This document provides information on diagnosing and treating various dermatological conditions in adults. It begins by outlining the objectives of identifying dermatology conditions, those requiring referral, and developing evaluation and treatment plans. It then describes several common conditions like dermatofibroma, contact dermatitis, hot tub folliculitis, perioral dermatitis, seborrheic keratoses, acne vulgaris, psoriasis, and skin tags. For each condition, it discusses characteristics, symptoms, signs, diagnosis, and treatment options. It also presents a case study describing a patient with a painful rash and diagnoses the patient with herpes zoster based on the clinical findings.
This document discusses atopic dermatitis (AD), also known as eczema. Some key points:
1. AD is a chronic, relapsing inflammatory skin disease that is most common in childhood. It affects 15-20% of children in industrialized nations.
2. Symptoms vary by age but commonly include itchy, red, scaly skin rashes. Lesions typically affect the face, neck, hands and skin folds.
3. AD results from a complex interaction between genetic and environmental factors. Triggers include wool, harsh soaps and emotional stress. Treatment focuses on reducing triggers and includes emollients, topical steroids and antihistamines.
Tinea versicolor is a common skin infection caused by the Malassezia fungus. It causes patches of discolored skin but is not harmful or contagious. While it may cause emotional distress, the fungus usually lives harmlessly on the skin. Tinea versicolor is more common in teenagers due to hormones and occurs in people of all ages. Factors like weak immune systems, hormones, sweat, and heat can cause the fungus to overgrow and discolor patches of skin.
Eczema, also known as dermatitis, is a common skin condition affecting 20% of patients referred to clinics. It is characterized by redness, swelling, blistering, crusting, and flaking in areas with poorly defined borders. Histologically, eczema shows inflammation of the epidermis and dermis. The causes include allergic and irritant contact dermatitis. Treatment depends on the severity and includes emollients, topical corticosteroids, wet wrap dressings, systemic antibiotics, and avoidance of exacerbating factors. Atopic eczema, the most common form, has a genetic component and usually starts in childhood.
This document discusses psoriasis and scabies. Psoriasis is a chronic inflammatory skin disorder characterized by thickened, scaly plaques that affects 1.5-3% of the population worldwide. Scabies is a contagious skin infection caused by the mite Sarcoptes scabiei that causes intense itching. Treatment for psoriasis includes topical therapies like corticosteroids and vitamin D analogues, phototherapy, and systemic immunosuppressants. Scabies is transmitted through direct skin contact and presents as a pimple-like rash and sores from scratching.
This document discusses various types of dermatitis and eczema. It begins with an introduction noting that dermatitis and eczema refer to inflammation of the skin. Eczema progresses through acute, subacute, and chronic stages. Prevalence in the US is 10-12% in children and 0.9% in adults, rising internationally. Atopic eczema is a chronic pruritic inflammation affecting the epidermis and dermis, commonly presenting in infants and children. Contact dermatitis results from allergic or irritant reactions to substances touching the skin. Other conditions discussed include lichen simplex chronicus, discoid eczema, seborrhoeic dermatitis, and
The document discusses allergy and defines it as an inappropriate immune response to normally harmless substances called allergens. It then discusses different types of allergic disorders including asthma, eczema, contact dermatitis, hay fever, food allergies, drug allergies, insect sting allergies, and anaphylaxis. It provides definitions and details on asthma and eczema, including causes, symptoms, diagnostic findings and treatment approaches.
This document discusses eczema and impetigo. It begins by defining eczema as a common form of skin inflammation that can affect people of any age. Family history and environmental factors can increase risk. The causes of eczema involve dry, sensitive skin and immune system issues. Treatment includes moisturizers, corticosteroids, immunosuppressants, and lifestyle changes. Impetigo is a superficial skin infection most common in children, caused by Staphylococcus or Streptococcus bacteria. It presents as fluid-filled vesicles or crusty yellow lesions. Treatment involves antibiotics like penicillin for 7-10 days.
This chapter discusses the clinical symptoms of atopic eczema. It describes itch as the primary symptom, with scratching leading to rashes. Flexural dermatitis is often visible. Atopic eczema typically starts in infancy and affects the face, neck, and limbs, following a craniocaudal pattern. The course is often constant eczema in infancy, followed by periods of remission and relapse in childhood, with 15-25% continuing into adulthood. Secondary infections are common. Various clinical features like papules, lichenification, and hyperpigmentation are discussed.
This document discusses atopic dermatitis (AD), also known as eczema. Some key points:
1. AD is a chronic, relapsing inflammatory skin disease that is most common in childhood. It affects 15-20% of children in industrialized nations.
2. Symptoms vary by age but commonly include itchy, red, scaly skin rashes. Lesions typically affect the face, neck, hands and skin folds.
3. AD results from a complex interaction between genetic and environmental factors. Triggers include wool, harsh soaps and emotional stress. Treatment focuses on reducing triggers and includes emollients, topical steroids and antihistamines.
Tinea versicolor is a common skin infection caused by the Malassezia fungus. It causes patches of discolored skin but is not harmful or contagious. While it may cause emotional distress, the fungus usually lives harmlessly on the skin. Tinea versicolor is more common in teenagers due to hormones and occurs in people of all ages. Factors like weak immune systems, hormones, sweat, and heat can cause the fungus to overgrow and discolor patches of skin.
Eczema, also known as dermatitis, is a common skin condition affecting 20% of patients referred to clinics. It is characterized by redness, swelling, blistering, crusting, and flaking in areas with poorly defined borders. Histologically, eczema shows inflammation of the epidermis and dermis. The causes include allergic and irritant contact dermatitis. Treatment depends on the severity and includes emollients, topical corticosteroids, wet wrap dressings, systemic antibiotics, and avoidance of exacerbating factors. Atopic eczema, the most common form, has a genetic component and usually starts in childhood.
This document discusses psoriasis and scabies. Psoriasis is a chronic inflammatory skin disorder characterized by thickened, scaly plaques that affects 1.5-3% of the population worldwide. Scabies is a contagious skin infection caused by the mite Sarcoptes scabiei that causes intense itching. Treatment for psoriasis includes topical therapies like corticosteroids and vitamin D analogues, phototherapy, and systemic immunosuppressants. Scabies is transmitted through direct skin contact and presents as a pimple-like rash and sores from scratching.
This document discusses various types of dermatitis and eczema. It begins with an introduction noting that dermatitis and eczema refer to inflammation of the skin. Eczema progresses through acute, subacute, and chronic stages. Prevalence in the US is 10-12% in children and 0.9% in adults, rising internationally. Atopic eczema is a chronic pruritic inflammation affecting the epidermis and dermis, commonly presenting in infants and children. Contact dermatitis results from allergic or irritant reactions to substances touching the skin. Other conditions discussed include lichen simplex chronicus, discoid eczema, seborrhoeic dermatitis, and
The document discusses allergy and defines it as an inappropriate immune response to normally harmless substances called allergens. It then discusses different types of allergic disorders including asthma, eczema, contact dermatitis, hay fever, food allergies, drug allergies, insect sting allergies, and anaphylaxis. It provides definitions and details on asthma and eczema, including causes, symptoms, diagnostic findings and treatment approaches.
This document discusses eczema and impetigo. It begins by defining eczema as a common form of skin inflammation that can affect people of any age. Family history and environmental factors can increase risk. The causes of eczema involve dry, sensitive skin and immune system issues. Treatment includes moisturizers, corticosteroids, immunosuppressants, and lifestyle changes. Impetigo is a superficial skin infection most common in children, caused by Staphylococcus or Streptococcus bacteria. It presents as fluid-filled vesicles or crusty yellow lesions. Treatment involves antibiotics like penicillin for 7-10 days.
