Slides interpretation

Slides Interpretation for Diploma 2011 By Dr Wedad Bardisi Consultant family physician

What is the diagnosis?

A stye or hordeolum
is an infection of the sebaceous glands at the base of the eyelashes. Styes are similar to chalazia, but tend to be of smaller size and feel much more painful and usually produce no lasting damage.
Styes are generally caused by a Staphylococcus aureus bacterial infection.
Although they are particularly common in infants, styes are experienced by people of all ages.
Styes can be triggered by stress or poor nutrition. Using the same razor to shave hair near both the eyes and a mustache can also spread staphylococcus bacteria, potentially leading to styes or other eye infections. The bacteria are contagious, so care should be taken to avoid touching the eye or sharing cosmetics, towels, or washcloths. Styes will last up to two and a half years without treatment, with treatment anywhere between 8 months and a month.

Signs and symptoms
The first signs of a stye are tenderness, pain and redness in the affected area. Later symptoms include itching, swelling, watering of the eye, sensitivity to light and discomfort when blinking.
A yellowish bump sometimes develops in the affected area. This can be found on the top, bottom, or any area pertaining to the eye.
Treatment
While most styes will drain on their own, this process can be accelerated by the application of a warm compress. There is also a specialized Polysporin topical ointment for styes. With treatment, styes typically resolve within one week.
Lancing of a stye is not recommended without technical expertise given its proximity to the eye. Styes may also cause a bruised feeling around the eye, which can be treated through the application of a warm cloth .

What is this?

A - chalazion
A chalazion is a meibomian gland lipogranuloma , is a cyst in the eyelid that is caused by inflammation of a blocked meibomian gland usually on the upper eyelid
Chalazions differ from styes (hordeolums) in that they are usually painless apart from the tenderness caused when they swell up, and in size (chalazia tend to be larger than styes).
A chalazion may eventually disappear on its own after a few months, though more often than not, some treatment is necessary

Signs and symptoms
Swelling on the eyelid
Eyelid tenderness
Sensitivity to light
Increased tearing
Heaviness of the eyelid
Sleepyness
The primary treatment is application of warm compresses for 10 to 20 minutes at least 4 times a day.
This may soften the hardened oils blocking the duct and promote drainage and healing.

What is the diagnosis

Ectropion
It is caused by a lack of tone of the delicate muscles that hold the lid taut against the eye.
Excessive tearing is a common with ectropion, but wiping the tears away only causes the lid to sag more.
Ectropion is most common among people over the age of 60.

Signs and Symptoms
Irritation
Burning
Gritty, sandy feeling
Excessive tearing
Red, irritated eyelid
Detection and Diagnosis
Ectropion can be diagnosed with a routine eye exam .

Entropion
Entropion , an eyelid that turns inward, is a problem that typically affects the lower lid.
It usually stems from a muscle spasm; however, it can also be caused by scarring from trauma or inflammation from certain diseases that involve the eyelids.
When the eyelid turns inward, the lashes rub against the eye, resulting in irritation, scratchiness, tearing and redness.
Surgery is often required to correct the problem.

Xanthelasma
Xanthelasma: is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids. Although not harmful or painful, these minor growths may be disfiguring and can be removed with:
trichloroacetic acid peel,
surgery,
lasers or
cryotherapy.

Removal can cause scarring and pigment changes, but it is unusual after treatment with trichloroacetic acid.
Because of the hereditary component, they may or may not indicate high blood levels of cholesterol .
Where there is no family history of xanthelasmata they usually indicate high cholesterol and may correlate with a risk of atheromatous disease
Associations
High cholesterol levels (specifically familialhypercholesterolemia)
Primary biliary cirrhosis
Menopause
Diabetes

Ptosis

Ptosis
Ptosis or drooping of the upper eyelid, may occur for several reason s such as: disease, injury, birth defect, previous eye surgery and age.
In most cases, it is caused by a weakness of the levator muscle
Children born with ptosis may require surgical correction of the lid if it covers the pupil. In some cases, it may be associated with a crossed or misaligned eye (strabismus).
Left untreated, ptosis may prevent vision from developing properly, resulting in amblyopia or lazy eye

