2. DISCLAIMER
Includes paediatric rashes
and covers *all* of
dermatology for finals
(pretty much – we think)
Lots of info – don’t stress
about knowing it all now,
but can use slides to
revise
Includes lots of images –
some are a bit much,
beware
5. IMPETIGO
o Superficial bacterial skin infection
o More common in children
o Very contagious (children should be kept off school)
Cause – staph. aureus or strep. pyogenes
Clinical fts:
o ‘Golden crust’ – usually around nose/mouth
o Bullous impetigo – also presents with systemic features
Mx:
o Hydrogen peroxide 1% cream
o Topical fusidic acid
o Oral flucloxacillin (more severe)
Complications:
o Cellulitis
o Sepsis
o SSSS
o Scarlet fever
6. ERYSIPELAS
Cause – strep. pyogenes
More superficial, limited form of cellulitis
Clinical fts - Red, raised, well-demarcated border
Mx – oral flucloxacillin
7. CELLULITIS
Cause – staph. aureus or strep. pyogenes
Affects dermis and subcutaneous tissue
Risk factors: (essentially anything affecting integrity of skin barrier)
o Diabetes mellitus
o Chronic venous insufficiency
o Oedema / lymphoedema
o Previous skin damage – trauma, leg ulcer, eczema
o Obesity
Clinical fts:
o Inflammation – pain, swelling, warmth, erythema
o Fever, malaise, lymphadenopathy
Clinical diagnosis
Mx:
o Draw marker around it (to
monitor)
o Flucloxacillin (PO / IV if severe)
Complications:
o Sepsis
o Necrosis
o Necrotising fasciitis
o Abscess
9. CHICKENPOX
Cause – varicella zoster virus
Highly contagious (droplet) – stops being contagious after all lesions crusted over
Symptoms 10d – 3wks post-exposure
Clinical fts:
o Widespread, red, raised, vesicular blistering lesions
o Rash starts on face / trunk and spreads outwards – affects whole body after 2-5d
o Pruritus, fever, fatigue, malaise
Mx:
o Usually mild, self-limiting
o Aciclovir – in immunocompromised pts, pts >14years or neonates
o Calamine lotion / chlorphenamine (for itching)
Complications:
o Bacterial infection
o Dehydration
o Pneumonia
o Encephalitis (presents as ataxia)
o Conjunctivitis
o Can lay dormant and present as
shingles later in life
10. SHINGLES
(HERPES ZOSTER)
Cause – reactivation of varicella zoster virus (after primary infection
(chickenpox) - lays dormant in dorsal root / cranial nerve ganglia)
Contagious – stops being contagious after all lesions crusted over
Shingles vaccine given to pts aged >70
Risk factors:
o Increasing age
o HIV
o Other immunosuppression
Clinical fts:
o 2-3 day prodrome period of burning pain
o Development of unilateral, vesicular rash along dermatomal distribution
(does not cross midline)
Clinical diagnosis
11. SHINGLES
(HERPES
ZOSTER)
CONT.
Mx:
o Oral antiviral within 72hrs of rash onset (e.g.