This chapter discusses the clinical symptoms of atopic eczema. It describes itch as the primary symptom, with scratching leading to rashes. Flexural dermatitis is often visible. Atopic eczema typically starts in infancy and affects the face, neck, and limbs, following a craniocaudal pattern. The course is often constant eczema in infancy, followed by periods of remission and relapse in childhood, with 15-25% continuing into adulthood. Secondary infections are common. Various clinical features like papules, lichenification, and hyperpigmentation are discussed.
Dr. Angelo Smith discusses various types of dermatitis and eczema. He covers topics such as the characteristic presentations, locations, triggers, and treatment approaches for atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, and seborrheic dermatitis among others. The document provides clinical guidance on distinguishing features, comorbidities, and management strategies for common inflammatory skin conditions.
Most Common Skin Disorders - Causes and Treatment | Sehat.comSehat.com
Almost everyone might have experienced at one time or the other the horror of dealing with a skin disorder/disease. Irrespective of the age, one can be affected by various skin ailments and if not treated properly the condition may get aggravated.
Ringworm is a fungal infection that spreads through contact with infected animals, soil, or other people. It causes a red, itchy rash that is sometimes in a ring shape and thick, dry, scaly skin. While not life-threatening, ringworm can recur so proper treatment by washing the affected area and applying antifungal ointment is important to prevent reinfection through good hygiene practices.
Atopic dermatitis is a chronic, highly pruritic skin disease that is common in childhood. It involves the cheeks, hands, feet and flexural areas. Seborrheic dermatitis affects sebaceous areas in adults and commonly presents as flaky, greasy scales on the scalp. Eczema has endogenous and exogenous forms. Endogenous eczema includes atopic dermatitis while exogenous eczema includes irritant and allergic contact dermatitis caused by external triggers. Proper treatment of eczema focuses on moisturization, reducing irritation and treating secondary infections.
Scabies is caused by tiny burrowing mites that infest the skin and lay eggs, causing intense itching. It spreads through direct, prolonged skin-to-skin contact. The mites burrow beneath the skin and lay eggs, causing a rash and itching that is usually worse at night. Scabies is diagnosed through examination of burrows and microscopic identification of mites. Treatment involves applying prescription creams or lotions to kill the mites. Multiple treatments and treating all contacts is usually needed to prevent reinfestation.
This document discusses eczema, including its classification, symptoms, and treatment. It begins by defining eczema as a skin condition characterized by itching and scratching. It then classifies eczema based on etiology, morphology, and chronicity. Symptoms of acute eczema include erythema, vesicles, and crusting, while chronic eczema features lichenification. Complications can be dermatological like infection or psychosocial like anxiety. Treatment involves identifying triggers, moisturizing, and using topical corticosteroids or immunosuppressants. It also focuses on atopic dermatitis, its causes, features in infants/children/adults, and management through avoidance of
This document provides information about Lyme disease and tick prevention. It lists helpful online resources for Lyme disease and tick identification. Lyme disease is caused by bacteria transmitted through the bites of infected blacklegged ticks. Symptoms can include a circular rash, flu-like symptoms, and joint pain. Preventing tick bites involves using repellent, wearing protective clothing, checking for ticks daily, and removing vegetation near the home. Prompt tick removal and monitoring for symptoms is important.
these set of slides are about skin infections particularly cellulitis...they aren't complete, however they can give you clues about these infections. hope you enjoy them
Dermatitis in animals types and lesionsTanmay Tewari
This document provides an overview of dermatitis and skin lesion classifications. It begins by defining eczema/dermatitis and discussing the two main classifications of endogenous and exogenous eczema. Major types of dermatitis are then outlined such as atopic dermatitis, contact dermatitis, and stasis dermatitis. The document concludes by describing and providing examples of different primary skin lesions including macules, papules, pustules, vesicles, scales, and scars.
This document provides information on various types of dermatitis (inflammation of the skin). It defines dermatitis and eczema, and discusses their classification including endogenous (internal) and exogenous (external) causes. It also summarizes different types of contact dermatitis including irritant and allergic reactions. Specific conditions like hand dermatitis, atopic dermatitis, and photocontact dermatitis are described. Diagnosis and treatment focus on identifying causes, avoiding triggers, and using topical corticosteroids.
Eczema herpeticum is a potentially life-threatening herpes infection that occurs when herpes simplex virus infects disrupted skin in patients with pre-existing skin conditions like eczema or atopic dermatitis. It presents with clusters of vesicles and punched-out erosions that spread and become hemorrhagic and crusted. Diagnosis involves identifying characteristic lesions along with fever and pain, and can be confirmed with tests like Tzanck smear, viral culture, or antibody testing. Aggressive treatment with IV acyclovir is required to prevent complications like herpes keratitis, which can lead to blindness. Early recognition and effective antiviral therapy are important given the potential severity of eczema her
Shingles is caused by the reactivation of the varicella zoster virus which causes chickenpox, presenting as a painful rash on one side of the body that is soon followed by blisters. It occurs more often in elderly people and can be prevented with vaccination. Treatment with antiviral drugs within 48 hours can limit post-herpetic neuralgia.
This document provides an overview of common skin diseases in pediatrics. It begins with an introduction noting that skin complaints make up 1/3 of pediatric outpatient visits. It then covers the anatomy and functions of skin, differences between neonatal and adult skin, how to approach diagnosis, and classifications of pediatric skin disorders. Specific conditions discussed include toxic erythema of newborns, miliaria rubra, acropustulosis of infancy, transient neonatal pustular melanosis, neonatal acne, congenital syphilis, and milia. Intertrigo, diaper dermatitis, cutis marmorata are also summarized.
The skin has three main layers - the epidermis, dermis and hypodermis. The epidermis is the outer protective layer, the dermis is a lower supporting layer that gives strength and acts as a reservoir to fight infections, and the hypodermis is a layer of fatty tissue that supports the skin. The skin acts as a protective barrier and plays roles in temperature regulation, sensation, and waste excretion. Fungal infections can be superficial or deep, with superficial infections affecting the outer layers and deep infections invading living tissue. Corticosteroids are anti-inflammatory drugs that work by suppressing the immune system and inflammatory response.
The document discusses atopic dermatitis (AD), also known as eczema. It defines AD as a pruritic, chronic inflammatory skin condition characterized by dry skin and itchy rashes. AD is common in childhood and often runs in families with other allergic diseases. The pathogenesis involves genetic predisposition, skin barrier defects, and abnormal immune responses. Clinical manifestations vary depending on the stage of life, from facial rashes in infants to thickened plaques on flexural areas in older patients. Treatment focuses on moisturizing the skin, identifying trigger factors, and using topical corticosteroids or calcineurin inhibitors to control symptoms.
Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition characterized by a defective skin barrier and sensitization that causes itching and skin lesions. It commonly begins in infancy and persists into adulthood. Risk factors include a family history of atopic conditions as well as environmental triggers. Clinically, it presents as red, itchy rashes in flexural areas of the skin that vary depending on the age of the patient. Treatment focuses on breaking the itch-scratch cycle through topical anti-inflammatory agents and moisturizers, with topical corticosteroids as first-line treatment for flares.
