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Common Dermatologic Issues in Family Planning

Common Dermatologic Issues in Family Planning. Roli Dwivedi, MD Medical Director Community University Health Care Center (University of Minnesota Medical Center). Disclosures and Disclaimers. This webinar is sponsored by the Region V Training Project of HCET.

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Common Dermatologic Issues in Family Planning

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  1. Common Dermatologic Issues in Family Planning Roli Dwivedi, MD Medical Director Community University Health Care Center (University of Minnesota Medical Center)

  2. Disclosures and Disclaimers This webinar is sponsored by the Region V Training Project of HCET. Any views or opinions in this presentation are solely those of the presenter and do not necessarily represent those of the funders. Health Care Education and Training, Inc. accepts no liability for the content of the presentation or for the consequences of any actions taken on the basis of the information provided. Roli Dwivedi, MD, states that she does not have a financial interest in or other relationship with any commercial product named in this presentation.

  3. Need Assistance? Health Care Education & Training 317-247-9008 Technical Support 866-229-3239

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  5. Roli Dwivedi, MD • Medical director and a family physician providing a full scope of medical care at the University of Minnesota Health Care Center • Specific interests include women’s health, adolescent health, and procedures • Honored by both the American Academy of Family Physicians and the Society of Teachers in Family Medicine for her teaching in this field • Graduate of Dr. Vaishampayan Memorial Medical College (Maharashtra, India), and served her residency at the University of Minnesota Medical Center

  6. Objectives • Describe common dermatological conditions encountered in the family planning context • Recognize situations warranting referral for further evaluation.

  7. Family Planning Context

  8. Steps in Dermatology Diagnosis • Keep your differential simple • Detailed history • Detailed exam • Primary, secondary and tertiary look • Magnified and tactile look • Positional look • Deeper look ( biopsy)

  9. ACNE

  10. Prevalence of Acne • In the US more than 50 million are affected by some form of Acne and over 17 million have Acne vulgaris • Women > Men • 79-95% of all teens are affected • May also begin in 20’s and 30’s and can persist in adults • Most patients are mild to moderate

  11. Component of Acne development • Follicular plugging and excessive sebum production • Enlargement of sebaceous glands and development of microcomedones • Propionobacterium acnes in microcomedones triggers inflammatory process

  12. Treatment of Acne • Topical retinoids • Tretinoin and Isotretinoin • Adapalene • Tazarotene ( only 0.1% for Acne) • Adapalene is best tolerated , Tazarotene is more effective but more irritating • Use of topical retinoids not recommended in pregnancy specially tazarotene is cat X.

  13. Treatment of Acne • Topical antimicrobials • Benzoyl peroxide • Topical antibiotics • Erythromycin, Clindamycin, Sulfacetamide and Dapsone • Combination therapy with antimicrobilas and topical retinoids is more effective

  14. Treatment of Acne • Systemic antibiotics • Doxycycline 100 mg BID • Minocycline 100 mg BID • Tetracycline 500 mg BID • Bactrim 1 tab Bid • Erythromycin 500 mg BID • Azithromycin 250-500 mg QD ( pulses)

  15. Pulse Dosing of Antibiotics in Acne • Azithromycin is most often used with various dosing regimens • Comparable efficacy with daily dosing of antibiotics.

  16. Newer Formulations for Acne • Oracea ( Doxycycline) • 30 mg immediate release • 10 mg delayed release • Periostat • Doxycycline 20 mg Po BID (FDA approved for treatment for Rosacea)

  17. Newer Formulations of Antibiotics • Solodyne • Extended release of Minocycline • Dosing is weight based • Lowest effective dose is1mg/kg/day • 45,90,135 mg daily dosing • Approved for 12 wks of use.

  18. Hormonal Therapy for Acne • Consider for patients with evidence of hyperandrogenism • Can be used for post-menarchal and adults who are trying to prevent pregnancy • Most common therapies are oral contraceptives and spiranolactone • Minimum 3-6 months therapy is required to determine efficacy.

  19. Treatment of Resistant Acne • Oral Isotretinoin- • Severe recalcitrant nodular acne • Scarring Acne • Acne causing significant psychological distress • Acne fulminans • Antibiotic induced gram negative folliculitis in patients with acne vulgaris

  20. Referral to Dermatology • Laser • Visible light • Chemical peel • Can also refer for Acutane treatment

  21. ROSACEA

  22. Rosacea • Chronic acneiform disorder • Affects middle age and older adults • Vascular dilatation of central face • Flushing reaction is provoked by hot spicy food, alcohol ingestion, temperature extremes and emotional reactions. • Varies from simple erythema to papule, nodule, cyst but no comedones

  23. Rosacea look alike • Acne • Seborrheic dermatitis • SLE • Carcinoid syndrome • Chronic topical glucocorticoid therapy

  24. Treatment- Rosacea • Life style changes • Mild cleanser and sunblock • Topical Metronidazole • Topical Azelaic acid • Topical Clindamycin,erythromycin or Sulfacetamide • Benzoyl peroxide • Topical permethrin cream

  25. Treatment- Rosacea • Topical Retinoids- Tretinoin or Adapalene • Oral antibiotics- Tetracyclin, Doxycyclin, Erythromycin and Minocyclin. • Oral Clonidine and beta blockers can be tried for flushing. • Topical Oxymetazoline for facial Erythema

  26. Referral to Dermatology • Severe nodulocystic and recalcitrant Rosacea • Rhinophyma unresponsive to topical and oral therapy • Pulsed dye vascular laser therapy, Intense pulsed light therapy.

  27. PSEUDOFOLLICULITIS BARBAE

  28. Pseudofolliculitis Barbae • Common in African American population • Papulopustular lesions right next to hair follicles. • Noninfectious, inflammatory condition occurring in males with curly hair

  29. Treatment- Pseudofolliculitis Barbae • Soften facial hair well with warm water before shaving. • The bearded area should be covered with gentle shaving gel before shaving. • A special razor can be used • Bump Fighter, the Foil Guard shaver and the PFB razor

  30. Treatment- Pseudofolliculitis Barbae • Use soft-bristled toothbrush in a circular motion on bearded area to dislodge hair tips • Shave in the direction of beard growth not against • Aftershave lotion should be avoided

  31. Treatment- Pseudofolliculitis Barbae • May use very mild steroid lotion for very brief period of time • Steroids on face can lead to skin color changes and atrophy • Topical Retinoids are sometimes helpful.

  32. HUMAN PAPPILOMAVIRUS

  33. Warts and HPV facts • Approximately 20 million people are infected with HPV. • Approximately 50% of sexually active people will acquire HPV • By age 50 ,80 % of female will have HPV • 6.2 million Americans get a new genital HPV infection each year • Females can be diagnosed for HPV. • No HPV test for men

  34. Plantar and Palmar Warts • Painful lesions on the sole of foot or digits • Caused by certain type of HPV ( type 1) • Skin to skin contact • Should be treated only if symptomatic as dermal scarring from treatment can itself be painful.

  35. How to differentiate Corns from Warts • Corns are maximally painful on direct pressure • Warts are more painful on pinching. • Corns do not have dots in it, where as black dots in warts are thrombosed capillaries with in them. • Corns do not disrupt foot prints • Corns tend to occur at pressure points where as warts can grow anywhere

  36. Treatment- Plantar Warts and Corns • Liquid nitrogen. • Salicylic acid • TCA ( Tri- Chloro acetic acid) • Cantharidin ( 0.7 %) • Cimetidine • Imiquimod ( Aldara) • Tretinoin

  37. Referral to Dermatology • Immunotherapy • Intralesional Bleomycin • Laser therapy • Topical treatment with cidofovir • Oral Acitretin • Super pharmacologic doses of Zinc.

  38. GENITAL WARTS (CONDYLOMA ACCUMINATA) • Genital HPV is STD!! ( type 6, 11, 16 and 18) • Most people with HPV remain asymptomatic and clear infection on their own, yet they can transmit virus • High and low risk • Low risk may lead to mild abnormality of pap or genital warts. • High risk ( 16 and 18) may cause cancer of cervix, vulva, vagina, anus and penis.

  39. Genital Warts • Single/ multiple/ cauliflower like growth. • Soft, moist pink or flesh colored • Raised or flat

  40. Condyloma Lata and Accuminata

  41. Genital Warts treatment • No treatment is better than other • No treatment is ideal for all causes • No cure!! • Treatment is directed towards changes made by HPV virus

  42. Genital Warts treatment • TCA ( Tri- Chloro acetic acid) • Podophylin • Cryotherapy • Aldara • 5 fluorouracil Epinephrine gel. • Laser • Intralesional Interferon alfa

  43. HERPES

  44. Herpes Classifications • Primary • Secondary • Recurrent • Herpes labialis • Herpes genitalis • Herpes zoster

  45. Clinical Symptoms • Fever, bodyache, generalized malaise with primary lesions. • Painful lesions • Dysuria • Lymphadenopathy

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