aciclovir)
o Analgesia
o Avoid contact with people who haven’t had
chickenpox
o Avoid sharing towels
Complications:
o Post-herpetic neuralgia – neuropathic pain after
rash heals (Mx with tricyclic antidepressants,
gabapentin
o Herpes zoster ophthalmicus – affects ophthalmic
division of trigeminal nerve (V1)
o Ramsey Hunt syndrome – ear pain, rash, facial
nerve palsy (Mx – oral aciclovir and corticosteroids)
13. TINEA
Tinea – dermatophyte fungal infections
3 main types:
o Tinea capitis – scalp
o Tinea corporis – trunk, legs or arms
o Tinea pedis – feet (athletes foot)
o Tinea ungium / onychomycosis –
fungal nail
ringwor
m
14. RINGWORM
Tinea capitis (scalp), tinea corporis:
Cause – trichophyton
Fts:
o Well-defined, dry, erythematous ring shaped patch
o May itch
Tinea pedis (athletes foot):
May be caused by sharing changing rooms with someone with condition, especially when
feet sweaty and damp for prolonged periods
Fts:
o Itchy, peeling skin between the toes
o Flaky, cracked patches
15. TINEA MANAGEMENT
Antifungals
Topical – clotrimazole, miconazole
Oral – griseofulvin, terbinafine, itraconazole,
fluconazole
Fungal nail mx:
o Amorolfine nail lacquer (6-12 months)
o Resistant causes – oral terbinafine
LFT monitoring needed
before starting
terbinafine and during
treatment
18. ECZEMA
Types:
o Atopic eczema (classic)
o Seborrheic eczema
o Eczema herpeticum
o Varicose eczema
o Pompholyx eczema
19. ATOPIC ECZEMA
Type 1 hypersensitivity reaction (exaggerated IgE response)
Caused by defects in skin barrier leading to inflammation in skin
Cause – genetic and environmental
Fts:
o Erythematous, dry, scaly, itchy patches
o Infancy – face and extensor surfaces
o Children and adults – flexor surfaces
o Usually presents in infancy
o Patients experiences flares
Complications:
o Psychosocial
o Excoriations –
lichenification
o Secondary bacterial
infection
o Commonly staph.
aureus
20. ATOPIC ECZEMA
MANAGEMENT
Soap substitutes
Avoid things that break down skin barrier e.g. scratching, scrubbing, very hot
baths
Emollients:
o Thin e.g. E45, diprobase, aveeno cream
o Thick, greasy e.g. 50:50 ointment, hydromol
Topical steroids: (use weakest steroid for shortest period)
o Mild – hydrocortisone (e.g. 1%)
o Moderate – clobetasone butyrate (Eumovate)
o Potent – betamethasone (Betnovate)
o Very potent – clobetasol proprionate (dermovate)
PO:
o Antihistamines
o Abx/antivirals – for secondary infection
Topical steroid side effects:
o Thin skin
o Telangiectasia
o Systemic absorption
21. SEBORRHOEIC
ECZEMA /
SEBORRHEIC
DERMATITIS
Children:
Commonly affects scalp (‘cradle cap’), nappy area, face and limb flexures
Mx:
o Mild – baby shampoo and baby oils
o Severe – mild topical steroids
Adults:
o Inflammatory reaction to Malassezia furfur
oEczematous lesions on scalp, periorbital, auricular and nasolabial folds
Mx:
o Scalp – OTC preparations including zinc pyrithone (e.g. Head and Shoulders), 2nd line
- ketoconazole
o Face and body – topical ketoconazole, topical steroids
22. ECZEMA
HERPETICUM
Can be life-threatening
Primary skin infection by herpes simplex
virus 1 or 2
Commonly in children with atopic
eczema
Fts:
oRapidly progressing painful rash
oMonomorphic, punched out lesions on
examination
Mx:
o IV aciclovir and admission
23. VARICOSE
ECZEMA
Aka venous stasis
o Skin changes due to blood pooling
(insufficient venous return)
o Can lead to venous ulcer
o Common in elderly people with
chronic venous insufficiency
Mx – mx underlying venous
disease
24. POMPHOLYX
ECZEMA
Fts:
o Small blisters on palms and soles
o Itchy
o Can be precipitated by humidity and
high temperatures
Mx:
o Cool compress
o Emollients
