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Commonly used dietary supplements include:
- Omega-6 fatty acids (e.g., safflower or sunflower oil)
- Omega-3 fatty acids (e.g., fish oils)
- Vitamin A.
Immunosuppressant and anti-inflammatory therapy serves to stop on-going destruction of the sebaceous glands. Like other inflammatory diseases, most animals receive an initial course to stop the inflammation and treatment is tapered off to the lowest dose that keeps the disease in remission. Oral cyclosporine may be used. Corticosteroids (e.g. prednisone) are used only if pruritus is a major clinical feature.
Most doctors consider this a normal physiological phenomenon and advise against treatment.
Topical treatments such as warm compresses to the chin area may be sufficient for mild cases. Veterinary intervention may be required for treatment if secondary infection occurs. In this case, treatment may begin with clinical drainage of the pustules and a course of oral antibiotics.
Clearing the acne can be accomplished using an old toothbrush or flea comb (one designated for this purpose) and brush the cat's chin. This will loosen debris and remove dried scabs. Cleansing pads containing salicylic acid can be rubbed gently and allowed to air dry on the affected area. This may dissolve the oil that is clogging skin pores. Epsom-salt compresses applied twice daily dry the affected area to relieve the inflammation and itchiness.
Placing the cat's water in a shallow dish may prevent the chin from absorbing the bacteria in the water while the cat is drinking. If the cat is allergic to plastics or dyes, using a stainless-steel or glass dish is recommended . Cats may also have food allergies that make the development of acne more likely, so that switching kibble, or changing to a hydrolysed diet may be effective. Maintaining good hygiene and grooming habits make the development of feline acne less likely. Washing and exfoliating the chin with a gentle benzoyl-peroxide solution also may be preventive of further outbreaks.
Treatments for CCCA remain investigational. Altering hair care practices has not been proven to assist in hair rejuvenation. High-dose topical steroids, antibiotics, immunomodulators such as tacrolimus (Protopic) and pimecrolimus (Elidel), and anti-androgen/5alpha Reductase inhibitors have been used with unknown efficacy.
Treatment consists of paring down the bulk of the tissue with a sharp instrument or carbon dioxide laser and allowing the area to re-epithelialise. Sometimes, the tissue is completely excised and the raw area skin-grafted.
Using non-oily cleansers and mild soap may not cause as much irritation to the skin as regular soap. Blackheads can be removed across an area with commercially available pore-cleansing strips or the more aggressive cyanoacrylate method used by dermatologists.
Squeezing blackheads and whiteheads can remove them, but it can also damage the skin. Doing so increases the risk of causing or transmitting infection and scarring, as well as potentially pushing any infection deeper into the skin. Comedo extractors are used with careful hygiene in beauty salons and by dermatologists, usually after using steam or warm water.
Complementary medicine options for acne in general have not been shown to be effective in trials. These include aloe vera, pyridoxine (vitamin B6), fruit-derived acids, kampo (Japanese herbal medicine), ayurvedic herbal treatments and acupuncture.
Some acne treatments target infection specifically, but there are treatments that are aimed at the formation of comedones as well. Others remove the dead layers of the skin and may help clear blocked pores.
Dermatologists can often extract open comedones with minimal skin trauma, but closed comedones are more difficult. Laser treatment for acne might reduce comedones, but dermabrasion and laser therapy have also been known to cause scarring.
Macrocomedones (1 mm or larger) can be removed by a dermatologist using surgical instruments or cauterized with a device that uses light. The acne drug isotretinoin can cause severe flare-ups of macrocomedones, so dermatologists recommend removal before starting the drug and during treatment.
Some research suggests that the common acne medications, retinoids and azelaic acid, are beneficial and do not cause increased pigmentation of the skin.
As mentioned above, primary cicatricial alopecias are classified by the predominant type of inflammatory cells that attack the hair follicles: i.e., lymphocytes, neutrophils, or mixed inflammatory cells. Treatment strategies are different for each subtype and detailed treatment options are beyond the scope of this discussion. However, certain general principals are reviewed below.
