Common skin problems

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Common skin problems

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Common skin problems

  1. 1. Common Skin Problems Dr. Sanjeeva Hulangamuwa Consultant Dermatologist GH Chilaw
  2. 2. ECZEMA
  3. 3. Acute eczema
  4. 4. Dry Eczema
  5. 5. Infantile Eczema
  6. 6. Chronic Lichenified Eczema
  7. 7. Contact Dermatitis to rubber slippers
  8. 8. Acute Contact Dermatitis to Vicks
  9. 9. Venous Eczema
  10. 10. Eczema herpeticum
  11. 11. Eczema Symptoms and Signs • Itchy skin patches • Oozing ( weeping ) – acute stage • Pigmentary changes • Dry thick patches in chronic stages • Recurrent attacks • Can associated with asthma and allergic rhinitis • Family members may have atopy • Common sites – face and flexures – infants and children legs – adults • Worsen with exposure to certain chemicals, dust, cement, fur,etc
  12. 12. Eczema (cont.) Management • Weepy areas - Condys ( potassium permangenate ) wash or compression • Steroid creams – hydrocortisone, betamethasone, clobetasol • Moisturizers – aquous cream, emulsifying ointment • Oral antibiotics for acute infective eczemas • Antihistamines for itching – chlorpheniramine, cetirizine, loratidine • Avoid frequent washing and soaps • Severe and resistant cases – prednisolone, azathioprine, methotrexate, ciclosporin • Rule out immunodeficiency syndromes in severe eczemas in infants
  13. 13. Photodermatitis
  14. 14. Chronic folliculitis
  15. 15. Seborrhoeic dermatitis
  16. 16. Chronic plaque psoriasis
  17. 17. Flexural Psoriasis in a baby
  18. 18. Erythrodermic Psoriasis
  19. 19. Psoriasis • Thick scaly erythematous plaques • Common sites - elbows, knees, umbilicus, scalp In some pts. whole body is involved • Scalp – scaling as in dandruff but severe • Nail changes and arthritis occur in some patients • Itching may or may not present • Family history may be positive • Rare presentations – pustular psoriasis and erythrodermic psoriasis • Diagnosis - clinically
  20. 20. Psoriasis • Topical application – steroid creams – hydrocortisone, betamethasone, clobetasol coal tar dithranol moisturizers – aquous cream, emulsifying ointment, liquid paraffin • Light therapy PUVA ( Psoralen tablets + ultraviolet A ) Ultraviolet B Solar PUVA – Expose to early morning sunlight 2h after taking the psoralen tablet
  21. 21. Psoriasis • Systemic treatment methotrexate, acitretin, ciclosporin,etc • Newer therapies Biological agents ( expensive )
  22. 22. INFECTIONS
  23. 23. Bacterial infections
  24. 24. Secondary bacterial infection of chicken pox scars
  25. 25. Staphylococcal scalded skin syndrome
  26. 26. Staphylococcal scalded skin syndrome • Common below 4y of age • Irritable • Refuse feeds • Febrile • Erythema and scaling around mouth, genital region and flexures • Skin is tender • Treatment flucloxacillin cloxacillin
  27. 27. Furuncles
  28. 28. Furuncles • Common in preschool children • Painful pustules and papules • Some rupture and discharge pus • Fever may occur • Common on face and scalp • Can be recurrent • Treatment oral – cloxacillin, erythromycin topical – soframycin ( framycetin ), fucidic acid, mupirocin
  29. 29. Impetigo
  30. 30. Bullous impetigo
  31. 31. Impetigo • Common in children • Honey colored crusted plaques • Sometimes blisters may occur ( bullous impetigo ) • Commonly occur peri-orificial ( around mouth, nose ) • Painful • Appears suddenly in a few days • Treatment Oral – cloxacillin Topical – soframycin, fusidic acid, mupirocin creams
  32. 32. Other bacterial infections • Eg; gram negative bacterial infections ( eg; pseudomonas ) anaerobic infections MRSA ( methicillin resistant staphylococcus aureas ) secondary bacterial infection of skin lesions ( eg; chicken pox scars, eczema, scabies )
  33. 33. VIRAL INFECTIONS
  34. 34. Herpes simplex infection