o Topical steroids
25. PSORIASIS
Common, chronic, autoimmune condition
Peak age of onset: 16-22 and 55-60 years
Well-demarcated, red, scaly patches on the skin (silver scale)
Types:
o Chronic plaque psoriasis
o Flexural psoriasis
o Guttate psoriasis
o Pustular psoriasis
o Erythrodermic psoriasis
Other psoriasis fts:
o Nail pitting
o Onycholysis
o Psoriatic arthritis
26. CHRONIC PLAQUE PSORIASIS
Most common type
Well-demarcated salmon-pink, silvery scaling lesions
On extensor surfaces and scalp
Koebner phenomenon – new plaques occur at sites of skin trauma
Mx:
o Regular emollients
o Potent corticosteroid + vit. D analogue
o Add coal tar preparation if resistant
29. PUSTULAR AND
ERYTHRODERMIC PSORIASIS
Both rare, can be life-threatening
Pustular psoriasis:
Commonly on palms and soles
Erythrodermic psoriasis:
Extensive erythematous areas, skin comes away in large patches leaving
raw exposed areas
31. ACNE VULGARIS
Affects teenagers and young adults
Pathophys – chronic inflammation in pilosebaceous unit in skin, increasing sebum production, trapped keratin and
blockage of pilosebaceous unit (comedone)
Fts:
oAffects face, chest and back
oMultifactorial – macules (flat marks), papules (small lumps), blackheads
oMild – open/closed comedones, sparse, no inflamed lesions
oModerate – multiple pustules/papules, widespread, no inflamed lesions
oSevere – widespread inflamed lesions, nodules, pitting, scarring
Mx:
o Conservative - good skin hygiene, avoid exacerbating factors
o Topical - benzoyl peroxide, retinoids , abx e.g. clindamycin
o PO – tetracyclines (3 month course), oral contraceptive pill (women), retinoids e.g. isotretinoin (Roaccutane)
Complications:
• Scarring
• Psychosocial impact
Retinoids:
• Contraindicated in pregnancy
(teratotogenic)
• SEs:
• Suicidal ideation
• Dry skin/lips
• Photosensitivity
Tetracyclines:
• Avoid in pregnancy – give erythromycin
• Avoid in under 12 years
32. ACNE ROSACEA
Affects men in 30s/40s most commonly
Fts:
oTypically affects nose/cheek/forehead
oFlushing
oTelangiectasia
oDevelops into erythema with papules/pustules
oPhotosensitivity – sunlight may exacerbate fts
Mx:
o Daily suncream
oMild – topical metronidazole
oSevere – oxytetracycline (oral abx)
oTopical brimodine – for flushing
oLaser therapy – for telangiectasia
Complications:
• Rhinophyma- thickening of skin
of nose and enlargement of
sebaceous glands
• Ocular - blepharitis
33. URTICARIA
Aka hives
Mast cells in skin release histamine and other pro-inflammatory chemicals
Cause:
o Acute – allergic reaction (allergic causes are most common)
o e.g. food, medications, latex, chemicals
o Chronic – autoimmune (idiopathic or inducible)
Fts:
o Pale, pink raised skin – ‘wheals’
o Itchy
Mx:
o Antihistamines (e.g. cetirizine)
o Prednisolone – in severe / resistant episodes
41. BASAL CELL CARCINOMA
(BCC)
Epidemiology - most common skin CA western
world
Locally invasive
Rarely mets - 0.3%
Causes:
o UV exposure
o Hx childhood sunburn / PMH skin CA / type 1
skin
o Older age
o Immunosuppression
o Exposure to carcinogens
o Genetic predisposition
Subclassifications
• Nodular (60-80%) - rodent ulcer,
erythematous/flesh colour, TURP (telangiestasia,
ulceration, rolled edges, pearly), sun exposed,
?central crater
• Superficial (10%) - scaly irreg plaque,
microerrosions, thin clear rolled edge
• Pigmented (5%) - blue black pigmentation
• Basosquamous (5%) - telangiectasia, central
crusting, differentiation SCC
• Morphoeic (<5%) - irreg borders, waxy scar plaque
Fts (nodular BCC):
o Pearly, flesh-coloured
papule
o Telangiectasia
o Rolled edge
o On sun exposed areas
42. BASAL CELL CARCINOMA
(BCC) CONT.
