Learn about common dermatological conditions. The lecture includes Common dermatological diseases, signs, and symptoms, treatment, and prevention.

1. Common skin diseases

2. • “The common forms of skin diseases
affecting the people in the country are
eczema, superficial fungal, bacterial
infections (common among children),
scabies, acne (pimples) and psoriasis,”

3. Common Skin problems

4. Characteristics:
• inflammatory epidermal rash
• acute or chronic
• non- contagious
• vesicles, redness, weeping, oozing, crusting,
scaling, itch
Dermatitis/Eczema

5. Dermatitis/Eczema
• multi-factorial
• chronic
• uncertain etiology
• not always associated with allergy
• wide range of presentations

6. Triggers

7. • Triggers:
– irritating substances, allergies, other diseases
• Prevention:
– avoiding irritants, stress, allergens
• .
Dermatitis/Eczema

8. Eczema Symptoms
• Characteristics:
– dry, red, itches or burns
– blisters and oozing lesions
– dry, crusted, scaly and thickened induced by
repeated scratching.
• Intense itching is frequently the first
symptom in most people with eczema.

9. Common sites

10. Common sites
• Children and adults - face, neck,
antecubital fossa, knees, and ankles.
• Infants - forehead, cheeks, forearms, legs,
scalp, and neck

11. • Eczema can sometimes occur as a brief
reaction that only leads to symptoms for a
few hours or days, but in other cases, the
symptoms persist over a longer time and
are referred to as chronic dermatitis.

13. • Exogenous
– Allergic contact, primary irritant contact, photo
allergic
• Endogenous
– Atopic, nummular, dishydrotic, pityriasis alba,
lichen simplex chronicus and seborrheic
Dermatitis/Eczema

14. Types of Eczematous Dermatitis
• Atopic dermatitis - most common of the
many types of eczema

15. What is atopy?
• Hereditary
• Develops with a group of conditions
• Not synonymous with allergy
• 10 % population atopic
• Allergic rhinitis is the most common
manifestation

16. Atopic Dermatitis
CLASSIC features:
• itchy and dry
• usually a family history of atopy
• ~ 3% infants are affected, signs appearing
between 3 months and 2 years
• known trigger factors
• asthma, hay fever, and eczema often occur in
the same families
• flexures usually involved

17. Distribution
Infants:
• – cheeks of the face, neck folds, scalp,
extensor surface of the limbs
• – flexures of limbs and groin
Childhood:
• – cubital and popliteal fossa

18. Criteria for diagnosis
Major Clinical Features:
• Pruritus
• Typical morphology and distribution
• Dry skin
• Personal or family history of atopy
• Chronic relapsing dermatitis
Source : AAFP

19. Atopic Dermatitis

20. Atopic Dermatitis

21. Treatment
MILD
• Soap substitutes
• Emolients apply BD to dry skin
– aqueous cream, paraffin creams (Dermeze), bath oils
(Alpha Keri), moisturizing lotions
• 1 % hydrocortisone
– short term for flares, if not responsive with
emolients or soap substitutes

22. Treatment
MODERATE
• as for mild
• Topical corticosteroids
• Vital for active areas

23. MODERATE
• Moderate strength (e.g. fluorinated) to
trunk and limbs, OD or BD
• Weaker strength (e.g. 1% hydrocortisone)
to face and flexures, OD or BD
• Use in cyclic fashion for chronic cases
(e.g. 10 days on, 4 days off)
• Oral anti-histamines nocte for itchiness
Treatment

24. WEEPING
• Burows solution – diluted
• Saline dressings
Treatment

25. General points of dermatitis
management
Acute weeping Wet dressings
Acute Creams
Chronic Ointments, with or without
Lichenified Ointments under occlusion
Infection Antibiotics (e.g. Mupirocin 2% topical
or oral)
Moisturising Use lotions not creams

26. CLASSIC features:
• itchy, inflamed skin
• red and swollen
• papulovesicular
• may be dried and fissured
Contact Eczema
(Contact Dermatitis)

27. Contact Eczema
(Contact Dermatitis)
• localized reaction
• redness, pruritus and burning in areas
where the skin has come into contact with
an allergen or an irritant.
• ~ 70% irritant cause

28. Irritant Contact Dermatitis
• Caused primarily by irritants such as acids
alkalis, detergents, soaps, oils, solvents.
• Once-only exposure or repeated
exposure
• Not allergy but irritation

