuvenation Procedures
Peels
What are Chemical Peels?
Types of Peels
Glycolic Acid (AHA)
Jessnar’s Peel
TCA Peel
Facial Fillers
Collagen
Collagen Lip Augmentation
Hyaluronic Acids
Juvederm
Radiesse
Marionette before After 3 months
Nasolabial before After 3 months
Cheeks before After 3 months
Sculptra
Before Sculptra
Sculptra after 3 treatments
Lasers
IPL Photo-Facial
IPL with Levulan Therapy
Laser Hair Removal
“What’s New”
Ablative & Non-Ablative Skin Resurfacing
Mechanism of Light-induced Skin Rejuvenation
Light absorption by tissue water
Inflammatory response
Release of inflammatory mediators into dermal interstitium
Aesthetica Cosmetic & Laser Center
Non-ablative tissue tightening

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Acne

Acne
By: David M. Bracciano, D.O.

Acne Vulgaris
* Chronic inflammatory disease of the pilosebaceous follicles
* Comedones, papules, pustules, cysts, nodules, and often scars
* Face, neck, upper trunk, and upper arms
* Disease of the adolescent
* 90% of all teenagers
* May also begin in twenties
* Usually involution by 25
* Occurs primarily in oily{seborrheic} areas of the skin
* Face occurs; cheeks> nose>forehead>chin
* Ears; comedones in concha, cysts in lobules
* Retroauricular and nuchal cysts

Comedo
* Commonly known as the blackhead
* Basic lesion of acne
* Produced by hyperkeratosis of the lining of the follicles
* Retention of keratin and sebum
* Plugging produced by the comedo dilates the mouth of the follicle
* Papules are formed by inflammation around the comedones

Severity of Acne
* Typical mild acne; comedones predominate
* More severe cases; pustules and papules predominate, heal with scar if deep
* Acne Conglobata; suppurating cystic lesions predominate, and severe scarring results
Types
* Acne comedo; mild case were eruption is composed almost entirely of comedones on an oily skin
* Papular acne; inflammatory papules, most common in young men with coarse, oily skin
* Atrophic acne; residual atrophic pits and scars
Etiology
* Keratin plug in lower infindibulum of hair follicle
* Androgenic stimulation of sebaceous, proliferation of propionbacterium acnes which metabolizes sebum to produce free fatty acids
Pathogenesis
* Disruption of the follicular epithelium permits discharge of the follicular contents into the dermis
* Causes the formation of inflammatory papules, pustules, and nodulocystic lesions
* FFA are chemotactic to components of inflammation
* Effects of tetracycline are obtained by the reduction of FFA
* Antibiotics do not produce involution of the inflammatory lesions present, but inhibit the formation of new lesions
* Topical retinoic acid acts on keratinization, causing horny cells to lose their stickiness
* Androgens enlarge the sebaceous glands
* In women consider hyperandrogenic state

Histology
Treatment
Antibacterials
Tetracyclines
Minocycline
Bacterial Resistance
Oral Contraceptives
Hormonal Therapy
Isotretinoin
Topical Treatment
Benzoyl Peroxide
Topical Retinoids
Topical Antibacterials
Other Topicals
Surgcial Treatment
Intralesional Corticosteroids
Complications of Acne
Acne Conglobata
Acne Fulminans
SAPHO Syndrome
Tropical Acne
Premenstrual Acne
Preadolescent Acne
Neonatal Acne
Infantile Acne
Acne Venenata
Acne Cosmetica
Acne Detergicans
Acne Aestivalis
Excoriated Acne
Acneiform Eruptions
Gram Negative Folliculitis
Acne Keloidalis
Hiradenitis Suppurativa
Perifolliculitis Capitis Abscedens
Acne vs. Rosacea
Ocular Rosacea
Granulomatous Rosacea
Rosacea Etiology
Differential Diagnosis Rosacea
Inflammatory rosacea
Rosacea Treatment
Rosacea Rhinophyma
Pyoderma Faciale
Perioral Dermatitis

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Dermatology

Dermatology
By: Katrice L. Herndon, MD
Internal Medicine/Pediatrics

Acne Vulgaris

* Acne is a self-limited disorder primarily of teenagers & young adults.
* Acne is a disease of pilosebaceous follicles.
* 4 factors are involved:
* External Factors that contribute to Acne
* Acne vulgaris typically affects those areas of the body that have the greatest number of sebaceous glands:
* In addition to the typical lesions of acne vulgaris, scarring and hyperpigmentation can also occur.
* Hyperpigmentation is most common in patients with dark complexions
* Classification of Acne

Acne Vulgaris What is this?

Acne Rosacea
* Rosacea is an acneiform disorder of middle-aged and older adults.
* Characterized by vascular dilation of the central face, including the nose, cheek, eyelids, and forehead.
* The cause of vascular dilatation in rosacea is unknown.
* The disease is chronic.
* rosacea is a chronic disorder characterized by periods of exacerbation and remission.
* Increased susceptibility to recurrent flushing reactions that may be provoked by a variety of stimuli including hot or spicy foods, drinking alcohol, temperature extremes, and emotional reactions.
* The earliest stage of rosacea is characterized by facial erythema and telangiectasias.
* Patients with rosacea may develop severe sebaceous gland growth that is accompanied by papules, pustules, cysts, and nodules.
Allergic Contact Dermatitis
Psoriasis
Psoriasis Treatment
Vitiligo
Pityriasis Rosea
Cellulitis
Erysipelas
Ecthyma
Treatment
Tinea Vesicolor
Cutaneous Warts
Differential Diagnosis
Secondary Syphilis
Treatment
Herpes Zoster
Treatment
Actinic Keratosis
References

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