Mx:
Surgical: excisional (WLE or moh micrographic surgery - high risk),
destructive (curettage, cautery, cryotherapy, CO2 laser)
Non surgical: top imiquimod/fluorouracil, radiotherapy
High risk - >2cm, poorly defined, site (ear, nose, eye, lip), micronodular,
morpeic, basosq, prev tx failure, immunosuppression, perineural/vasc
invasion
Clearance margins: low (4-5cm 95%), high (82% so moh), recurrent (5-
10mm)
45. MALIGNANT MELANOMA
Malignant proliferation of melanocytes
Aggressive mets
5th most common CA UK - highest mortality skin CA
Risk factors:
o Exposure XS UV radiation
o Severe childhood sunburn / skin type / PMH malignant melanoma or atypical moles
o Immunosuppression
o FH / genetic mutations
o Multiple (over 100) or large (more than 20cm) naevi/moles
Diagnostic fts:
o Major (2 points)
o Minor (1 point)
o Suspicion = 3+
Pathophysiology:
• Benign naevus
• Dysplastic/atypical naevus
• Radial growth phase - outwards
• Vertical growth phase - deep
• Metastasis
46. MALIGNANT MELANOMA -
TYPES
Superficial spreading:
o Most common (70%)
o Young people
o Arms, legs, back, chest
Nodular:
o Second most common, most
aggressive
o Sun exposed skin
o Middle aged
o Red/black lump, bleeds/oozes
Lentigo maligna:
o Elderly
Acral lentiginous:
o Half of POC melanomas, rare
o Less sun exposed areas - palms,
soles, nails
o Hutchinson’s sign - subungual
pigmentation (affects nails), palms,
soles
Other - Desmoplastic melanoma,
amelanotic melanoma
47. MALIGNANT MELANOMA
CONT.
Ix:
Biopsy
o Excisional
o Incisional (punch)
High risk: CT scan
+LDH: cell turnover
Mx:
o Wide Local Excision (WLE)
o Electrochemotherapy
o Sentinel lymph node biopsy
Prognosis: Breslow’s thickness
50. STEVENS-JOHNSON
SYNDROME (/TEN)
Disproportional immune response causing epidermal necrosis
Same spectrum of diseases including erythema multiforme
Fts:
o Maculopapular rash with target lesions
o Vesicles/Bullae development
o Mucosal involvement
o Systemic symptoms
o Positive Nikolsky sign
Mx: supportive
Complications:
o Secondary infections - bacterial infection, sepsis
o Permanent damage – skin, hair, nails, lungs, genitals
o Visual complications - sore eyes, severe scarring, blindness
Causes:
Most commonly - reaction to drug,
e.g.:
o penicillin
o sulphonamides
o carbamazepine, lamotrigine,
phenytoin
o allopurinol
o NSAIDs
o oral contraceptive pill
Other causes - infective (rarer)
SJS: <10% skin
surface
TEN: >10% skin
surface (more severe,
requires ITU input)
51. MENINGOCOCCAL
SEPTICAEMIA
!Medical Emergency!
Cause - group B meningococci - Neisseria Meningitidis
Fts:
o Feverish, unwell
o Non-blanching purpuric rash on lower limbs
o Cold peripheries
Mx:
o IV ceftriaxone (definitive)
o Urgent adx, sepsis 6
o IM benzylpenicillin (in community before hospital)
o Notify PHE (notifiable disease): contacts past 7 d, single dose PO
ciprofloxacin/rifampicin
Complications:
• Death - circulatory
collapse
• DIC
• Shock
• Limb ischaemia
52. NECROTISING FASCIITIS
!Medical/Surgical emergency!