Signs and Symptoms
The symptoms are dependent on the underlying problem and may include:
Drooping lid (may affect one or both eyes)
Irritation
Difficulty closing the eye completely
Eye fatigue from straining to keep eye(s) open
Children may tilt head backward in order to lift the lid
Crossed or misaligned eye
Double vision

Treatment
Ptosis does not usually improve with time, and nearly always requires corrective surgery by an ophthalmologist specializing in plastic and reconstructive surgery. In most cases, surgery is performed to strengthen or tighten the levator muscle and lift the eyelid. If the levator muscle is especially weak, the lid and eyebrow may be lifted. Ptosis can usually be performed with local anesthesia except with young children .

Ptyrigum due to excessive sun exposure treatment is surgical excision.

keratoconus

Keratoconus (KC) is a progressive, noninflammatory, bilateral (but usually asymmetrical) disease of the cornea, characterized by paraxial stromal thinning that leads to corneal surface distortion.
Visual loss occurs primarily from irregular astigmatism and myopia and secondarily from corneal scarring .

Causes
Although not definitively identified, genetic inheritance; systemic and ocular associations; eye rubbing; atopy, specifically ocular allergies; and CL wear are proposed risk factors.
Several reports suggest, coincidentally, associations with KC and other corneal dystrophies .

Hyphema: blood in the anterior chamber due to trauma

Subcongenctival haemorrhage spontaneous remmision

Corneal abrasion

This 10-year-old boy this reaction to the paraphenylenediamine pigment enhancer in a henna tattoo 3 weeks after placement of the tattoo

Diagnosis is hypersensitivity reaction
(Contact dermatitis)
Treatment
Avoid the causative lesion
Treat with corticosteroids

CONTACT DERMATITIS

Clubbing

Cyanosis due to congenital heart disease

Acanthosis nigricans

Acanthosis Nigricans
Causes :
Over weight
Diabetes mellitus.
GIT malignancy

Acanthosis nigricans

Atopic dermatitis

Atopic dermatitis
There is quite a variation in the appearance of atopic dermatitis between individuals. From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches. In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.

The presence of infection or an additional skin condition, the creams applied, the age of the person, their ethnic origin and other factors can alter the way eczema looks and feels.
There are however some general patterns to where the eczema is found on the body according to the age of the affected person.

Treatment
Treatment of atopic dermatitis may be required for many months and possibly years.
It nearly always requires:
Reduction of exposure to trigger factors (where possible)
Regular emollients (moisturisers)
Intermittent topical steroids
zathioprine

In some cases management may also include one of more of the following:
Topical treatment such as
Pimecrolimus cream or tacrolimus ointment
Antibiotics
Antihistamines
Phototherapy
Oral corticosteroids
Cyclosporin

This child developed high fever, developed this rash 4 days ago

Oral examination of his mouth showed these lesions . What is the diagnosis?

Diagnosis
This patient has measles.
Measles is an acute, highly communicable viral disease with fever, conjunctivitis, coryza, cough, and Koplik spots.
Koplik spots are small, red, irregularly-shaped spots with blue-white centers found on the mucosal surface of the oral cavity.
Koplik’s spots develop on palate during the pre-eruptive measles on day 3 of the illness .

Koplik spots

This individual with measles is displaying red Koplik spots on his buccal mucosa during the 3rd day of the rash. Koplik's spots occur 1-2 days before to 1-2 days after the cutaneous rash. Their presence is considered to be pathognomonic for measles, and appear as punctate blue-white spots on the bright red background of the oral buccal (cheek) mucosa.

Measles

This child with measles is displaying the characteristic red blotchy pattern on his body during third day of the rash.
Measles is an acute, highly communicable viral disease with prodromal fever, conjunctivitis, coryza, cough, and Koplik spots on the buccal mucosa. A red blotchy rash appears around day 3 of the illness, first on the face, and then becoming generalized.

Measles

This presented with this sore lesion on his lip what is the diagnosis?

Herpes Labialis, Herpes Simplex
This is a herpes simplex lesion of the lower lip on the 2nd day after onset.
Also known as a cold sore, this lesion is caused by the contagious herpes simplex virus Type-1 (HSV-1).
The HSV-1 virus remains in the body throughout an exposed person’s entire life.