Treatment of the lymphocytic group of cicatricial alopecias (including lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and pseudopelade (Brocq) involves use of anti-inflammatory medications. The goal of treatment is to decrease or eliminate the lymphocytic inflammatory cells that are attacking and destroying the hair follicle. Oral medications may include hydroxychloroquine, doxycycline, mycophenolate mofetil, cyclosporine, or corticosteroids. Topical medications may include corticosteroids, tacrolimus, pimecrolimus, or Derma-Smoothe/FS scalp oil. Triamcinolone acetonide, a corticosteroid, may be injected into inflamed, symptomatic areas of the scalp.
Treatment of the neutrophilic group of cicatricial alopecias (folliculitis decalvans, tufted folliculitis) is directed at eliminating the predominant pathogenic microbes that are invariably involved in the inflammatory process. Oral antibiotics are the mainstay of therapy, and topical antibiotics may be used to supplement the oral antibiotics. In dissecting cellulitis, pathogenic microbes are not usually present. Isotretinoin in small doses may be helpful in treating dissecting cellulitis.
Treatment of the mixed group of cicatricial alopecias (folliculitis keloidalis) may include antimicrobials, isotretinoin, and anti-inflammatory medications.
You should discuss any treatment with your dermatologist, who will also explain potential side effects, as well as laboratory tests that are needed before starting treatment and sometimes are monitored during treatment.
The course of cicatricial alopecia is usually prolonged. Treatment is continued until the symptoms and signs of scalp inflammation are controlled, and progression of the condition has been slowed. In other words, itching, pain, tenderness, and burning have cleared, scalp redness, scaling, and/or pustules are no longer present, and the progression of the hair loss has been stopped or slowed. Treatment may then be stopped. Unfortunately, the cicatricial alopecias may reactivate after a quiet period and treatment may have to be repeated.
Surgical treatment for cosmetic benefit is an option in some cases after the disease has been inactive for one to two or more years. Hair restoration surgery or scalp reduction may be considered in these instances.
Severe acne usually indicates the necessity of prescription medication to treat the pimples. Prescription medications used to treat acne and pimples include isotretinoin, which is a retinoid. Historically, antibiotics such as tetracyclines and erythromycin were prescribed. While they were more effective than topical applications of benzoyl peroxide, the bacteria eventually grew resistant to the antibiotics and the treatments became less and less effective. Also, antibiotics had more side effects than topical applications, such as stomach cramps and severe discoloration of teeth. Common antibiotics prescribed by dermatologists include doxycycline and minocycline. For more severe cases of acne dermatologists might recommend accutane, a retinoid that is the most potent of acne treatments. However, accutane can cause various side effects including vomiting, diarrhea, and birth defects if taken during pregnancy.
Medications with good evidence include ivermectin and azelaic acid creams and brimonidine, doxycycline, and isotretinoin by mouth. Lesser evidence supports metronidazole cream and tetracycline by mouth.
Metronidazole is thought to act through anti-inflammatory mechanisms, while azelaic acid is thought to decrease cathelicidin production. Oral antibiotics of the tetracycline class such as doxycycline and oxytetracycline are also commonly used and thought to reduce papulopustular lesions through anti-inflammatory actions rather than through their antibacterial capabilities.
Using alpha-hydroxy acid peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea. Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed.
The flushing and blushing that typically accompanies rosacea is typically treated with the topical application of alpha agonists such as brimonidine and less commonly oxymetazoline or xylometazoline.
Treating rosacea varies depending on severity and subtypes. A subtype-directed approach to treating rosacea patients is recommended to dermatologists. Mild cases are often not treated at all, or are simply covered up with normal cosmetics.
Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions, a decrease in the number, duration, and intensity of flares, and concomitant symptoms of itching, burning, and tenderness. The two primary modalities of rosacea treatment are topical and oral antibiotic agents. Laser therapy has also been classified as a form of treatment. While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended. Long-term treatment, usually one to two years, may result in permanent control of the condition for some patients. Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission. Other cases, left untreated, worsen over time.