29. Allergic contact dermatitis
• Caused by allergens; immunologically
mediated
• Nickel from jewelries, studs from jeans,
keys, coins
• Due to delayed hypersensitivity – or days
to years
• Common in industrial or occupational
situations where it usually affects the
hands and forearms

30. Diagnostic hallmarks

31. Diagnosis
• History and examination
• What to ask?
– Occupation, family history, vacation or travel
history, clothes, topical application
• Refer to a dermatologist for patch testing

32. • Determine triggers/offenders and remove it
• Wash with water (only) and pat dry (avoid soap)
• If acute and with blisters, apply Burrows
compresses
• Oral prednisone for severe cases (start with 25-
50 mg for adults x 1-2weeks
• Topical steroid cream
• Antibiotics if infected
Diagnosis

33. Contact Dermatitis

34. Contact Dermatitis

35. Seborrheic Eczema
(Seborrheic dermatitis)
CLASSIC features:
• skin inflammation
• unknown cause
• not always associated with pruritus
• familial

36. • Characteristics:
– yellowish, oily, scaly patches of skin
• 2 types:
– infants “cradle cap”
– adult form
Seborrheic Eczema
(Seborrheic dermatitis)

37. Seborrheic dermatitis of infancy
Seborrheic Dermatitis Atopic Dermatitis
Age of onset Mainly within first 3
months
Usually after 2 months
Itchiness Nil or mild Usually severe
Distribution Scalp, cheeks, neck
folds, axillae, folds of
elbows and knees
Starts on face
Elbows and knee
flexures
Typical features Cradle cap
Red and yellow greasy
scale
Vesicular and weeping
Becomes dry and
cracked
Napkin rash Common Less common

38. Seborrheic Eczema
(Seborrheic dermatitis)
• Common sites: hair bearing areas
– Scalp and eyebrows
– face (creases of the cheeks)
– nasal folds
• Triggers:
– Emotional stress, oily skin, infrequent
shampooing and weather conditions

39. Adult seborrheic dermatitis
Clinical features:
• Red rash with yellowish greasy scale
• Secondary candidiasis infection common
in flexures
• Dandruff a feature of scalp area
• Worse with stress and fatigue
• Chronic and recurrent

40. Seborrheic Eczema
(Seborrheic dermatitis)

41. Seborrheic Eczema
(Seborrheic dermatitis)

42. Treatment
• Keep areas dry and clean
• Warm bath, pat areas dry with soft cloth
• Keep skin expose to air as much as
possible
• Use emulsifying ointment or lotion

43. Treatment
• Rub scales of cradle cap gently with baby
oil, then wash away loose scales
• Change wet or soiled nappies often
• Apply a thin smear of Zinc cream for mild
areas on body

44. Treatment
Scalp – Infants
• 1-2 % sulphur and 1-2% salicylic acid in
aqueous cream
• Egozite cradle cap lotion
– Apply overnight to scalp, shampoo off the
next day with mild shampoo
– Use 3x a week until clear

45. Treatment
Older children and adults
• Selenium sulfide 2.5% shampoo
OR
• Ketoconazole 1-2 % shampoo

46. Face Flexures and trunk
• Ketoconazole 2% cream, OD or BD
• 2% sulphur and 2 % salicylic acid in
aqueous cream
• Hydrocortisone 1% (face and flexures)
• Betamethasone 0.02-0.05% (severe
irritation on trunk)
• Desonide 0.05% lotion bd or tds for
face/eyelids and weeping areas

47. Napkin area
• Mix equal parts of 1% hydrocortisone with
nystatin or ketoconazole 2% or
clotrimazole 1%

48. Nummular Eczema
(Nummular dermatitis)
CLASSIC features:
• extremely itchy, usually chronic
• personal or family history of atopy,
asthma, or allergies increases the risk of
developing the condition
• occurs most frequently in elderly men and
women.