Dermatitis, also known as eczema, is an inflammation of the skin that causes redness, swelling, intense itching, and the formation of lesions. It has various causes depending on the type, such as contact with irritating substances for contact dermatitis. The main types are contact dermatitis, occupational dermatitis, dyshidrotic eczema, and nummular eczema. Treatments include topical steroid creams to reduce inflammation and itching, moisturizers, antihistamines, pain relievers, and avoiding triggers.
The document discusses skin infections and dermatosis. It defines dermatosis as diseases of the integumentary system, including skin, nails, and hair. It describes four main types of skin infections - bacterial, viral, fungal, and parasitic - listing examples of each type and their symptoms. The document also covers causes, diagnosis, treatment and prevention of skin infections. It then discusses various skin conditions that are considered dermatosis, providing examples of common and less common forms.
This PowerPoint presentation summarizes information about psoriasis for a medical student presentation. It defines psoriasis as a chronic inflammatory skin disease causing rapid skin cell production, buildup, and flaking. The presentation covers the types of psoriasis including plaque, guttate, inverse, pustular, and erythrodermic psoriasis. It discusses the genetic and environmental factors involved in psoriasis development and outlines management approaches like topical treatments, phototherapy, and systemic drugs. The presentation concludes by summarizing results from an Italian study finding high rates of depressive symptoms in psoriasis patients, particularly younger men and those with less education.
This document defines psoriasis as a chronic, immune-mediated inflammatory skin disease characterized by well-circumscribed erythematous scaly plaques. It disrupts the normal cycle of skin cell proliferation and differentiation, causing keratinocytes to replicate rapidly within days rather than weeks. Psoriasis has no cure, but can be managed with topical therapies like vitamin D analogs, phototherapy, or systemic drugs when widespread. Calcipotriol is a first-line topical therapy that exerts immunomodulatory and anti-proliferative effects on keratinocytes and T cells to reduce inflammation and hyperplasia.
Interflora España apoya todas las iniciativas que tienen que ver con el negocio justo.
Aparte de la intermediación, Interflora tiene una división de servicios a floristas llamada Central de Servicios que entre otros productos específicos para profesionales, vende rosa de Ecuador. Nuestro proveedor es un consorcio llamado Ecuadorian Spirit que ya vende rosa en Alemania desde hace 4 años y en EEUU con el sello FLP (Flower Label Program) y FLOR Ecuador, que son incluso más exigentes que el @sellofairtrade, respecto a las condiciones laborales y ambientales de las fincas. (presentación en Ingles).
Más información sobre FLOR Ecuador en Más información sobre el sello FLOR Ecuador en http://www.florecuador.org
Dr. Angelo Smith discusses various types of dermatitis and eczema. He covers topics such as the characteristic presentations, locations, triggers, and treatment approaches for atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, and seborrheic dermatitis among others. The document provides clinical guidance on distinguishing features, comorbidities, and management strategies for common inflammatory skin conditions.
Most Common Skin Disorders - Causes and Treatment | Sehat.comSehat.com
Almost everyone might have experienced at one time or the other the horror of dealing with a skin disorder/disease. Irrespective of the age, one can be affected by various skin ailments and if not treated properly the condition may get aggravated.
Ringworm is a fungal infection that spreads through contact with infected animals, soil, or other people. It causes a red, itchy rash that is sometimes in a ring shape and thick, dry, scaly skin. While not life-threatening, ringworm can recur so proper treatment by washing the affected area and applying antifungal ointment is important to prevent reinfection through good hygiene practices.
Atopic dermatitis is a chronic, highly pruritic skin disease that is common in childhood. It involves the cheeks, hands, feet and flexural areas. Seborrheic dermatitis affects sebaceous areas in adults and commonly presents as flaky, greasy scales on the scalp. Eczema has endogenous and exogenous forms. Endogenous eczema includes atopic dermatitis while exogenous eczema includes irritant and allergic contact dermatitis caused by external triggers. Proper treatment of eczema focuses on moisturization, reducing irritation and treating secondary infections.
Scabies is caused by tiny burrowing mites that infest the skin and lay eggs, causing intense itching. It spreads through direct, prolonged skin-to-skin contact. The mites burrow beneath the skin and lay eggs, causing a rash and itching that is usually worse at night. Scabies is diagnosed through examination of burrows and microscopic identification of mites. Treatment involves applying prescription creams or lotions to kill the mites. Multiple treatments and treating all contacts is usually needed to prevent reinfestation.
This document discusses eczema, including its classification, symptoms, and treatment. It begins by defining eczema as a skin condition characterized by itching and scratching. It then classifies eczema based on etiology, morphology, and chronicity. Symptoms of acute eczema include erythema, vesicles, and crusting, while chronic eczema features lichenification. Complications can be dermatological like infection or psychosocial like anxiety. Treatment involves identifying triggers, moisturizing, and using topical corticosteroids or immunosuppressants. It also focuses on atopic dermatitis, its causes, features in infants/children/adults, and management through avoidance of
This document provides information about Lyme disease and tick prevention. It lists helpful online resources for Lyme disease and tick identification. Lyme disease is caused by bacteria transmitted through the bites of infected blacklegged ticks. Symptoms can include a circular rash, flu-like symptoms, and joint pain. Preventing tick bites involves using repellent, wearing protective clothing, checking for ticks daily, and removing vegetation near the home. Prompt tick removal and monitoring for symptoms is important.
these set of slides are about skin infections particularly cellulitis...they aren't complete, however they can give you clues about these infections. hope you enjoy them
Dermatitis in animals types and lesionsTanmay Tewari
This document provides an overview of dermatitis and skin lesion classifications. It begins by defining eczema/dermatitis and discussing the two main classifications of endogenous and exogenous eczema. Major types of dermatitis are then outlined such as atopic dermatitis, contact dermatitis, and stasis dermatitis. The document concludes by describing and providing examples of different primary skin lesions including macules, papules, pustules, vesicles, scales, and scars.
This document provides information on various types of dermatitis (inflammation of the skin). It defines dermatitis and eczema, and discusses their classification including endogenous (internal) and exogenous (external) causes. It also summarizes different types of contact dermatitis including irritant and allergic reactions. Specific conditions like hand dermatitis, atopic dermatitis, and photocontact dermatitis are described. Diagnosis and treatment focus on identifying causes, avoiding triggers, and using topical corticosteroids.
Eczema herpeticum is a potentially life-threatening herpes infection that occurs when herpes simplex virus infects disrupted skin in patients with pre-existing skin conditions like eczema or atopic dermatitis. It presents with clusters of vesicles and punched-out erosions that spread and become hemorrhagic and crusted. Diagnosis involves identifying characteristic lesions along with fever and pain, and can be confirmed with tests like Tzanck smear, viral culture, or antibody testing. Aggressive treatment with IV acyclovir is required to prevent complications like herpes keratitis, which can lead to blindness. Early recognition and effective antiviral therapy are important given the potential severity of eczema her
Shingles is caused by the reactivation of the varicella zoster virus which causes chickenpox, presenting as a painful rash on one side of the body that is soon followed by blisters. It occurs more often in elderly people and can be prevented with vaccination. Treatment with antiviral drugs within 48 hours can limit post-herpetic neuralgia.
This document provides an overview of common skin diseases in pediatrics. It begins with an introduction noting that skin complaints make up 1/3 of pediatric outpatient visits. It then covers the anatomy and functions of skin, differences between neonatal and adult skin, how to approach diagnosis, and classifications of pediatric skin disorders. Specific conditions discussed include toxic erythema of newborns, miliaria rubra, acropustulosis of infancy, transient neonatal pustular melanosis, neonatal acne, congenital syphilis, and milia. Intertrigo, diaper dermatitis, cutis marmorata are also summarized.