Common over-the-counter medications for pimples are benzoyl peroxide and/or salicylic acid and antibacterial agents such as triclosan. Both medications can be found in many creams and gels used to treat acne (acne vulgaris) through topical application. Both medications help skin slough off more easily, which helps to remove bacteria faster. Before applying them the patient needs to wash his or her face with warm water and dry. A cleanser may also be used for that purpose. Acne rosacea is not caused by bacterial infection. It is commonly treated with tretinoin. A regimen of keeping the affected skin area clean plus the regular application of these topical medications is usually enough to keep acne under control, if not at bay altogether. The most common product is a topical treatment of benzoyl peroxide, which has minimal risk apart from minor skin irritation that may present similar as a mild allergy. Recently nicotinamide (vitamin B), applied topically, has been shown to be more effective in treatment of pimples than antibiotics such as clindamycin. Nicotinamide is not an antibiotic and has no side effects typically associated with antibiotics. It has the added advantage of reducing skin hyperpigmentation which results in pimple scars.
Antifungal treatments including ketoconazole, zinc pyrithione and selenium disulfide have been found to be effective. Ketoconazole appears to have a longer duration of effect.
Ketoconazole is a broad spectrum antimycotic agent that is active against "Candida" and "M. furfur". Of all the antifungals of the imidazole class, ketoconazole has become the leading contender among treatment options because of its effectiveness in treating seborrheic dermatitis as well.
Ciclopirox is widely used as an anti-dandruff agent in most preparations.
Typical medical advice is to use diluted baby shampoo on a cotton swab to cleanse the eyelid. There is no agreement on the dilution, which ranges from a few drops to a half cup warm water, to a 50/50 mix.
Shampoos use a combination of special ingredients to control dandruff.
If the cradle cap is not severe, it could simply be combed out gently after bathing. The softened scales can then be brushed away with a soft brush, comb or cloth, but if not done very gently, this could worsen the condition and bring about temporary hair loss. Applying petroleum jelly (e.g., Vaseline) liberally overnight is another popular treatment. The softened scales either fall off during the night, or can be brushed off in the morning. Making a paste from sodium bicarbonate (baking soda) and leaving it on the affected area for 10 minutes can also help lift the scales. There have been no studies done on these treatments.
There is broad disagreement regarding the role of shampoos. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, but the exact denotation of the label "mild" in this context is not quite clear. Baby shampoos often contain detergent surfactants, perfumes, quaternium-15 and other eczemagenic irritants. Again, no studies have been performed on non-prescription shampoos.
In stubborn cases some doctors may recommend keratolytic (dandruff) shampoos (e.g. with sulfur, selenium, zinc pyrithione, or salicylic acid) while others warn against the use of medicated shampoos in newborns due to systemic absorption. Dandruff shampoos often contain sodium dodecyl sulfate, a noted skin irritant.
Steroid and tar preparations have also been used but may have drawbacks. Immunomodulators (tacrolimus/Protopic, pimecrolimus/Elidel) have not been approved for babies under two years.
Ketoconazole shampoos and creams are currently shown to be the most effective medical treatment of moderate to serious cradle cap. Research indicates that this anti-fungal medication is not absorbed into the bloodstream.
Hair will not regrow once the follicle is destroyed. However, it may be possible to treat the inflammation in and around surrounding follicles before they are destroyed, and for this reason it is important to begin treatment as early as possible to halt the inflammatory process. Minoxidil solution (2% or 5%) applied twice daily to the scalp may be helpful to stimulate any small, remaining, unscarred follicles. The progression of hair loss is unpredictable. In some cases, progression is slow and there is always sufficient hair remaining to cover the affected scalp areas; in other cases, progression can be rapid and extensive.
Fordyce spots are completely benign and require no treatment. Often their presence is considered normal anatomic variance rather than a true medical condition.
The decision to observe or treat a nevus may depend on a number of factors, including cosmetic concerns, irritative symptoms (e.g., pruritus), ulceration, infection, and concern for potential malignancy.
Non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are most used in PDP treatment. These drugs inhibit cyclo-oxygenase activity and thereby prostaglandin synthesis. Since PGE is likely to be involved in periosteal bone formation and acroosteolysis, this is why these drugs can alleviate the polyarthritis associated with PDP. In addition, NSAIDs and corticosteroids decrease formation of inflammatory mediators, reducing inflammation and pain. In case of possible gastropathy, the COX-2 selective NSAID etorixocib is preferred.
