dr_allanskin_lecture_part_11-final_no_pics.ppt

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dr_allanskin_lecture_part_11-final_no_pics.ppt

  1. 1. DERMATOLOGY MODULE Dr Rangitha Allan GP with special interest in Dermatology. Coventry tPCT March 2007
  2. 2. Structure of the Skin Largest organ of the body, consists of: – epidermis – dermis – subcutaneous fat – skin appendages
  3. 3. Functions of the skin • Protective barrier against the environment • Thermo regulation • Metabolism • Sensation • Inflammation
  4. 4. A skin problem is the fourth most common reason for consultations in primary care. 70% of consultations arise from seven conditions 1 Acne 2 Eczema 3 Psoriasis 4 Viral warts and other skin infections 5 Tumours 6 Vascular lesions 7 Leg ulcers
  5. 5. Eczema Eczema is characterised by erythema and pruritis In the acute phase there are characteristically vesciles or small blisters In the chronic phase there is lichenification cracking or fissuring of the skin
  6. 6. Is it Eczema ? Tinea infections can mimic eczema Tenia pedis on the feet Tinea corporis Tinea of the hand - unilateral and in manual workers -scaling is pronounced in the palmar creases Psoriasis – atypical form Scabies can trigger an eczema reaction
  7. 7. Standard dermatological terms used in and around eczema Erythema: redness due to increased skin perfusion e.g. eczema, drug reactions
  8. 8. Vesicles a fluid-filled circumscribed elevated lesion less than 1 cm in diameter
  9. 9. Bulla a fluid-filled circumscribed elevated lesion greater than 1cm in diameter e.g. pemphigoid
  10. 10. Pustule a circumscribed collection of pus e.g. folliculitis
  11. 11. Weal (Hive) a roundish or flattish pale-red elevation that is characteristically evanescent, disappearing within hours e.g. urticaria
  12. 12. Lichenification A papular thickening of the skin associated with accentuation of the normal skin markings, hyperpig- mentation and sometimes scaling e.g. chronic eczema, lichen simplex
  13. 13. Fissure A linear defect that extends from the skin surface into the dermis e.g. dermatitis, fungal infections affecting the toes and web spaces
  14. 14. Eczema is classified into • Endogenous eczema e.g. atopic eczema seborrhoeic eczema • Exogenous eczema which could be divided into a) irritant contact – carried by external chemicals b) allergic contact – metal, fragrance, lanolin
  15. 15. As a general rule • Endogenous eczemas are diagnosed by the distribution and morphology of the rash • Allergens through patch testing • Irritants by the history
  16. 16. Treatment of Eczema 1. Avoiding irritants / allergens 2. Triple therapies: emollients washing advice/aids topical steroids 3. Adjunct therapies: bandaging/wet wraps antibiotics antihistamines 4. Other therapies: dietary manipulation complimentary therapies systemic therapies
  17. 17. Psoriasis Occurs in 1-3% of the population. Aetiology of psoriasis is unknown, -the focus is on immunopathogenisis Psoriasis has typical characteristic features and presentations. The most common presentation is chronic plaque psoriasis.
  18. 18. Chronic plaque psoriasis presents with • Well demarcated • Raised • Salmon pink coloured • Scaly • Patches on the extensor aspects of the limbs – Elbows – Knees Lower back and scalp
  19. 19. Plaque
  20. 20. Scalp
  21. 21. Another common presentation is Guttate Psoriasis • Presents in childhood and adolescents Usually follows a streptococcal sore throat Self limiting in 8-10 weeks
  22. 22. Flexural psoriasis • Axillae • Groins • Inframammary grooves
  23. 23. Erythrodermic psoriasis
  24. 24. Pustular psoriasis
  25. 25. Psoriatic nail
  26. 26. Arthropathic psoriasis
  27. 27. Acne May affect up to 40% of the population at some time in their lives. Aetiology: True cause is unknown A combination of factors are responsible • A high rate of sebum secretion • micro-comedone formation • Sebum inspissation • inflammation
  28. 28. Distributions: • Face • Chest • Shoulders • Back
  29. 29. Severities • Mild - comedones Papules
  30. 30. Moderate • More papules • Few pustules
  31. 31. Severe • Pustules • Cyst • Scarring
  32. 32. Severity of acne – face
  33. 33. Severity of acne –back and chest
  34. 34. • Psychological effect • Psychosocial effect
  35. 35. Management recommendations • Treat early • Show empathy with positive approach • Use topicals • Anti comedonal e.g. adapalene • Antibiotics • Topical retinoids • Use oral antibiotics • Review therapeutic effect after 2-3 months • Refer for systemic retinoids in all severe acne
  36. 36. Skin infections Viral infections • Warts – human papilloma virus • Herpes labialis • Herpes zoster
  37. 37. Warts
  38. 38. Herpes labialis
  39. 39. Zoster
  40. 40. Bacterial Infections • Superficial cutaneous infections – Erythrasma – corynebacturium minutissimum – Intertrigo = in opposing skin sites gp A, B streptococcus C minitissimum • Pyodermas (on the epidermis) – Impetigo – staph aureus • Abscess, furuncle and carbuncle – Caused by staph aureus
  41. 41. Erythrasma
  42. 42. Intertrigo
  43. 43. Impetigo
  44. 44. Soft tissue infections • Erysipelus • Gp A B – haemolytic streptococci rarely staphylococcus • Cellulitis
  45. 45. Cellulitis
  46. 46. Mycobacterial infections • Leprosy – lupus pernio • TB – lupus vulgaris
  47. 47. Lupus Vulgaris
  48. 48. Infestations and Bites Scabies: mites transmitted by close contact itchy specially at night Diagnosis – look for burrows / mites Distrubutions • Finger webs • Genitals • Breasts • Umbilicus • Axillae / groin
  49. 49. Rash
  50. 50. Mite
  51. 51. Management of Scabies • Permethrin 5% cream (lyclean) • Malathion 0.5% aquous lotion • Treat all close contacts • Wash beddings/towels/clothing at 60oC • Advise regarding administration of topicals properly • Inform patients that the itching will not subside for 4-6 weeks
  52. 52. Lice • Body lice • Head lice Diagnosis by identifying the lice/eggs Management – Personal care – Wet combing/bug busting – Permethrin 5% – Malathion – carberyl 1% aquous solution
  53. 53. Head Lice
  54. 54. Bites • Fleas • Bed bugs • Ticks Itchy, linear lesions often on legs.
  55. 55. Managment • Antihistamine • Antibiotics if infected • Eurax cream • Bite repellent sprays
  56. 56. Dermatology Reading List Core Text: 1 ABC of Dermatology 4th edition Paul K Buxton BMJ Publishing Gp Ltd. 1. Roxburghs common skin diseases. Mark R. Arnold, A Hodder Headline Grp publications 2. Clinical Medicines. Kumar & Clarke 3. Differential Diagnosis in Dermatology. 3rd edition Richard Ashton & Barbara Leppard
  57. 57. Recommended Reading: Oxford Textbook of Medicine Weatherall, Ledingham & Worrell Reference: Textbook of Dermatology Rook, Wilkinson & Ebling Blackwell Science Ltd

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