The skin has three main layers - the epidermis, dermis and hypodermis. The epidermis is the outer protective layer, the dermis is a lower supporting layer that gives strength and acts as a reservoir to fight infections, and the hypodermis is a layer of fatty tissue that supports the skin. The skin acts as a protective barrier and plays roles in temperature regulation, sensation, and waste excretion. Fungal infections can be superficial or deep, with superficial infections affecting the outer layers and deep infections invading living tissue. Corticosteroids are anti-inflammatory drugs that work by suppressing the immune system and inflammatory response.
The document discusses atopic dermatitis (AD), also known as eczema. It defines AD as a pruritic, chronic inflammatory skin condition characterized by dry skin and itchy rashes. AD is common in childhood and often runs in families with other allergic diseases. The pathogenesis involves genetic predisposition, skin barrier defects, and abnormal immune responses. Clinical manifestations vary depending on the stage of life, from facial rashes in infants to thickened plaques on flexural areas in older patients. Treatment focuses on moisturizing the skin, identifying trigger factors, and using topical corticosteroids or calcineurin inhibitors to control symptoms.
Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition characterized by a defective skin barrier and sensitization that causes itching and skin lesions. It commonly begins in infancy and persists into adulthood. Risk factors include a family history of atopic conditions as well as environmental triggers. Clinically, it presents as red, itchy rashes in flexural areas of the skin that vary depending on the age of the patient. Treatment focuses on breaking the itch-scratch cycle through topical anti-inflammatory agents and moisturizers, with topical corticosteroids as first-line treatment for flares.
Dermatitis, also known as eczema, is an inflammation of the skin that causes redness, swelling, intense itching, and the formation of lesions. It has various causes depending on the type, such as contact with irritating substances for contact dermatitis. The main types are contact dermatitis, occupational dermatitis, dyshidrotic eczema, and nummular eczema. Treatments include topical steroid creams to reduce inflammation and itching, moisturizers, antihistamines, pain relievers, and avoiding triggers.
The document discusses skin infections and dermatosis. It defines dermatosis as diseases of the integumentary system, including skin, nails, and hair. It describes four main types of skin infections - bacterial, viral, fungal, and parasitic - listing examples of each type and their symptoms. The document also covers causes, diagnosis, treatment and prevention of skin infections. It then discusses various skin conditions that are considered dermatosis, providing examples of common and less common forms.
This PowerPoint presentation summarizes information about psoriasis for a medical student presentation. It defines psoriasis as a chronic inflammatory skin disease causing rapid skin cell production, buildup, and flaking. The presentation covers the types of psoriasis including plaque, guttate, inverse, pustular, and erythrodermic psoriasis. It discusses the genetic and environmental factors involved in psoriasis development and outlines management approaches like topical treatments, phototherapy, and systemic drugs. The presentation concludes by summarizing results from an Italian study finding high rates of depressive symptoms in psoriasis patients, particularly younger men and those with less education.
This document defines psoriasis as a chronic, immune-mediated inflammatory skin disease characterized by well-circumscribed erythematous scaly plaques. It disrupts the normal cycle of skin cell proliferation and differentiation, causing keratinocytes to replicate rapidly within days rather than weeks. Psoriasis has no cure, but can be managed with topical therapies like vitamin D analogs, phototherapy, or systemic drugs when widespread. Calcipotriol is a first-line topical therapy that exerts immunomodulatory and anti-proliferative effects on keratinocytes and T cells to reduce inflammation and hyperplasia.
Interflora España apoya todas las iniciativas que tienen que ver con el negocio justo.
Aparte de la intermediación, Interflora tiene una división de servicios a floristas llamada Central de Servicios que entre otros productos específicos para profesionales, vende rosa de Ecuador. Nuestro proveedor es un consorcio llamado Ecuadorian Spirit que ya vende rosa en Alemania desde hace 4 años y en EEUU con el sello FLP (Flower Label Program) y FLOR Ecuador, que son incluso más exigentes que el @sellofairtrade, respecto a las condiciones laborales y ambientales de las fincas. (presentación en Ingles).
Más información sobre FLOR Ecuador en Más información sobre el sello FLOR Ecuador en http://www.florecuador.org
El átomo está compuesto de protones, neutrones y electrones. Los protones y neutrones se encuentran en el núcleo, mientras que los electrones orbitan alrededor del núcleo en nubes de probabilidad. El número de protones define qué elemento químico es, mientras que el número total de protones y neutrones determina el isótopo específico.
The document discusses the red panda, providing its scientific name, habitat in mountains in Burma and China between 2,200 and 4,800 meters in elevation, diet of bamboo, fruit, berries and seeds, physical description with a white face and black and white rings on its tail, breeding of live young, behaviors of spending days curled up in trees and climbing, diet consisting of 95% bamboo, and conclusion that red pandas are interesting with many cool traits.
The document discusses the red panda, providing its scientific name, habitat in mountains in parts of Asia, diet of bamboo and other plants, physical description with black and white fur, breeding of live young, climbing behavior, diet consisting mostly of bamboo, and conclusion that red pandas have interesting traits.
The document discusses the feedback received from an audience on a music video project. It describes conducting an initial questionnaire to determine preferences on aspects like genre, artist gender, and video style. The results guided decisions like using a female artist, singer-songwriter genre, and basic visuals. A second questionnaire after viewing the video provided feedback on what worked and opportunities for improvement. Seeing the contrast between initial ideas and audience response helped the creators understand how to better appeal to their target demographic.
El átomo está compuesto de protones, neutrones y electrones. Los protones y neutrones se encuentran en el núcleo, mientras que los electrones orbitan alrededor del núcleo en nubes de probabilidad. El número de protones define qué elemento químico es, mientras que el número total de protones y neutrones determina el isótopo específico.
This document provides information about the capital cities, constitutions, economies, industries, and other facts for 14 U.S. states: Colorado, Utah, Kansas, New Mexico, Connecticut, North Dakota, Nebraska, South Dakota, Washington, Wyoming, Rhode Island, Vermont, New Hampshire, and Maine. For each state, it lists the capital city, constitution or admission date, top agricultural products, and main industries.
1990020084832 stotra ratna with bhashyartha of vedanta desika and acharya h...Hariprasad Manchi
Barcode - 1990020084832
Title - Stotra Ratna with Bhashyartha Of Vedanta Desika and Acharya Hrudayanveshini Kannada Pratipadartha by Vijaya Raghvendracharya
Subject - LANGUAGE. LINGUISTICS. LITERATURE
Author - Yamunacharya
Language - kannada
Pages - 472
Publication Year - 1956
Creator - Fast DLI Downloader
Ancient Egypt had a rich culture that lasted over 5000 years, influencing later cultures in Europe, the Middle East and Africa. Some key aspects of their culture included hieroglyphic writing, literature dating back to the Old Kingdom, religions such as ancient Egyptian and later Coptic Christianity and Islam, and architectural marvels like the Great Pyramids and Sphinx. The Egyptians also made contributions to arts like sculpture, painting, pottery and music.
This document provides information about common skin conditions and diseases. It begins with an overview of the structure and function of skin, including its two main layers - the epidermis and dermis. It then discusses six common skin conditions in adults: acne, cellulitis, psoriasis, shingles, skin cancers, and vasculitis. Treatment options are provided for each condition. The document also summarizes six common skin conditions in children: chickenpox, eczema, Henoch–Schönlein purpura, impetigo, impetiginized eczema, and miliaria.
This document provides information about a dermatology module including the learning outcomes, common skin conditions and their treatments, diagnostic procedures, nursing care plans, ethical and medico-legal considerations, and health education principles. The module aims to help students identify skin lesions, design nursing care plans, describe health education, and discuss ethical and legal issues related to caring for patients with skin disorders. It covers 10 common conditions like folliculitis, furuncles, impetigo, herpes, warts, tinea, scabies, pediculosis, dermatitis, and basal cell carcinoma.
This document discusses several conditions related to the skin:
1. Miliaria is caused by blocked sweat ducts, presenting as clear, red, or deeper colored bumps depending on the depth of blockage. Treatment focuses on keeping cool and dry.
2. Erythema ab igne, perniosis, Raynaud's phenomenon, and sunburn are all conditions caused by exposure to heat or cold and present with redness, swelling, or discoloration of the skin. Management prioritizes avoidance of triggers and medication for symptoms.
3. Callosities and corns develop from pressure and friction, with corns specifically causing pain. Treatment aims to reduce pressure through padding or
Fungal skin infections are commonly affect the outer layer of the skin, nails and hair. Most of the fungi causing infections are usually dermatophytes (tinea), yeast (candida) and molds
Dr Muhammad Raza's presentation provides information about atopic dermatitis (eczema), including its signs and symptoms, causes, diagnosis, and management. The key points are that it is a chronic skin condition causing red, itchy, cracked skin that is common in children; has genetic and immunological factors; and is typically diagnosed clinically and managed through moisturizers, topical steroids, and other topical or systemic treatments depending on severity. The goal is for participants to understand the basic concepts, diagnosis, management, and appropriate referrals for atopic dermatitis.
This document discusses dermatitis and its variants. It begins by defining dermatitis as inflammation of the skin that presents as itchy, scaly and usually red skin. It then categorizes the main types as atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, discoid dermatitis, asteatotic dermatitis, venous stasis dermatitis, and seborrheic dermatitis. For each type, it describes the causes, clinical features, management options, and provides examples of what the conditions may look like. The conclusion states that dermatitis is a very common cause of itchy skin eruptions that can usually be treated top
Acne and rosacea are extremely common skin conditions that can have a significant psychological and social impact. Acne is caused by factors like blocked hair follicles, increased sebum production, inflammation, bacteria, and hormones. Rosacea has different clinical forms including papules/pustules and redness/telangiectasias. Both are managed with topical treatments like retinoids, antibiotics, and oral antibiotics/isotretinoin for more severe cases. Patients require long-term treatment to control symptoms.
Dr. Angelo Smith discusses various types of dermatitis and eczema. He covers topics such as the characteristic presentations, locations, triggers, and treatment approaches for atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, and seborrheic dermatitis among others. The document provides clinical guidance on distinguishing features, management, and considerations for different forms of dermatitis and eczema.
Skin is made up of three main layers: the epidermis, dermis, and hypodermis. The epidermis is the top layer and contains cells that produce melanin, which determines skin color. The dermis contains blood vessels, hair follicles, and sweat and oil glands. The hypodermis is a subcutaneous fat layer. Common skin disorders discussed include bacterial infections like MRSA and cellulitis, fungal infections, viral infections like chickenpox, and inflammatory conditions like eczema, psoriasis, and rosacea. Special considerations are discussed for assessing and treating skin of elderly patients and those with diabetes or other conditions.
This document provides an overview of common skin disorders and conditions that may be seen in sleep patients. It discusses the anatomy of the skin and various layers. Specific conditions covered include dermatitis, eczema, hives, psoriasis, skin cancer, fungal infections, bacterial infections like MRSA, viral infections like chickenpox and shingles, and autoimmune disorders like lupus. Proper skin cleaning and electrode placement for patients with skin issues are also addressed.
The document discusses various types of fungal infections including tinea corporis, tinea cruris, tinea pedis, tinea capitis, tinea versicolor, and onychomycosis. It provides information on the causes, symptoms, and treatment options for each infection, noting that treatment often involves topical or oral antifungal medications administered for several weeks. Adjuvant therapies like ketoconazole may also be used to help treat fungal infections.
This document provides information about superficial fungal infections. It begins by classifying fungal diseases into four groups based on pathogenicity: superficial mycoses, mucocutaneous mycoses, subcutaneous mycoses, and deep mycoses. Later pages discuss specific superficial fungal infections like tinea pedis, tinea cruris, tinea facialis, pityriasis versicolor, and tinea unguium/onychomycosis. Diagnosis involves clinical examination, microscopy of samples, and fungal cultures. Management consists of topical and oral antifungal agents as well as prevention through hygiene practices.
Scabies is a contagious skin infection caused by the Sarcoptes scabiei mite. It is common in areas with poverty and overcrowding. Scabies causes intense itching and a pimple-like rash, usually involving the hands, wrists, elbows, and genitals. Complications can include impetigo and secondary infections if left untreated. Scabies is diagnosed by identifying mites, eggs, or feces in skin scrapings under a microscope and is treated with topical scabicides applied to all areas of the body and clothing. Prevention requires treating all contacts, bathing, laundering clothing and bedding, and maintaining good hygiene and sanitation
This document discusses atopic dermatitis/eczema. It begins with definitions of dermatitis, atopy, and atopic dermatitis. It then discusses the epidemiology, noting it commonly develops by age 5 and resolves by adulthood. Clinical presentation includes itch, family history of atopy, dry skin, and typical lesion morphology and distribution. Management focuses on emollients, topical corticosteroids, and oral antihistamines. Differential diagnoses include seborrheic dermatitis and contact dermatitis.
This document discusses the assessment and management of inflammatory and allergic skin conditions including dermatitis, allergic reactions, and psoriasis. It describes the main types of dermatitis such as atopic dermatitis, contact dermatitis, features such as rashes, itching, thickening of skin. It also discusses allergic reactions, triggers, and treatments including topical corticosteroids and antibiotics. Psoriasis is introduced as a chronic inflammatory skin disorder affecting areas like the elbows and knees with thick, silvery scales and management includes slowing skin turnover and controlling the disease cycle.
Eczema is a non-contagious skin condition that causes itching, inflammation, and sometimes pain. It has no cure but can be effectively treated. The main types of eczema are contact dermatitis, atopic eczema, seborrheic dermatitis, and napkin dermatitis. Treatment depends on the type and severity of eczema, and involves moisturizers, topical corticosteroids or immunomodulators, oral medications in severe cases, and managing triggers. The goal is to relieve symptoms and prevent complications like infection.
Sebaceous cysts are benign skin growths that form under the skin. They are usually small, round bumps that form above the shoulders. While small cysts are typically not painful, large cysts can cause considerable pain. Sebaceous cysts are caused by factors like acne, scratching of the skin, or surgery. They are not contagious. Sebaceous cysts can be cured by surgically removing them."
1) The document discusses treatment options for common warts, which are caused by human papillomavirus. It provides an overview of different wart types and treatments.
2) Many common warts will resolve spontaneously, but recalcitrant warts often require ongoing treatment. The evidence and efficacy of different treatment options is considered important when choosing how to treat recalcitrant warts.
3) For fresh common warts, the best practice is to first use salicylic acid, and if no improvement after 6 weeks, proceed to liquid nitrogen cryotherapy. Recalcitrant warts that do not resolve after repeated treatments may require alternative options such as laser therapy or intralesional immunotherapy.
