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14-Year-Old Patient with Facial Bumps | Complete Clinical Evaluation and Management Plan ,adolescent health [soapnote %powerpoint] PATIENT WITH FACIAL BUMPS | COMPLETE CLINICAL EVALUATION AND MANAGEMENT PLAN ,ADOLESCENT HEALTH
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14 - Year-Old Patient with Facial Bumps | Complete Clinical Evaluation and Management Plan ,adolescent health [soapnote %powerpoint] PATIENT WITH FACIAL BUMPS | COMPLETE CLINICAL EVALUATION AND MANAGEMENT PLAN ,ADOLESCENT HEALTH I-HUMAN CASE WEEK #2/14-YEAR-OLD PATIENT WITH FACIAL BUMPS
Case Overview: Patient: 14 - year-old adolescent Chief Complaint: Facial bumps History: Present for weeks/months (ask onset/duration) Associated Symptoms: Pain, itching, discharge, systemic symptoms? Past Medical History: Skin issues, allergies, medications? Family History: Skin diseases, acne, autoimmune disorders? Social History: Hygiene, cosmetics, diet, stress, smoking? Review of Systems: Focus on systemic symptoms—fever, weight loss, fatigue. Clinical Evaluation:
1. History Taking: - Onset, duration, progression of bumps.
2. Milia - Small, white, firm cysts caused by trapped keratin. - Common on cheeks, eyelids, nose. - Usually asymptomatic, no inflammation. 3. Molluscum Contagiosum - Viral infection (poxvirus). - Flesh-colored, dome-shaped, umbilicated papules. - Contagious, often grouped. 4. Folliculitis - Inflammation/infection of hair follicles. - Small pustules with erythema, sometimes painful. - Caused by bacteria (e.g., Staph aureus), fungi, or irritation. 5. Keratosis Pilaris - Rough, small follicular papules with keratin plugs. - Typically on cheeks, upper arms, thighs. - Not inflamed or painful. 6. Contact Dermatitis - Allergic or irritant reaction to topical agents (cosmetics, soaps). - Red, itchy bumps or plaques. - History of exposure important.
7. Eczema (Atopic Dermatitis) - Dry, itchy, inflamed skin. - May cause excoriated bumps or papules on face. 8. Perioral Dermatitis - Papulopustular eruption around the mouth and sometimes eyes. - Often linked to steroid use or cosmetics. 9. Sebaceous Hyperplasia - Enlarged sebaceous glands; yellowish papules with central umbilication. - More common in adults but can appear in adolescents. 10. Viral Exanthems - Some viral infections can cause facial papules or vesicles (e.g., chickenpox). 11. Impetigo - Bacterial superficial skin infection. - Honey-colored crusted lesions, often around the nose and mouth. 12. Dermatofibroma
Diagnosis Lesion Type Key Features Common Location Folliculitis Pustules at hair follicles Painful, may be infected Face, scalp, beard area Keratosis Pilaris Rough, follicular papules Keratin plugs, non-inflamed Cheeks, arms, thighs Contact Dermatitis Red, itchy papules/plaques History of exposure Anywhere exposed Eczema Dry, itchy, inflamed skin Chronic, excoriated lesions Face, flexural areas Perioral Dermatitis Papulopustular rash Around mouth, no comedones Perioral area Impetigo Honey-crusted lesions Superficial bacterial infection Around nose, mouth Sure! Here’s a comprehensive treatment plan for the common and some less common causes of facial bumps in a 14-year-old adolescent: Treatment Plan for Facial Bumps in Adolescents
1. Acne Vulgaris Mild Acne: - Topical treatments: o Benzoyl peroxide (2.5%–5%) once daily to twice daily — antimicrobial, reduces inflammation. o Topical retinoids (adapalene 0.1%) once daily at bedtime — normalizes follicular epithelial desquamation. o Topical antibiotics (clindamycin) combined with benzoyl peroxide to reduce resistance. Moderate to Severe Acne: - Oral antibiotics (doxycycline or erythromycin) for 3– 6 months. - Continue topical therapy alongside. - In females, consider combined oral contraceptives (estrogen-progestin) if indicated. - Avoid systemic corticosteroids unless otherwise directed. Severe Nodulocystic Acne: - Refer to dermatologist for consideration of isotretinoin therapy (oral vitamin A derivative). Adjunctive Measures:
1. Patient Education Handout (Printable Style) Understanding Acne in Adolescents What You Need to Know What is Acne? Acne is a common skin condition during the teenage years caused by hormonal changes that increase oil production in the skin. It causes pimples, blackheads, whiteheads, and sometimes painful cysts on the face and other areas. How to Care for Your Skin: - Wash your face gently twice a day with a mild cleanser. - Use only skincare and makeup labeled “non- comedogenic” or “oil-free.” - Do not pick, squeeze, or pop pimples — this can cause scars. - Be patient — acne treatments usually take 6 to 8 weeks to work.
Using Your Acne Medications: