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14-Year-Old Patient with Facial Bumps | Complete Clinical Evaluation and Management Plan, Exams of Integrated Case Studies

Massachusetts Institute of Technology (MIT)Integrated Case Studies

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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2024/2025

Available from 06/09/2025

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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

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Download 14-Year-Old Patient with Facial Bumps | Complete Clinical Evaluation and Management Plan and more Exams Integrated Case Studies in PDF only on Docsity!

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.

Keratosis pilaris.
Other less common causes: cysts, dermatofibroma, benign nevi. Investigations (if needed):
Usually clinical diagnosis.
Skin swab/culture if secondary infection suspected.
Dermoscopy (if needed).
Biopsy (rarely, if diagnosis unclear). **Management Plan:

Education and Counseling:**

Normal course of adolescent acne or benign skin bumps.
Importance of skin hygiene without over-washing.
Avoid picking or squeezing lesions to prevent scarring.
Nutritional advice (balanced diet, avoid high glycemic foods if acne).
Address psychosocial impact, support self-esteem. 2. Medical Treatment: If Acne Vulgaris (likely):

Mild Acne: o Topical benzoyl peroxide or salicylic acid. o Topical retinoids (adapalene preferred in adolescents).
Moderate to Severe Acne: o Topical antibiotics (clindamycin) plus benzoyl peroxide to reduce resistance. o Oral antibiotics (doxycycline or erythromycin) if widespread or inflammatory lesions. o Hormonal therapy (e.g., oral contraceptives) in females if indicated.
Severe Nodulocystic Acne: o Consider referral to dermatologist for isotretinoin. Other Lesions:
Milia: often resolve spontaneously; may be removed by dermatologist.
Molluscum contagiosum: usually self-limiting.
Folliculitis: treat with topical/oral antibiotics depending on severity. 3. Follow-Up:
Reassess after 6-8 weeks.
Monitor for side effects of treatments.
Adjust therapy based on response.
Psychosocial support if acne affects mental health.

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:

Moderate to severe or recurrent: o Topical antibiotics (mupirocin). o Oral antibiotics if bacterial infection confirmed or suspected (cephalexin, dicloxacillin).
Avoid shaving or irritating skin. 5. Keratosis Pilaris
Regular use of moisturizers with urea or lactic acid to soften keratin plugs.
Gentle exfoliation with alpha-hydroxy acids or salicylic acid.
Reassure patient; chronic but benign condition. 6. Contact Dermatitis
Identify and avoid the irritant or allergen.
Use emollients regularly.
Topical corticosteroids (low to moderate potency) to reduce inflammation.
Oral antihistamines for itching if needed. 7. Eczema (Atopic Dermatitis)
Moisturizers applied multiple times daily.

Avoid triggers and irritants.
Topical corticosteroids for active inflammation.
Consider topical calcineurin inhibitors if corticosteroids contraindicated. 8. Perioral Dermatitis
Stop topical steroids immediately if used.
Gentle skin care, avoiding heavy creams and cosmetics.
Topical antibiotics (metronidazole or erythromycin gels).
Oral antibiotics (tetracycline or doxycycline) in more severe cases. 9. Impetigo
Topical mupirocin ointment applied three times daily for 5 days.
Oral antibiotics (cephalexin or dicloxacillin) if widespread or systemic signs. General Recommendations for All Facial Skin Conditions:

Minimize treatment side effects 2. Treatment Regimen: a. Topical Therapy (First-line)
Benzoyl Peroxide 2.5%-5% gel or wash : Apply once daily at bedtime; can increase to twice daily as tolerated. Action: Antimicrobial and anti-inflammatory.
Topical Retinoid (Adapalene 0.1% gel) : Apply once daily at bedtime after cleansing, avoiding eyes and mouth area. Action: Normalizes skin cell turnover, prevents clogged pores.
Topical Clindamycin 1% gel (optional, combined with benzoyl peroxide): Use once or twice daily if inflammation is prominent. b. Oral Therapy (if moderate to severe or extensive acne)
Doxycycline 100 mg once daily or 50 mg twice daily , for 3–6 months. Contraindicated in children <8 years and pregnancy.
Continue topical therapy during oral treatment. c. Adjunctive Care

Use gentle, non-comedogenic cleanser twice daily.
Avoid harsh scrubbing or abrasive cleansers.
Avoid oily or comedogenic cosmetics. 3. Follow-up:
Assess response and side effects after 6–8 weeks.
Adjust treatment if no improvement or worsening.
Consider referral to dermatologist if severe or nodulocystic acne. 4. Patient Education Handout: Understanding Acne
Acne is common in teens due to hormone changes that increase oil production.
Lesions can be blackheads, whiteheads, pimples, or cysts. How to Care for Your Skin
Wash your face gently twice daily with mild cleanser.
Use only products labeled “non-comedogenic” or “oil-free.”
Avoid picking or squeezing pimples—it causes scarring.

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:

Apply topical medications as your healthcare provider instructs, usually once daily at bedtime.
Some dryness, redness, or peeling may happen at first — this is normal. Use a gentle moisturizer if your skin feels dry.
Use sunscreen every day — acne medicines can make your skin more sensitive to the sun. Healthy Habits:
Eat a balanced diet and drink plenty of water.
Try to manage stress — stress can make acne worse.
Avoid excessive sun exposure and tanning beds. When to Contact Your Doctor:
If you develop a rash, severe irritation, or allergic reaction to your medicine.
If your acne worsens or you develop painful nodules or cysts.

14-Year-Old Patient with Facial Bumps | Complete Clinical Evaluation and Management Plan, Exams of Integrated Case Studies

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