This document provides information on various types of dermatitis and eczema. It discusses the definitions and characteristics of conditions like chronic eczema/dermatitis, acute eczema/dermatitis, irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis, discoid eczema, seborrheic dermatitis, and their signs, symptoms, causes, diagnosis and treatment options. Patch testing and other laboratory examinations are mentioned as ways to identify the cause and properly diagnose different types of dermatitis. Management involves identifying and removing triggers, using topical corticosteroids and other creams or ointments, phototherapy, and occasionally systemic therapies
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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Travel Clinic Cardiff: Health Advice for International Travelers
44 adultdermatology
1. Adult Dermatology:
Name That Rash and Lesion
Wendy L. Wright, MS, RN, ARNP, FNP, FAANP
Adult/Family Nurse Practitioner
Owner - Wright & Associates Family Healthcare
Amherst, NH
Partner – Partners in Healthcare Education, LLC
Objectives
Upon completion of this lecture, the
participant will:
1. Identify various dermatology conditions found
in adults
2. Discuss those dermatology conditions that
require an immediate referral
3. Develop an appropriate plan for evaluation,
treatment, and follow-up of the various lesions
Dermatofibroma
Common, benign asymptomatic lesions
May be slightly itchy; Retract beneath the skin
when you try to elevate them
1 10
1-10 lesions occurring on the extremities; most
common location is the anterior surface of the
lower leg
Etiology: fibrous reaction to trauma, virus or an
insect bite
Multiple lesions: Systemic lupus
Wright, 2008 1
2. Dermatofibroma
Size: 3 – 10 mm in size
Color: pink - brown
Appearance: may appear slightly scaly and
feel hard
Treatment:
Generally – nothing needs to be done about these
lesions
Not worrisome
Biopsy occasionally warranted if unsure of lesion
etiology
Dermatofibroma
Dermatofibroma
Wright, 2008 2
3. Dermatofibroma
Treatment
Monitor
Elliptical
Elli ti l excision
i i
Shave excision
Cryosurgery
Contact Dermatitis:
Rhus Dermatitis
Rhus Dermatitis
Poison ivy, poison oak and poison sumac produce more
cases of contact dermatitis than all other contactants
combined
Occurs when contact is made between the leaf or
internal parts of the roots and stem and the individual
Can occur when individual touches plant or an animal
does and then touches human
Eruption can occur within 8 hours of the contact but may
take up to 1 week to occur
Clinical Pearls
Poison ivy is not spread by scratching
No oleoresin is found in the vesicles and
therefore, can not be spread by
scratching
Lesions will appear where initial contact
with plant occurred
Resin needed to be washed from skin
within 15 minutes of exposure to
decrease risk of condition
Wright, 2008 3
4. Clinical Presentation
Clinical presentation
Characteristic linear appearing vesicles are likely to
appear first
Often surrounded by erythema
y y
Intensely itchy
Lesions often erupt for a period of 1 week and will
last for up to 2 weeks
More extensive and widespread presentation can
occur with animal exposures or burning of the plants
/ smoke exposure
Contact Dermatitis
Contact Dermatitis
Wright, 2008 4
5. Treatment
Cool compresses 15 – 30 minutes three
times daily
Topical calamine or caladryl lotions
Zanfel (OTC) wash – binds urushiol oil and
removes from body/blisters
75% decrease in itching and rash within 24 hours
per package
Colloidal oatmeal baths (AVEENO) once
daily
Treatment
Oral antihistamines
May wish to use sedating antihistamines at
bedtime
Topical corticosteroids
Avoid
A id usage on th f
the face
Oral prednisone vs. injectable Kenalog or
similar
20 mg two times daily x 7 days
Kenalog 40 mg injection (IM)
Follow-up
Monitor for secondary infections
Impetigo
Staph vs. strep
MRSA
Education:
Lesions will decrease over a 2 week period
May continue to erupt over 48 hours despite
steroid administration
Not spreading lesions with rubbing or scratching
Wright, 2008 5
6. Hot Tub Folliculitis
Inflammation of the hair follicle
Caused by infection which occurs within 8 hours
– 5 days of using contaminated hot tub or
whirlpool
Unfortunately,
Unfortunately showering after exposure
provides no protection
Pseudomonas is the most common cause of hot
tub folliculitis
May also be caused by Staphylococcus, but
unusual
MSSA or MRSA
Clinical Presentation
One or more pustules may first appear
Fever may or may not be present;
usually low grade if it does occur
Malaise and fatigue may accompany
the outbreak
Pustules may have wide rims of
erythema
Hot Tub Folliculitis
Wright, 2008 6
7. Treatment
Culture of lesions is likely warranted
White vinegar wet compresses – 20 minutes
on three x daily may provide significant
benefit
Oral Antibiotics
Ciprofloxacin is preferred agent if hot tub
folliculitis is suspected due to pseudomonas
coverage
Discuss contagiousness
No evidence that it is spread person - person
Perioral Dermatitis
Occurs in young women and closely
resembles acne
Papules and pustules are frequently present
Lesions are confined to chin and nasolabial
folds
f ld
Can also occur in children
Cause is unknown but is believed to be
exacerbated by benzoyl peroxide, tretinoin,
alcohol based products and frequent
moisturizing
Perioral Dermatitis
Wright, 2008 7
8. Treatment
Tetracycline creams
Two times daily x 4 weeks
Erythromycin creams
Two times daily x 4 weeks
Metrogel
Two times daily x 4 weeks
May not be as effective as above agents
Avoid topical steroids
Stop moisturizing
Seborrheic Keratoses
Most common benign skin lesion
Unknown origin
No potential for malignancy
Usually asymptomatic
Rarely familial
Most individuals develop 1 or more of
these lesions throughout lifetime
Seborrheic Keratoses
Characteristics
Smooth surface with tiny round, embedded
pearls
May be
M b rough, d and cracked
h dry d k d
Sharply demarcated
Appear stuck on the surface
Vary in size from 2 mm to 3 cm
Lesions are completely epidermal with no
deep tissue penetration
Wright, 2008 8
9. Seborrheic Keratoses
Seborrheic Keratosis
Can Mimic a Malignant Melanoma
Wright, 2008 9
10. Seborrheic Keratoses
Treatment
Reassurance
Lesions are only removed for cosmetic
purposes or f a biopsy if pathology i
for bi th l is
unknown
If removed, shave excision
Cryosurgery
Monitor for any increase in size, change in
appearance
Acne Vulgaris
Etiology
Disease involving the pilosebaceous unit
Most frequent and intense where sebaceous
glands are the largest
Acne begins when sebum production
increases
Propionibacterium acnes proliferates in the
sebum
P. acnes is a normal skin resident but can
cause significant inflammatory lesions when
trapped in skin
Acne Vulgaris
Noninflammatory lesions
Open and closed comedones
