Question

E.S. is a 15-year-old girl brought to the clinic for the fourth time in the last year with an inflammatory set of lesions on her back and chest, These lesions are surrounded by normal skin. They are highly irritated and the client complains that she can barely stand to wear clothing over these areas. The client’s mother states that this runs in the family.

Case Questions

1. Considering the signs and symptoms presented what is the likely diagnosis for E.S.?
2. What is the underlying pathophysiology of this inflammatory process?
3. What are the comorbidities for this disorder?
4. How is this disorder treated, and what is the rationale for using these specific treatments?

Answer 1

1)*SIGNS AND SYMPTOMS:

*Inflammatory lesions in acne include small red bumps (papules), pustules, large red bumps (nodules) and pseudocysts (these are fluctuant nodules).

*Inflammatory acne lesions are often painful.

2)PATHOPHYSIOLOGY OF INFLAMMATION:

*The initial inflammation phase consists of three subphases: acute, subacute, and chronic (or proliferative). The acute phase typically lasts 1–3 days and is characterized by the five classic clinical signs: heat, redness, swelling, pain, and loss of function. The subacute phase may last from 3–4 days to ~1 mo and corresponds to a cleaning phase required before the repair phase. If the subacute phase is not resolved within ~1 mo, then inflammation is said to become chronic and can last for several months. Tissue can degenerate and, in the locomotor system, chronic inflammation may lead to tearing and rupture. Alternatively, after the subacute inflammatory phase, tissue can repair and be strengthened during the remodeling phase.

*From a mechanistic point of view, the acute response to tissue injury occurs in the microcirculation at the site of injury. Initially, there is a transient constriction of arterioles; however, within several minutes, chemical mediators released at the site relax arteriolar smooth muscle, leading to vasodilation and increased capillary permeability. Protein-rich fluid then exudes from capillaries into the interstitial space. This fluid contains many of the components of plasma including albumin, fibrinogen, kinins, complement, and immunoglobulins that mediate the inflammatory response.

*The subacute phase is characterized by movement of phagocytic cells to the site of injury. In response to adhesion, molecules released from activated endothelial cells, leukocytes, platelets, and erythrocytes in injured vessels become sticky and adhere to the endothelial cell surfaces. Polymorphonuclear leukocytes such as neutrophils are the first cells to infiltrate the site of injury. Basophils and eosinophils are more prevalent in allergic reactions or parasitic infections. As inflammation continues, macrophages predominate, actively removing damaged cells or tissue. If the cause of injury is eliminated, the subacute phase of inflammation may be followed by a period of tissue repair. Blood clots are removed by fibrinolysis, and damaged tissues are regenerated or replaced with fibroblasts, collagen, or endothelial cells. During the remodeling phase, the new collagen laid down during the repair phase (mainly type III) is progressively replaced by type I collagen to adapt to the original tissue. However, if inflammation becomes chronic, further tissue destruction and/or fibrosis occurs.

3)COMBORDITIES FOR INFLAMMATORY LESIONS:

4)TREATMEND$RATIONALE:

*Skincare tips

*No inflamed acne treatment will work if you don’t properly care for your skin. Follow these tips to ensure you get the most out of the treatment options you try:

• While you shouldn’t try to pop any type of acne lesion, this is especially important for inflamed acne. Doing so can increase inflammation and cause it to spread.
• Wash your face morning and night with a gentle, gel-based cleanser.
• Shower immediately after working out.
• Follow your cleansing routine with an oil-free moisturizer, even if it feels counterintuitive. Skipping this step can deplete natural oils and water from your skin. In response, your sebaceous glands produce more oil, which leads to more acne.
• Wear a sunscreen-based moisturizer or foundation every single day. While this will help to protect your skin from UV rays, it’s also a must if you’re using retinoids or other treatments that make your skin more sensitive to the sun.
• If you wear makeup, look for oil-free and non-comedogenic options that won’t clog your pores or make your acne worse. Also, be sure to thoroughly remove your makeup before washing your face at night

*MEDICAL TREATMENT:

• Topical retinoids. Retinoids are powerful vitamin-A derivatives that remove dead skin cells. ...
• Isotretinoin. ...
• Oral antibiotics. ...
• Topical antibiotics. ...
• Hormonal treatments.
• H202 (CLEAN THE LESIONS)