49. • Characteristics:
– coin-shaped patches that may be crusted and
scaling
• Common sites:
– arms, back, buttocks, and lower legs
•
Nummular Eczema
(Nummular dermatitis)

50. Nummular Eczema
(Nummular dermatitis)

51. CLASSIC features
• chronic skin inflammation
• “scratch-itch cycle” from a localized itch
• women are commonly affected
• most frequent in people 20-50 years of age
Neurodermatitis
(Lichen simplex chronicus)

52. • Characteristics:
– scaly patches of skin later becoming
thickened and leathery
• Common sites:
– head, lower legs, wrists, or forearms.
Neurodermatitis
(Lichen simplex chronicus)

53. Neurodermatitis
(Lichen simplex chronicus)

54. Stasis Dermatitis
(Varicose eczema)
CLASSIC features:
• skin irritation on the lower legs, generally
related to venous insufficiency
• occurs almost exclusively in middle-aged and
elderly people
• risk increases with advancing age

55. • venous insufficiency – compromised
function of valve of the veins
• 6-7 % of population over 50 years of age
are affected
Stasis Dermatitis
(Varicose eczema)

56. Stasis Dermatitis
(Varicose eczema)
• Characteristics:
– itchy and/or reddish-brown discoloration of the skin on
one or both legs.
– blistering, oozing skin lesions and ulcers may later
develop in affected areas.
– chronic circulatory problems lead to an increase in
fluid buildup (edema) in the legs.

57. Stasis Dermatitis
(Varicose eczema)
• Itchiness skin discoloration blisters
 oozing lesions  ulcers edema

58. Stasis Dermatitis
(Varicose eczema)

59. Dishydrotic Eczema
(Dishydrotic dermatitis)
CLASSIC features:
• skin irritation on the palms of hands and soles
of the feet
• males and females are equally affected
• people of any age may be affected

60. Dishydrotic Eczema
(Dishydrotic dermatitis)
CLASSIC features:
• more common during spring and summer and in
warmer climates
• occurs in up to 20% of people with hand
eczema
• unknown cause

61. Dishydrotic Eczema
(Dishydrotic dermatitis)
Characteristics:
• clear, deep blisters that itch and burn
• Dishydrotic eczema also known as:
Vesicular palmoplantar dermatitis,
dishydrosis or pompholyx.

62. Dishydrotic Eczema
(Dishydrotic dermatitis)

63. Eczema Treatment
Therapeutic goal:
• to prevent itching, inflammation, and
worsening of the condition.

64. Eczema Treatment
Basic Therapies
• lifestyle changes
• use of medications
– Application of cream or ointment
– Over bathing must be avoided

65. Eczema Treatment - Medications
• Corticosteroid creams - decrease the
inflammatory reaction in the skin.
• Oral antihistamines for severe itchiness
• Oral corticosteroids (such as prednisone)
short course to control an acute outbreak
of eczema, BUT long-term use is
discouraged

66. Is eczema really preventable?
• While eczema is not totally preventable,
there are self-care measures that can be
done can to help manage symptoms and
reduce the severity of outbreaks

67. Prevention
• Good skin care is a key component in the
control of eczema especially for milder
cases.

68. Prevention
• Avoiding irritant
– changing laundry detergent
• Avoiding allergens
– new climate or new jobs

71. Napkin rash
• Irritant dermatitis – commonest cause
• Keep area dry
• Change wet or soiled nappies often
• Wash gently and pat dry, do not rub
• Avoid excessive bathing and soap
• Avoid powders and plastic pants
• Use emollients to keep skin lubricated

72. Impetigo (School sores)
• contagious superficial bacterial skin
infection caused by Strep. pyogenes or
Staph aureus or both.
2 forms:
• Vesiculopapular with honey coloured
crusts (Staph or Strep)
• Bullous type, usually S. aureus

73. Impetigo
• The first sign of impetigo is a patch of red,
itchy skin.
• Characteristics:
– pustules and crust, yellow-brown sores
• Distribution:
– face, arms, and other body parts
• Treatment : antibiotics

74. Impetigo

75. Treatment
• Remove crust with gentle washing
• If mild and limited: antiseptic cleaning with
chlorhexidine or povidone iodine, then
mupirocin tds x 10 days
• If extensive oral flucloxacillin, cephalexin,
or erythromycin x 10 days

76. Hives

77. Hives (Urticaria)
A common allergic reaction that looks like
welts
Characteristics:
itchy, stinging or burning
varies in size and may coalesce to form
larger areas
Distribution:
appears anywhere and last minutes or days.