Inflammatory lesions
Papules, pustules and nodules (cysts)
Wright, 2008 10
11. Acne Vulgaris
Symptoms
Papular lesions on the face, chest and
back
White heads
Whi h d
Black heads
Signs
Papular lesions
Closed and open comedones
Closed Comedones
Closed Comedones
Wright, 2008 11
12. Open Comedones
Cystic Acne
Acne Vulgaris
Diagnosis
History and physical examination
Plan
Diagnostic: None
Wright, 2008 12
13. Acne Vulgaris
Therapeutic
Benzoyl Peroxide (2.5%, 5% and 10%)
Effective as initial medication
Begin early on in the disease process
Tretinoin
Very effective agent
Start with 0.05% - 0.1% cream
Reduces and minimizes scarring
Topical Antibiotics
Initial medication or can be combined with benzoyl peroxide
Erygel, clindamycin are most commonly utilized
Acne Vulgaris
Therapeutic
Oral Antibiotics
Tetracycline
Minocycline
Erythromycin
y y
Cephalosporins
Should only be used when topicals are ineffective or when
patient has moderate disease at presentation
OCP’s
Women desiring contraception who also have acne
Accutane
Cystic acne or mod-severe disease
Acne Vulgaris
Plan
Educational
6 weeks for improvement to be seen
Avoid antibacterial soaps
Dove soap or similar is recommended
Avoid hats
Foods have not been implicated as a cause
Caramel products may worsen situation
Avoid picking at the lesions
Review side effects of the medications
Wright, 2008 13
14. Psoriasis
Etiology
1-3% of the population worldwide
Transmitted genetically
Disease is lifelong; often beginning in childhood
Characterized by chronic, recurrent
exacerbations and remissions
Stress can precipitate an episode
Strep pharyngitis has been known to precipitate
the onset
Psoriasis
Etiology
Physically and emotionally disabling
Erodes self esteem and often forces the
patient into a life of concealment
Medications can precipitate (Beta
blockers, lithium)
Psoriasis
Symptoms
Red, scaling papules that coalesce to form
round-oval plaques
Scale is silvery white and is adherent
When removed, bleeding occurs (Auspitz’s
sign)
May begin at a site of a sunburn or surgery
This is called Koebner’s phenomenon
Elbows, knees, scalp, gluteal cleft, toenails, fingernails
Extensor surfaces
Wright, 2008 14
15. Psoriasis
Signs
Erythematous papules
Plaques
Nail involvement
May be associated with arthritis
Psoriasis
Guttate Psoriasis
Wright, 2008 15
16. Psoriasis
Diagnosis
History and physical examination
Biopsy if uncertain
Plan
Diagnostic: None
Psoriasis
Therapeutic
Topical corticosteroids
Pulse therapy
Two weeks on/ two weeks off
Caution: side effects
Dovonex
Vitamin D3 analogue
Works by inhibiting epidermal cell proliferation
Can be used long-term and is very safe
Dovonex ointment two times daily x 8 weeks
May see about a 70% improvement
Tar: newer preparations are more pleasant
Intralesional steroids
Psoriasis
Therapeutic
Ultraviolet light B
Retinoids
Systemic Treatments
Methotrexate
Plaquenil
Enbrel
Wright, 2008 16
17. Psoriasis
Plan
Educational
Moisturize
Consider psychological therapy
Review the nature of this chronic
disease
Skin Tags (Achrochordons)
Very commonly encountered benign
lesions
Seen in approximately 25% of men and
women
Most common locations: axilla, neck,
inguinal region
Usually begin in 2nd decade and peak by
the 5th decade of life
Skin Tags (Achrochordons)
Appearance
Begins as a tiny flesh-toned or brown
lesion
May increase t 1 cm i size
M i to in i
Hallmark: polypoid mass on a long
narrow stalk
Bleeds very easily; particularly because
they often get caught on a necklace or
clothing
Wright, 2008 17
19. Case Study
S:TM is a 64-year-old Caucasian male who presents with
a painful rash located on his right buttock.
Describes the rash as red and blistered
Has been present x 96 hours and is in for an evaluation because
the pain is severe.
Pain is “9” on 0 – 10 scale. Has tried oral OTC medications without
significant improvement Pain is described as a burning sensation;
improvement.
deep in his buttock.
Denies precipitating factors. Pain began approx 2 days before the
rash appeared. Denies fever, chills, new soaps, lotions, changes in
medications.
Medications: atorvastatin 40 mg 1 po qhs; amlodipine 5
mg 1 po qhs; loratidine 10mg 1 po qd; aspirin 81 mg 1 po
qam; various vitamins
Case Study
Allergies: NKDA
PMH: dyslipidemia; hypertension; obesity,
allergic rhinitis
Social history: 30 pack year history of
cigarette smoking; none x 10 years; M hi i t
i tt ki Machinist;
happily married x 40+ years
Case Study
O: T:97.8; P: 94; R:18; BP: 148/90
Skin: p/w/d; approximately 15-20 vesicles
located on right buttock overlying an
erythematous base; vesicles are clustered but
without obvious pattern; no streaking,
petecchiae. Few scattered vesicles on posterior
aspect of right thigh; no lesions on left buttock or
leg
Hips: FROM: no tenderness, erythema,
masses
Wright, 2008 19
20. Case Study
O: PE continued
Back: From: no tenderness, erythema, masses
Abdomen: Soft, large; + BS; no masses, tenderness,
hsm
Neuro: intact including light touch pain vibratory to
touch, pain,
right lower extremity; heel, toe walking intact
+ Allodynia
Clothing, light touch, cool object
+ Hyperalgesia
Painful stimuli elicited significant pain
Examples of Herpes Zoster
Herpes Zoster
Wright, 2008 20
22. Risk Factors
Increasing age (50-60 years and beyond)
Varicella infection when < 2 years of age
Immunosuppression
Stress (controversial)
Trauma
Malignancies
25% of patients with Hodgkin’s will develop
zoster1
1Stankus, S. et. Al. Management of Herpes Zoster and Postherpetic Neuralgia. Am Fam
Physician 2000;61:2437-44, 2447-8)
Goals of Treatment
Treat acute viral infection
Shorten course
Reduce lesions
Treat acute pain
Prevent complications
Postherpetic neuralgia
Acute Treatment Options
Antiviral
Goal: Reduce viral reproduction
Corticosteroids
Initially postulated that these reduce viral
replication; recent studies have not found this to
be true
However, they do decrease pain
Pain Management
Topical agents
Anti-inflammatory agents
Narcotics
Postherpetic neuralgia prevention
www.aad.org/pamphlets/herpesZoster.html
Wright, 2008 22
23. Antiviral Treatment Options
Ideally, want to begin within the first 72
hours of the eruption as benefits may be
reduced if started after that
These medications decrease duration of
the rash and severity of the pain
Studies vary as to how much these products
actually reduce the incidence of post-
herpetic neuralgia
1Stankus, S. et. Al. Management of Herpes Zoster and Postherpetic Neuralgia. Am Fam
Physician 2000;61:2437-44, 2447-8)
Controlled Trials of Antiviral Agents in
Herpes Zoster
% of patients 3 months 6 months
with PHN at:
Acyclovir vs. 25% vs. 54% 15% vs. 35%
Placebo
Valacyclovir vs. 31% vs. 38% 19.9% vs. 25.7%
Acyclovir
Famciclovir vs. 34.9% vs. 49.2% 19.5% vs. 40.3%
Placebo
Adapted from Johnson RW. J Antimicrob Chemother. 2001;47:1-8.