Risk factors: recent trauma, burns, soft tissue infections, DM (esp tx SGL2 i),
IVDU, immunosuppression
Fts:
o Severe pain
o Acute onset, erythematous, swelling, presents as worsening cellulitis with
disproportionately severe pain
o Hypoaesthesia/tender light touch over infection
o Skin necrosis / gas gangrene (creps - subcut emphysema)
o Fever / tachy late stages
Most common: perineum (Fournier’s gangrene)
Ix: X-ray (soft tissue gas)
Mx: urgent surgical debridement (+haemodynamic support), IV abx
(vancomycin, piperacillin+tazo)
Prognosis : poor – high mortality
• Rapidly spreading infection of deep fascia
with secondary tissue necrosis
• Important but difficult to recognise early
• Classifications: type I (mixed
aerobes/anaerobes, post-surgery/diabetics,
most common), type II (strep pyogenes)
53. STAPHYLOCOCCAL SCALDED
SKIN SYNDROME (SSSS)
Cause – staph. aureus
Produces epidermolytic toxins
Toxins protease enzymes break down protein in skin
Skin damage and break down
Epidemiology: under 5yo (older people immunity to
toxins)
Fts:
o Patches of erythema, generalised
o Thin and wrinkled skin
o Bullae - fluid filled blisters (bursts leaves sore
erythematous skin)
o Looks like burn/scald
o Systemic sx - fever, lethargy, dehydration
Nikolsky sign positive - gentle rubbing makes skin rub
away
Complications - sepsis + death
Mx:
• Hospital admission
• IV abx
• IV fluids and electrolytes
• Usually makes full recovery
57. MEASLES
Cause – morbillivirus (droplet spread)
Fts:
o Maculopapular rash – starts behind ears then spreads to
whole body
o High fever
o Koplik spots
Mx:
o MMR vaccine (prevention)
o If non-vaccinated child comes into contact with measles,
offer MMR within 72hrs
o Supportive mx
o Notifiable disease
Complications:
• Encephalitis
• Pneumonia
• Febrile seizures
• Otitis media
58. SCARLET FEVER
Cause - Group A beta-haemolytic strep - e.g. strep pyogenes
Epidemiology - 2-6yrs, resp route transmission (via tonsillitis)
2-4d incubation
Fts:
o Fever (24-48hrs)
o Sandpaper skin - rough, macular rash on flexures
o Strawberry tongue
o Sore throat & cervical lymphadenopathy
Diagnosis: throat swab
Mx:
Phenoxymethylpenicillin (Pen V) 10d QDS
� Start as soon as suspicion - do not wait for throat swab
� If allergy penicillin - clarithromycin/erythromycin
Notify PHE - Notifiable disease
24rs off school after abx commencement
Complications
• Otitis media (common)
• Rheumatic fever 20d after
• Acute glomerulonephritis
10d after
• Sepsis, meningitis,
necrotising fasciitis
59. RUBELLA
Aka German measles
Cause – rubella virus
Fts:
o Maculopapular rash for 3-5 days – starts of face the spreads to body
o Lymphadenopathy
o Low-grade fever
Severe damage to fetus if pregnant non-vaccinated woman exposed to
rubella (especially in 1st trimester)
Congenital rubella: deafness, jaundice, haemolysis, learning disability
60. 5TH DISEASE / PARVOVIRUS
Aka slapped cheek / erythema infectiosum
Cause: parvovirus (DNA, resp secretions, vertical transmission too)
Fts:
o Prodrome (1/52) - mild flu like sx
o Slapped cheek looking rash
Mx: supportive
Complications:
o Aplastic crisis
o Foetal disease - hydrops & death
61. 6TH DISEASE / ROSEOLA
INFANTUM
Cause: human herpes virus 6 & 7 (oral secretions from family often)
Under 2 yrs
Fts:
o High fever 3-5d
o Followed by - generalised macular rash (face + body)
Mx: Supportive
