3. Aetiology and
epidemiology
• Chronic inflammation with or without localised infection in
the pilosebaceous units.
• Usually seen in adolescents.
• Caused by obstruction of pilosebacious follicle with keratin
plugs.
• Forms: comedones, inflammation, pustules.
ACNE
4. Clinical
features
• Red, inflammed sore 'spots' on skin, typically on face, neck,
upper chest and back.
• Charecteristic lesions:
- Blackheads & whiteheads
Inflammes papules and pustules
Post-inflammatory erythematous or pigmented macules and
scars
6. Investigations
& Management
• Investigations usually not necessary.
• If atypical - skin swabs / hormonal tests
• Treatment depends on severity.
1. Single topical therapy (topical retinoids, benzoyl peroxide)
2. Topical combination therapy (topical antibiotic, benzoyl
peroxide, topical retinoid)
3. Oral antibiotics + topical retinoid or benzoyl peroxide
4. COCP is an alternative for oral antibiotics in women
5. Oral isoretinoin: only under specialist supervision
7. Aetiology and
epidemiology
• Chronic, itchy, inflammatory skin condition that affects all
ages groups.
• Most frequently seen in childhood.
• Typically occurs in flares and remissions, if severe can be
continuous.
• Multifactorial causes aetiology: genetic, skin barrier
dysfunction, environmental triggers (pets, pollen), immune
system dysfunction.
ECZEMA
8. Clinical
features
• Presents with itchy, dry rash with or without excoriations.
• Often seen in hands or localized to flexures of limbs.
• If infected: can be weeping, crusted, present with fever or
malaise.
10. Investigations
& Management
• Investigations usually no necessary. Clinical diagnosis.
• Stepped approach to treatment
1. Avoid triggers
2. Emollients
3. Topical steroids (hydrocortisone, betamethasone)
Topical calcineurin inhibitors (Tacrolimus, Pimecrolimus)
4. Anti-histamines if severe itch (cetirizine, loratadine)
5. If severe and extensive: short course of oral corticosteroids.
(prednisolone)
6. If infected, antibiotics given. (flucloxacillin) / topical
antiseptic (fusidic acid)
11. Aetiology and
epidemiology
• Chronic autoimmune skin disorder
• Can affect any age group, in a third of patient's symptoms start in
childhood
• Multifactorial cause but there appears to be a genetic component
• Commonly appears over extensor surfaces of elbows and knees,
and scalp
• Increased risk of cardiovascular disease and arthritis
psoriasis
12. Clinical
features &
Investigations
• Dry, scaly, flaky patches with silver scales
• These are caused by abnormal keratinocyte proliferation
• Different types:
• Plaque – thick, red patches of skin with silver scales, most common
form in adults
• Guttate – common in children, can be triggered post-streptococcal
infection, small and red raised pastules that are scaly
• Pustular and Erythrodermic psoriasis is rare
Diagnosis is usually clinical
14. Investigations
& Management
• Investigations are not necessary, unless there is an infection
• X-ray may be necessary if there is associated psoriatic
arthritis
• Management includes a step-wise approach for symptomatic
relief
• NICE Guidelines:
1.Potent steroid (betamethasone)andVit D analogue
(calcipotriol) for 4 weeks
2.Vit D analogue 2x daily
3.Coal tar or diathranol
4.Phototherapy 3x a week
5.Systemic treatment with methotraxate or anti-TNF
16. WARTS
• Firm and rough lumps on the skin that may be skin colored or
darker
• Most people will have a wart in their lifetime, they self-resolve in
months or years
• Different types: plane warts, mosaic warts, genital warts (HPV 6/11)
• Trauma can cause bleeding
1. Salicylic acid solution or creams – can be bought OTC
2. Cryotherapy
3. Imiquimod for genital warts
4. Chemical treatment – formaldehyde or silver nitrate
17. CYSTS
• Cyst is a fluid-filled membranous sac that can form anywhere in the
body
• Common causes of cysts: blockage of duct, infection, chronic
inflammation, genetic
• Most cysts are benign and self-resolve, if infected can be treated with
antibiotics and drainage
• Types:
• Epidermoid
• Sabaceous
• Breast cyst
• Pilonodal cyst
• Popliteal cyst – can be inflammatory or due to injury
• Mucous cyst
18. BENIGN NECK LUMPS
• Thyroglossal cyst – common in young adults, moves up on tongue
protrusion
• Thyroid goitre- generalised swelling of the thyroid gland, can be
autoimmune or due to iodine deficiency
• Branchial cyst – cyst in the anterior triangle on the neck, congenital
abnormality
• Lymphadenopathy – history of local infection or viral illness
• Lipoma – benign tumour of fat tissue
• Salivary gland swelling – due to infection or blockage
• Carotid body tumours – pulsatile neck mass that doesn't move on
swallowing
20. Older adults,
Aetiology and
epidemiology
• Malignant tumors due to uncontrolled proliferation of skin
cells.
• Most common types: Basal cell carcinoma, Squamous cell
carcinoma and melanoma.
• Most commonly affects older adults, but can affect younder
adults and rarely children.
• Common in individuals with fair skin, people who've
had skin cancer before, has a family history of cancer
21. Clinical
features
• Appear as progressive lump or nodule or a changing lesion.
• Complications:
1. Ulceration
2. Bleeding
3. Local invasion
4. Metastasis