Infliximab can reduce pain and arthritis in PDP. It is a monoclonal antibody that blocks the biological action of TNF-α (tumor necrosis factor-alpha). TNF-α is an inflammatory cytokine found in high levels in PDP and it is involved in the production of other inflammatory mediators which increase the expression of RANKL. RANKL is thought to increase bone resorption.
Surgical excision is the standard of care. Some individuals advocate the use of hair removal laser for the treatment of congenital nevi. While this is likely safe and effective for small congenital nevus, laser removal for larger lesions might pose a liability for the laser surgeon if malignancy developed from a deep (dermal) component of the nevus that is not reached by the laser. Repigmentation after laser treatment of congenital nevi or superficial curettage supports this concern.
Many are surgically removed for aesthetics and relief of psychosocial burden, but larger ones are also excised for prevention of cancer, although the benefit is impossible to assess for any individual patient. Proliferative nodules are usually biopsied and are regularly but not systematically found to be benign. Estimates of transformation into melanoma vary from 2-42% in the literature, but are most commonly considered to be at the low end of that spectrum due to early observer bias.
PFAPA syndrome typically resolves spontaneously. Treatment options are used to lessen the severity of episodes. Treatment is either medical or surgical.
One treatment often used is a dose of a corticosteroid at the beginning of each fever episode. A single dose usually ends the fever within several hours. However, in some children, they can cause the fever episodes to occur more frequently. Interleukin-1 inhibition appears to be effective in treating this condition.
Surgical removal of the tonsils appears to be beneficial compared to no surgery in symptom resolution and number of future episodes. The evidence to support surgery is; however, of moderate quality.
Retinoids are used to improve skin manifestations. Retinoids can act on retinoid nuclear receptors and thus regulate transcription. For example, isotretinoin, the most effective drug to treat acne, improves cosmetic features by inducing apoptosis within human sebaceous glands. As a result of this, the increase of connective tissue and hyperplasia of the sebaceous glands is inhibited. Retinoids also decrease procollagen mRNA in fibroblasts, improving pachyderma.
Like retinoids, colchicines can also improve skin manifestations. It is able to bind to the ends of microtubules to prevent its elongation. Because microtubules are involved in cell division, signal transduction and regulation of gene expression, colchicine can inhibit cell division and inflammatory processes (e.g. action of neutrophils and leukocytes). It is suggested that colchicine inhibit chemotactic activity of leukocytes, which leads to reduction of pachydermia.
Use of botulinum toxin type A (BTX-A) improved leonine facies of patients. BTX-A inhibits release of acetylcholine acting at the neuromuscular junction. Furthermore, it blocks cholinergic transmission to the sweat glands and therefore inhibits sweat secretion. However, the exact mechanism for improving leonine faces is unknown and needs to be further investigated.
Surgical excision of a sebaceous cyst is a simple procedure to completely remove the sac and its contents.
There are three general approaches used: traditional wide excision, minimal excision, and punch biopsy excision.
The typical outpatient surgical procedure for cyst removal is to numb the area around the cyst with a local anaesthetic, then to use a scalpel to open the lesion with either a single cut down the center of the swelling, or an oval cut on both sides of the centerpoint. If the cyst is small, it may be lanced instead. The person performing the surgery will squeeze out the keratin surrounding the cyst, then use blunt-headed scissors or another instrument to hold the incision wide open while using fingers or forceps to try to remove the cyst intact. If the cyst can be removed in one piece, the "cure rate" is 100%. If, however, it is fragmented and cannot be entirely recovered, the operator may use curettage (scraping) to remove the remaining exposed fragments, then burn them with an electro-cauterization tool, in an effort to destroy them in place. In such cases the cyst may recur. In either case, the incision is then disinfected and, if necessary, the skin is stitched back together over it. A scar will most likely result.
An infected cyst may require oral antibiotics or other treatment before or after excision. If pus has already formed then incision and drainage should be done along with avulsion of cyst wall with proper antibiotics coverage.
An approach involving incision, rather than excision, has also been proposed.