Herpes simplex
This patient presented with herpes simplex lesions around her mouth due to the herpes simplex virus Type-1, (HSV1) pathogen.
Herpes simplex virus type1 usually is the cause for oral lesions sometimes referred to as “cold sores”, “fever blisters” or more technically known as “recurrent herpes labialis”.
Virus Diseases, Herpesviridae Infections, Herpes Simplex, Herpes Labialis

Cold sores

Seborrheic Dermatitis
Common, chronic dermatosis of unknown aetiology, characterized by scaling and redness occurring primarily in the areas with the highest concentration of sebaceous glands, namely the scalp, face, presternal and intertriginous areas.
On the scalp, it generally appears first as small patches of scales, progressing to involve the entire scalp with exfoliation of excessive amounts of dry scales. It is very common during the infancy age group, approximately 50 per cent of infantile cases occur before 5 weeks of age.
synonyms
Seborrheic Dermatitis, Seborrheic Eczema, Dysseborrheic Dermatitise

Seborrheic Dermatitis -

What is this lesion?

Diaper Dermatitis
Variety of inflammatory disorders of the skin that occur on the lower aspect of the abdomen, genitalia, buttocks, and upper portion of the thighs initiated by a combination of factors, the most significant being irritation by the urine and faeces, occlusion and candida colonisation.
Diffuse reddening of the skin with papules, vesicles, oedema, and scaling of the involved areas as well as psoriasiform lesions, secondary erosions, ulcerations and infiltrated nodules in more severe cases may occur. Diaper dermatitis peaks between the ages of 6 and 10 months.

Diaper Dermatitis

What is the diagnosis ?

Pityriasis Versicolor (Tinea Versicolor)
A common chronic, noninflammatory and usually symptomless disorder, characterized by the occurrence of multiple macular patches of all sizes and shapes, and varying in pigmentation from fawn-coloured to brown.
It is produced by the proliferation of the lipophilic yeast, Malassezia furfur which is part of the normal flora of human skin.
It can but is most commonly seen in young adults and is comparatively rare in children .
Treatmenoccur at any age t antifungal cream and shampoo

Tinea Corporis ( Ringworm of the Body, Tinea Circinata)
Dermatophyte infection of the skin including lesions of the trunk and limbs.
All known dermatophytes may produce lesions.
Infection is acquired from an active lesion of an animal, by direct human contact, or from soil.
Spread from existing localized infection, e.g. feet, is not uncommon.
Characteristic lesions are circular and sharply marginated with a raised edge.
Scaling is a common but not constant finding.
Lesions may also be eczematous, vesicular and pustular in nature.

Tinea Corporis

Pityriasis rosea

Pityriasis rosea
Pityriasis rosea is a rash that occurs most commonly in people between the ages of 10 and 35, but may occur at any age.
The rash can last from several weeks to several months.
Usually there are no permanent marks as a result of this condition.
It may occur at anytime of year, but pityriasis rosea is most common in the spring and fall.

Signs and Symptoms
Pityriasis rosea usually begins with a large, scaly, pink patch on the chest or back, which is called a "herald" or "mother" patch.
It is frequently confused with ringworm, but antifungal creams do not help because it is not a fungus.

Within a week or two, more pink patches appear on the chest, back, arms, and legs. Patches may also occur on the neck, but rarely on the face.
The patches are oval and may form a pattern over the back that resembles the outline of a Christmas tree .
Sometimes the disease can produce a very severe and widespread skin eruption.

About half the patients will have some itching, especially when they become warm.
Physical activities like jogging and running, or bathing in hot water, may cause the rash to temporarily worsen or become more obvious.
There may be other symptoms including fatigue and aching. The rash usually fades and disappears within six to eight weeks, but can sometimes last much longer.

Treatment
may include external and internal medications for itching.
Aveeno oatmeal baths, anti-itch medicated lotions and steroid creams may be prescribed to combat the rash.
Warm, rather than hot, baths may be suggested.
Strenuous activity, which could aggravate the rash, should be discouraged.
Ultraviolet light treatments given under the supervision of a dermatologist may be helpful .