  35. 35. Herpes simplex infection • Common in immuno – compromised patients Eg; AIDS, Diabetes, malnourished, etc • Common sites – lips, genital area • Presents with sudden eruption of painful grouped vesicles • Genital herpes is a sexually transmitted disease • Can be recurrent in some patients Treatment • Aciclovir • Topical or oral antibiotics to prevent secondary infections
  36. 36. Chicken pox
  37. 37. Chicken pox • Fever • Body aches and pains • Vesicular skin eruption • Starts from head and gradually spreads to trunk and limbs • Crusting occurs in 7-10 days Complications • Common in adults and in immuno suppressed individuals eg; pneumonia, secondary bacterial infection, myocarditis, thrombocytopenia, encephalitis, osteomyelitis, hepatitis Treatment • Aciclovir • Antibiotics if needed
  38. 38. Chicken pox • Chicken pox in pregnancy ( 1st trimester ) may lead to foetal abnormalities Prevention varicella vaccine
  39. 39. Herpes zoster
  40. 40. Herpes Zoster • Treatment aciclovir antibiotics if necessary for the secondary bacterial infection
  41. 41. Molluscum contagiosum
  42. 42. • Treatment spontaneously resolves sometimes larger lesions – prick with a sterile needle and extrude the contents trichloroacetic acid electro cautery
  43. 43. Viral warts
  44. 44. Plantar warts
  45. 45. Plane warts
  46. 46. Treatment • Cryotherapy • Electrocautery – in a few occasions • 5% imiquimod – genital warts • Wart implantation • Hypnotherapy
  47. 47. Hand foot mouth disease
  48. 48. FUNGAL INFECTIONS
  49. 49. Tinea corporis
  50. 50. Tinea corporis
  51. 51. Tinea incognito
  52. 52. Tinea capitis
  53. 53. Kerion - due to zoophilic fungal infection
  54. 54. Tinea infections • Reddish or skin colored patches • Common sites – groins, buttocks, submammary areas, etc • Annular or polycyclic • Elevated edge • Can be itchy Treatment • Topical antifungals – miconazole, clotrimazole, terbinafine • Oral antifungals – griseofulvin, terbinafine
  55. 55. Pityriasis versicolor
  56. 56. Treatment • Ketoconazole – oral and topical • Itraconazole – oral • Fluconazole - oral
  57. 57. Candidiasis
  58. 58. Candidiasis • Common sites Oral mucosa, genital mucosa, flexural areas ( neck, groins ), periungual ( around the nails ) • Precipitating conditions Diabetes mellitus, AIDS, other immuno suppressed pts, Patients on prednisolone and broad spectrum antibiotics Treatment miconazole oral paste 2% ketoconazole cream oral fluconazole, itraconazole
  59. 59. Chromoblastomycosis
  60. 60. Madura foot
  61. 61. Fungal infections • There are so many other different fungal infections • Some are deep fungal infections • Needs skin biopsy and fungal cultures to diagnose them • Needs prolong oral antifungal treatment
  62. 62. Parasitic infections
  63. 63. Scabies
  64. 64. Crusted scabies
  65. 65. Scabies • Very itchy skin condition • Papular eruption • Common sites are finger webs, genital region, abdomen and thighs • Can lead to crusted scabies in neglected patients Investigation Skin scrapings – will reveal the parasite – Sarcoptes scabei • Treatment 5% Permethrin Sulphar ointment Benzyl benzoate Should treat the family members at the same time
  66. 66. LEPROSY • Caused by Mycobacterium Leprae • Very slow growing bacterium • Has a long incubation period before the onset of the clinical disease • Common in over crowded places with poor ventilation
  67. 67. Tuberculoid Leprosy
  68. 68. Tuberculoid Leprosy
  69. 69. Borderline tuberculoid leprosy
  70. 70. Tuberculoid Leprosy • Presents with Hypopigmented patches Sensory impairment Enlarged superficial nerves Treatment • Multi drug treatment ( MDT – PB ) for 6months ( pauci bacillary ) Rifampicin Dapsone • However MDT ( MB ) for 12 months needed for some patients
  71. 71. Lepromatous Leprosy
  72. 72. Lepromatous Leprosy • Can be infective to others • Clinical Features skin colored and erythematous nodules Some have leonine facies Infiltration of the ears Peripheral neuropathy Trophic ulcers Certain internal organs could be involved • Treatment Multi drug treatment ( MDT – MB ) for 12months ( multi bacillary ) Rifampicin Clofazimine Dapsone
  73. 73. Ulnar claw hand
  74. 74. Trophic ulcers
  75. 75. Type 1 reaction
  76. 76. ENL (type 2) reaction
  77. 77. Treatment – Lepra reactions prednisolone azathioprine clofazimine thalidomide
  78. 78. Cutaneous Tuberculosis (Skin TB) • Long standing non healing skin patches • Various morphological patterns present Investigations • Skin biopsy • Mantoux test • Chest Xray • PCR studies • T spot test Treatment • Anti TB therapy
  79. 79. Verrucous TB
  80. 80. Scrofuloderma
  81. 81. Lupus vulgaris
  82. 82. Cutaneous Leishmaniasis
  83. 83. Cutaneous Leishmaniasis • Non healing volcano like skin lesions • Occur on exposed areas of the body • Common in certain parts of the country North central province, southern province Investigations Skin smears to identify the parasite Skin biopsy for histology Treatment Liquid nitrogen Sodium stibo gluconate injection ( local / IM )
  84. 84. NUTRITIONAL DEFICIENCIES
  85. 85. Zn deficiency
  86. 86. Zn deficiency
  87. 87. Zinc deficiency • Common below 2 years • Adults – in alcoholic pts. • Eczema like skin eruptions • Red, dry and scaly skin patches over the genital area, face and flexures • Child is irritable • Refuse feeds Investigations Serum Zn level, alkaline phosphatase Treatment Zinc replacement
  88. 88. Other nutritional deficiencies • There are many other nutritional deficiencies which cause skin manifestations Eg; Iron deficiency Protein energy malnutrition Biotin deficiency Essential fatty acid deficiency B12 deficiency
  89. 89. DRUG ERUPTIONS
  90. 90. Drug Eruptions • Drug eruptions can present with various patterns • Proper drug history is important in diagnosis • Some are mild and some can be life threatening • Internal organs can be affected in some drug reactions
  91. 91. Morbiliform type eruption
  92. 92. Urticaria
  93. 93. Fixed drug eruption
  94. 94. Striae due to prolong application of topical steroids
  95. 95. Stevens johnson syndrome
  96. 96. Toxic epidermal necrolysis
  97. 97. Drug hypersensitivity syndrome
  98. 98. Stevens johnson syndrome and toxic epidermal necrolysis Can be life threatening Management stop the offending drug immediately monitor the vital functions investigate to detect the internal organ involvement (liver and kidney) skin care oral care eye care – urgent eye referral if eyes are involved increase hydration and fluid balance chart antibiotics to prevent secondary infection prednisolone and IV immunoglobulins sometimes antiepileptics
  99. 99. EXFOLIATIVE DERMATITIS
  100. 100. EXFOLIATIVE DERMATITIS • More than 90% of the skin is involved • Itching • Erythema ( redness ) • Scaling • Dehydration • Low urine out put • Aetiology Common causes Eczema, Psoriasis, Drugs, Lymphomas, etc
  101. 101. Treatment Moisturizers – aquous cream, emulsifying ointment liquid paraffin Increase oral fluids and to maintain a fluid balance chart High protein diet Antibiotics if there are signs of infection Antihistamines ( eg; chlorpheniramine ) for itching skin biopsy Need to find the aetiology and treat the cause Needs regular follow up
  102. 102. ACNE
  103. 103. Hidradenitis suppurativa
  104. 104. Punch out & Ice pick Scars
  105. 105. Acne • Very common skin problem • Starts around puberty • Chronic inflammation of the pilosebaceous units • Clinical features comedones, papules, pustules, cysts and scars face, chest and upper back are usually involved • Need to treat early to prevent unsighty scars
  106. 106. Treatment Depends on the sex, age, severity and extent of the disease • Topical benzoyl peroxide antibiotic creams and lotions – erythromycin, clindamycin retinoid creams and gels • Oral antibiotics – erythromycin, doxycyclines hormonal – cyproterone acetate with ethynyl estradiol isotretinoin ( most effective ) • Chemical peeling salicylic acid and trichloroacetic acid
  107. 107. vasculitis
  108. 108. Vasculitis • Inflammation of blood vessels • Hall mark is the ‘palpable purpura’ • Erythematous papules and patches on dependent parts of the body • Fever, arthralgia, abdominal pain, malaise, etc
  109. 109. Approach to the patient Suspect vasculitis Exclude non-vasculitic disorders that mimic vasculitis Investigate to establish vasculitis evaluate the extent of the systemic involvement look for underlying disorders
  110. 110. Sweets syndrome
  111. 111. Erythema nodosum
  112. 112. SKIN CANCERS
  113. 113. Skin cancers • Common in white skin individuals • Rare in Asians • Eg; Basal cell carcinoma, Squamous cell carcinoma, Melanoma, etc Risk factors high sun exposure white skin family history immunosupression chronic ulcers and scarring arsenic ingestion
  114. 114. Basal cell carcinoma
  115. 115. Basal cell carcinoma
  116. 116. Squamous cell carcinoma
  117. 117. Squamous cell carcinoma
  118. 118. Malignant melanoma
  119. 119. Management complete excision radiotherapy look for metastases ( local and distal spreading )
  120. 120. BLISTERING DISEASES
  121. 121. Causes of blisters • Frictional • Cold and Thermal injury • Bullous Impetigo • Diabetes • Insect bites • Drug reaction • Herpes Simplex infection • Chicken Pox, Herpes Zoster • Epidermolysis Bullosa • Autoimmune Eg; Pemphigus, Pemphigoid
  122. 122. • There are many causes for blisters • We must find the cause and treat • Some conditions such as auto immune blistering disorders need special treatment and regular follow up
  123. 123. Pemphigus Vulgaris
  124. 124. Pemphigus Vulgaris • Flaccid blisters • Easily ruptured and left with erosions • Mouth, genital area and eyes can be involved • Can be life threatening • Common in Asians Treatment • Depends on the severity of the disease • Mainstay of treatment is steroids • IV dexamethasone and cyclophosphamide pulse therapy • Antibiotics for the secondary infection • Sometimes IV Immunoglobulins and plasmapharesis
  125. 125. Bullous Pemphigoid • Tense blisters • Oral lesions are very rare • Common in old age • Incidence is high in west • Less severe than Pemphigus Treatment • Prednisolone • Azathioprine • Dapsone • Tetracycline • Topical steroids
  126. 126. Epidermolysis Bullosa
  127. 127. Epidermolysis Bullosa • Blisters appear on frictional sites • These are mechanical blisters • Exacerbates with sweating, hot and humid climates Treatment • Prevention of repeated trauma • Loose clothes • Keep the skin dry and clean • Minimal handling
  128. 128. Linear IgA disease ( chronic bullous dermatosis of childhood )
  129. 129. Linear IgA disease ( chronic bullous dermatosis of childhood )
  130. 130. Linear IgA disease ( chronic bullous dermatosis of childhood ) • Tense blisters • Mainly peri-orificial ( around mouth and genitalia ) • Oral mucosa can be involved Treatment • Dapsone • prednisolone
  131. 131. DIABETES SKIN MANIFESTATIONS
  132. 132. • Various systemic diseases including Diabetes Mellitus have skin manifestations • Therefore skin features are important to detect underlying illnesses
  133. 133. Carbuncle on the nape of a diabetic man. This is a staphylococcal infection of several contiguous hair follicles. Carbuncle
  134. 134. Diabetic Bulla
  135. 135. Older lesions of necrobiosis lipoidica are often pigmented as well as obviously atrophic, but often lose the more inflamed appearance of more recent lesions. Necrobiosis Lipoidica
  136. 136. Melasma
  137. 137. Pityriasis rosea
  138. 138. Pyogenic granuloma
  139. 139. Dermatitis artefacta by proxy
  140. 140. Urticaria
  141. 141. Miliaria
  142. 142. Miliaria
  143. 143. Vitiligo
  144. 144. Lichen planus
  145. 145. Granuloma annulare

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