Complications:
o Febrile seizures
o Aseptic meningitis
o Hepatitis
o Encephalitis
62. HAND, FOOT
AND MOUTH
DISEASE
Cause – Coxsackie A16, enterovirus
Fts:
o Mild systemic upset – sore throat, fever
o Oral ulcers
o Later, painful vesicular rash on palms and
soles of feet
Mx:
o Supportive – analgesia, hydration
Complication:
o Dehydration
63. MOLLOSCUM
CONTAGIOSU
M
Molluscum contagiosum virus (poxvirus) - direct
contact/sheets
1-4yrs
Fts:
o Small, flesh coloured papules with central dimple
o Appear in crops
Mx: self-limiting (takes up to 18mo)
Complications: bacterial infection (Mx: top fusidic
acid / po flucloxacillin)
66. RHEUMATIC FEVER
Hypersensitivity 2 reaction to recent (2-6wks earlier) strep pyogenes
infection
Multisystem disease
Fts:
o SC nodules - firm, painless
o Erythema marginatum rash - torso, proximal limbs
o Heart - valvular (mitral) disease , pericardial rub
o Migratory arthritis
o Systemic symptoms
o Sydenham chorea
Mx:
o Pen V 10d QDS
o NSAIDs - joint pain
o Aspirin & steroids - heart
Complications:
• Recurrence
• Mitral stenosis
• Heart failure
67. PITYRIASIS ROSACEA
Cause: ? herpes hominis virus 6/7 (not fully known)
Adolescents + young adults
CF:
o Prodrome (sometimes)
o Herald patch - 2d prior to general rash, faint red/pink, scaly, oval, >2cm, torso
o Widespread smaller herald patches - Christmas tree pattern
o Systemic sx
Mx:
o Spontaneous self limiting after 3mo
o Discolouration takes longer to resolve
68. ERYTHEMA
NODOSUM
Inflammation of SC fat (panicullitis)
Not just in children but more commonly so
Fts:
o Tender erythematous nodular lesions
o Shins most commonly (also forearms/thighs)
o Resolves after 6wks
o Should heal without scarring
Causes:
o Systemic disease - IBD, sarcoidosis, behcets
o Infection - strep, TB, brucelleosis
o Drugs - penicillins, sulphonamides, COCP
o Malignancy
o Pregnancy
69. ERYTHEMA MULTIFORM
Hypersensitivity reaction
Fts:
o Target lesions
o Back of hands/ feet before the torso (UL>LL)
o Pruritis
o Sudden onset over few days - mild fever, stomatitis, arthralgia,
headache, systemic sx
o Major - mucosal involvement
Mx:
Self limiting
Major - adx, IV steroids/fluids, analgesia
Causes
o Viruses: HSV, orf
o Bacterial: strep, mycoplasma
o Sarcoidosis
o Idiopathic
o Malignancy
o Connective tissue disorders
e.g. SLE
o Drugs: penicillin,
carbamazepine, sulphonamide,
allopurinol, NSAIDs, COCP,
nevirapine
70. KAWASAKI DISEASE
Medium vessel vasculitis
Under 5yrs
More common in boys, East Asian
No clear cause
Ix:
o FBC - anaemia, raised leucocytes+ platelets
o Raised LFTs, EST, CRP
o Raised WCC on urine dip
Mx:
o High dose aspirin (treats thrombosis risk) - usually CI in children due to risk of
Reye’s syndrome
o IVIG
Complications:
o Coronary artery disease
o Thrombosis
Fts:
• High fever >39C >5d
• Unwell
• Erythematous widespread
maculopapular rash &
desquamation on palms & soles
• Strawberry tongue
• Cracked lips
• Cervical lymphadenopathy
71. ‘FUN’ FACTS
Erythema ab igne – rash following exposure to infrared radiation
(e.g. after hot water bottle, sitting next to open fire)
Lyme disease – typical ‘bulls-eye’ rash, caused by Borrelia
burgdorferi, spread by ticks, mx – doxycycline
Acanthosis nigricans – symmetrical, brown plaques found on neck,
axilla and groin. Often due to type 2 diabetes, PCOS, obesity, GI
cancer. Due to insulin resistance