Recently, both the antiviral drug Famvir and the antibiotic erythromycin have been claimed to produce healing in one to two weeks.
For severe cases a few days of oral anti-inflammatory medications such as prednisone may be necessary to promote healing.
For mild cases, no treatment is required as this disease is not a dangerous skin condition.

Nummular Eczema
Cutaneous eruption characterized by discoid or coin-shaped plaques of eczema.
The lesions usually occur on the extensor surfaces of the extremities, but the face and trunk may also be involved.
The specific aetiology is unknown. However, it seems to appear in a cold and dry environment and is aggravated by excessive bathing and local irritants such as wool. Often, a heavy colonisation of the lesions by staphylococci has been found.

Nummular Eczema, Eczema

Nummular Eczema, Eczema Nails

Dermatitis Herpetiformis

Dermatitis herpetiformis
Dermatitis herpetiformis (DH) is an autoimmune blistering disorder associated with a gluten-sensitive enteropathy
It is characterized by grouped excoriations; erythematous, urticarial plaques; and papules with vesicles.
These are located on the extensor surfaces of the elbows, knees, buttocks, and back. It is exquisitely pruritic, and the vesicles are often excoriated to erosions by the time of physical examination.

Causes
DH has recently been proposed as a cutaneous manifestation of asymptomatic-to-mild Celiac Disease.
The genetic predisposition to the development of gluten sensitivity underlies the disease .
Strict compliance with a gluten-free diet results in normalization of the small bowel mucosal changes and control of the cutaneous manifestations of DH in most patients .

Associated GI conditions include gluten enteropathy, gastric atrophy, gastric hypochlorhydria, and pernicious anemia.
Associated autoimmune diseases include dermatomyositis, type 1 diabetes mellitus, myasthenia gravis, rheumatoid arthritis, Sjögren syndrome, systemic lupus erythematosus, and thyroid abnormalities.
Thyroid abnormalities are present in as many as 50% of DH patients and include hypothyroidism, hyperthyroidism, thyroid nodules, and thyroid cancer. .

Associated neoplastic conditions include GI lymphomas and non-Hodgkin lymphoma; patients are at increased risk of developing these cancers. A gluten-free diet may reduce incidence of DH-associated lymphomas

Epidermolysis Bullosa

Epidermolysis bullosa (EB) is a group of inherited bullous disorders characterized by blister formation in response to mechanical trauma.
Epidermolysis bullosa (EB) is a genetic disease and no drugs are known to correct the underlying molecular defects. Prolonged use of steroids is contraindicated in the treatment of inherited forms of EB.
No other drugs, including phenytoin and tetracycline, have improved the blistering or epithelial dis adhesion in EB significantly or consistently.

Pemphigus

Gout Tophi

The 40 year old female developed a papulosquamous eruption beginning on her trunk and spreading to all four extremities. She recently had a streptococcal infection, treated with antibiotics

This is a classic history and shape of guttate psoriasis .

Acne Rosacea

Albinism

Alopecia areata

Angiodema

Basal cell carcinoma

Behçet's Syndrome1

Chancroid1

Cicatricial Pemphigoid2

Condyloma Acuminatum1

Drug reaction

Eczema Herpeticum1

Erysipelas

Erythema Annulare Centrifugum1

Erythema Multiforme2

Erythema Nodosum1

Newborn Skin: Common Rashes Cutis marmorata, a normal reticulated mottling of the skin caused by vascular response to cold.

Erythema toxicum neonatorum can result in a "flea-bitten" appearance.

Acne neonatorum typically consists of closed comedones on the forehead, nose, and cheeks.

Clinical recommendation
Infants who appear sick and have vesiculopustular rashes should be tested for Candida , viral, and bacterial infections.
Acne neonatorum usually resolves within four months without scarring. In severe cases, 2.5% benzoyl peroxide lotion can be used to hasten resolution.
Miliaria rubra (also known as heat rash) responds to avoidance of overheating, removal of excess clothing, cool baths, and air conditioning.

Infantile seborrheic dermatitis usually responds to conservative treatment, including petrolatum, soft brushes, and tar-containing shampoo.
Resistant seborrheic dermatitis can be treated with topical antifungals or mild corticosteroids.

Slides interpretation

by Mohammed Azharuddin

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