Corticosteroids
Often utilized despite mixed results in clinical
trials
Prednisone, when used with acyclovir, in one
study reduced pain associated with herpes
zoster
t
Corticosteroids are currently recommended for
individuals over 50 years of age with HZ
Dosage:
30 mg bid x 7 days; 15 mg bid x 7 days; 7.5 mg bid x
7 days1
1Stankus, S. et. Al. Management of Herpes Zoster and Postherpetic Neuralgia. Am Fam
Physician 2000;61:2437-44, 2447-8)
Wright, 2008 23
24. Pain
Pain associated with herpes zoster can range
from mild – severe
Clinician must tailor pain medication options
based upon individual presentation
Pain Management
Topical Agents
Calamine lotion to lesions 2 – 3x/day
Betadine to lesions qd
Capsaicin cream once lesions crusted 3 – 5x/day
Topical lidocaine 5% patch f 12 h
T i l lid i t h for hours at a ti
t time
once lesions are crusted
1Stankus, S. et. Al. Management of Herpes Zoster and Postherpetic Neuralgia. Am Fam
Physician 2000;61:2437-44, 2447-8)
Acute Pain Management
Oral Agents
Acetaminophen
Has not been shown to be effective in trials)
Ibuprofen or similar
Not likely to be effective with neuropathic p
y p pain
Nerve Blocks
Have been shown to be effective for many individuals
with severe pain in some trials; other trials -
ineffective
Wright, 2008 24
25. And…the use of medications such
as TCA’s, gabapentin, pregabalin,
oxycodone and tramadol during the
acute phase of HZ decrease pain
but also may also reduce the risk of
PHN
Follow-up
Monitor for secondary infections
Monitor for evidence of postherpetic
neuralgia
g
Monitor for adverse impact on
quality of life
Bullous Pemphigoid
Bullous pemphigoid is a rare, benign subepidermal
rash characterized by bullae formation
Origin is unknown
Disease of the elderly
Most cases occur after 60 years of age
No evidence to support any association with other
conditions or diseases
May be an association with concomitant
medication usage
Wright, 2008 25
26. Bullous Pemphigoid
Clinical Manifestations
Begins with a localized area of erythema
which looks similar to hives/urticaria
Itching i
It hi is moderate – severe
d t
Over the course of 1 – 3 weeks – area
becomes darker red or cyanotic in
appearance
Resembles – erythema multiforme
Vesicles and bullae rapidly appear
Bullous Pemphigoid
Clinical Manifestations
Most common locations are:
Abdomen
Groin
Flexor surfaces of the arms and legs
Palms and soles are also affected
Nikolsky’s sign is negative
Bullous Pemphigoid
Clinical Manifestations
May last 9 weeks – 17 years
Average – 2 years
Periods of remission will follow
exacerbations
Afebrile
No systemic illness
Wright, 2008 26
27. Bullous Pemphigoid
Diagnosis
History and physical examination
CBC with differential
Eosinophilia will be present in 70%
or greater of individuals
Biopsy of lesions/skin
Treatment
Atarax or similar for itching
Topical steroids
May be helpful in some
Oral antibiotics
Successful resolution i some with th f ll i agents:
S f l l ti in ith the following t
TCN or Minocycline
Erythromycin
Systemic steroids
Immunosuppressive agents
MTX
Azathioprine
Wright, 2008 27
28. Actinic Keratoses
Common, sun-induced, premalignant
lesions
Incidence: Increases with age, light
complexion
Caused by years of sun exposure
Lesions frequently appear after the
summer suggesting that sun exposure
may cause lesions to become more
active
Actinic Keratoses
Clinical presentation:
Slightly roughened area that often bleeds when
excoriated
Best recognized by palpation than observation when
first begins
Progresses to an adherent yellow crust
Size: 3-6 mm
Common location: scalp, temples, forehead, hands
Lesion with drainage suggests degeneration into a
malignancy
Actinic Keratosis
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29. Actinic Keratosis
Keratin may
accumulate and
transform lesion into
a cutaneous horn
Frequently seen on
the pinna of the ear
Actinic Keratoses
Prognosis
Can spontaneously regress if sun
exposure is eliminated
Good
G d prognosis if treated adequately
i d d l
Small percentage transform into a
squamous cell carcinoma which can
metastasize
60% of all squamous cell carcinomas
began as an actinic keratosis
Actinic Keratoses
Treatment
Cryosurgery
Preferred method
Surgical Removal
S i lR l
Tretinoin
0.05% - 0.1% cream applied once daily at bedtime
If no improvement in 3 – 4 months, treat with
cryosurgery
Wright, 2008 29
30. Actinic Keratoses
Treatment
5-fluorouracil
Topical chemotherapeutic agents
Example – Actinex
Imiquimod (Aldara)
2x weekly x 16 weeks
Acid peels
Glycolic acid chemical peels
Sunscreen
Follow-up
Continuous monitoring of skin for changes in
lesions
Monitor for new lesions
Sunscreen is essential
Minimize sun exposure
Basal Cell Carcinoma
Most common cutaneous malignancy found
in humans
Presenting complaint: bleeding or scabbing
sore that heals and recurs
Risk factors: fair skin, sun exposure, tanning
salon, previous injury
Incidence: Men > women: Incidence
increases after age 40
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31. Basal Cell Carcinoma
Location: 85% appear on the head and
neck; 25-30% on the nose alone
Prognosis: Excellent because basal cell
carcinomas rarely metastasize but will
grow and spread to adjacent locations
Very common for a 2nd or 3rd basal cell
to appear
Basal Cell Carcinoma
Six Clinical Types:
Nodular (21%): rounded mass
Most common form
Pearly white or pink
Telangiectatic vessels are present
T l i t ti l t
Ulcerating center is common
May present as a nonhealing lesion
Superficial (17%): Least aggressive lesion
Pigmented: May resemble a melanoma
Basal Cell Carcinoma
Six Clinical Types:
Cystic: Similar to nodular lesion
Sclerosing: Borders indistinct
May grow for years before recognized
May resemble a scar – depressed lesion
Nevoid: very rare; inherited as an
autosomal dominant trait; Multiple
BCC’s appear at birth
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33. Squamous Cell Carcinoma
Arises in the epithelium and is common
in middle-aged to elderly population
2 types
Areas of prior radiation or thermal injury
and in chronic ulcers: most likely to
metastasize
Actinically damaged skin: Least likely to
metastasize
Squamous Cell Carcinoma
Risk factors
Sun exposure
Renal transplant recipients (253 fold
increase secondary to immunosuppression)
Areas of chronic inflammation or thermal
burns
Location
Sun exposed regions: scalp, back of the
hands, and superior aspect of the pinna
Squamous Cell Carcinoma
Clinical Presentation
May arise from previous actinic keratosis
Thick, adherent scale with a red, inflamed
base
Firm, movable, elevated lesion with a
sharply defined border
Can spread locally and metastasize
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34. Squamous Cell Carcinoma
Squamous Cell Carcinoma
Squamous Cell Carcinoma
Treatment
Referral to dermatology or plastics
depending upon location / availability
p g p y
Electrodessication
Excision with margins
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35. Malignant Melanoma
Very dangerous cancer that arises from the
cells of the melanocytic system
Can metastasize to any organ including the
brain
Epidemic proportions - Lifetime risk: 1:90
Risk factors
Sun exposure
Family history of melanoma
Immunosuppression
Malignant Melanoma
ABCDE’s of Malignant Melanoma
Asymmetry
Borders
Color
Diameter enlargement
Enlarging or evolving
Malignant Melanoma
Characteristics
Can be black, brown, red, white or blue
Types
yp
Superficial spreading
Lentigo maligna
Nodular melanoma
Acrallentiginous melanoma
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36. Malignant Melanoma
Malignant Melanoma
Malignant Melanoma
Treatment
Biopsy with elliptical excision only
Shave excision and punch biopsy are NOT
recommended
Referral to dermatology/general surgeon/plastics
depending upon access
Surgical excision with margin clearing
1-2 cm margin
Recent evidence that a 3 cm margin may improve
survival rates
Wright, 2008 36
37. Thank You!
I Would Be Happy To
Entertain Any
Questions
Wendy L. Wright, MS, RN, ARNP, FNP, FAANP
Partners in Healthcare Education, LLC
www.4healtheducation.com
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