78. Hives
Triggers:
– medications, foods, food additives,
temperature extremes are some causes of
hives.
Treatment:
– antihistamines

79. Head lice
• Cause: Pediculus humanus capitis
• Spread from person to person by direct
contact.

80. Head lice
• Clinical features:
• Asymptomatic or can cause itching of the
scalp
• White spots of nits can be mistaken for
dandruff
• Unlike dandruff, nits cannot be brushed off
• Diagnosis by finding lice or nits
• Wet combing improves detection rate.

81. Treatment
• Pyrethrins/piperonyl foam or shampoo –
leave for 20 mins minimum
• Permethrin 1% scalp preparation

82. Scabies
• Sarcoptes scabiei
• School aged children,nursing homes,
prison
• Female mite burrows just beneath the skin
lays eggs and dies.
• Mite antigen (excreta) causes allergic
reaction.

83. Scabies
Clinical features:
• Intense itching (warm and night)
• Erythematous papular rash
• Hands and wrist
• Elbows, axilla, ankles and feet

84. Scabies
• Permethrin 5 % cream (preferable)
– Leava overnight then wash off
– Single application
OR
• Benzyl benzoate 25% emulsion (dilute
with water if under 10 years) leave for 24
hours
• **May be used for all ages except children
under 2 months

85. • For children < 2 mos
• Use sulphur 5% cream for 2-3 days OR
crotamiton 10% cream daily for 3-5 days

86. Resistant head lice
• A US RCT showed that 1% permethrin
plus a 10 day course of Cotrimoxazole
was the best treatment for resistant cases.

87. How to remove head lice
• Combing with a hair conditioner
• Use a 1:1 water and vinegar mixture,
leave for 15 minutes then comb with a fine
toothed comb

88. Gnawed nails

89. Gnawed Nails
• Biting nails may be nothing more than an
old habit, BUT in some cases it may be a
sign of persistent anxiety that could benefit
from treatment.
• Nail biting or picking has also been
associated with obsessive-compulsive
disorder.

90. Pityriasis versicolor

91. • Superficial yeast infection
• Malassezia sp.
• Reddish brown slightly scaly patches on
upper trunk
• Hypopigmented area that will not tan
Pityriasis versicolor

92. Treatment
• Selenium sulfide (Selsun shampoo)
• Wash area and leave for 5-10 minutes,
wash off
• Daily for 2 weeks nocte, then every 2nd
day x 2 weeks then monthly

93. • Econazole 1% solution nocte x 3 nights
• Ketoconazole shampoo once daily x 10
minutes for 10 days
• Terbinafine 1% cream BD x 2 weeks

94. Tinea pedis
(Athlete's Foot)
• peeling, redness, itching, burning, and
sometimes blisters and sores
• Contagious
– passed by direct contact, sharing shoes worn
by an infected person, or by walking barefoot
in areas such as locker rooms or near pools.
• Treatment:
– topical antifungal lotions or oral medications
for more severe cases.

96. • begins with a single, scaly pink patch with a
raised border.
• scaly rash appears on the arms, legs, back,
chest, and abdomen, and sometimes the neck.
• rash may appear "Christmas tree" shaped
across the body.
Pityriasis rosea

97. Pityriasis rosea
• cause is unknown
• non-contagious but can be itchy.
• resolves in 6-8 weeks without treatment.
• often seen between the ages of 10 and 35.

98. Pityriasis rosea

99. Xeroderma (dry skin)

100. Verruca vulgaris
• Verruca vulgaris. The common wart is a
benign growth caused by localized
infection with one of the many types
of human papillomavirus. These small
DNA viruses are part of the papovavirus
group.

101. Warts
• Warts are especially common among
children and adolescents and may occur
on any mucocutaneous surface. The
hands are a particularly frequent location.
The typical wart is a roughsurfaced nodule
that may be either lighter or darker than
the surrounding skin.

102. Molluscum contagiosum

103. Molluscum contagiosum
• small pearly or flesh-colored bumps.
• The bumps may be clear, and the center
often is indented.
• caused by a virus.

104. Distribution
• Infants – cheeks of the face, neck folds,
scalp, extensor surface of the limbs
• Flexures of limbs and groin
• Childhood –cubital and popliteal fossa

105. Prognosis
• 60 % normal by 6 years
• 90 % by puberty

106. Treatment
• Avoid soap and perfumed products
• Should be low pH
• Apply emolient right after bath
• Short tepid showers for older children
• Avoid rubbing and scratching

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108. Finish
Good Luck with your studies