Dermatology for Pharmacy Students. Second Year D. Pharm, PCI Syllabus for Diploma in Pharmacy ER 2020-2021

1. BY
KIRAN B. DHAMAK
DERMATOLOGY
Psoriasis, Scabies, Eczema

2. Introduction
 Dermatology is the branch of medicine dealing with
the skin.
 It is a speciality with both medical and surgical
aspects.
 A dermatologist is a specialist medical doctor who
manages diseases related to skin, hair, nails, and
some cosmetic problems.

3. Psoriasis

4. Introduction
 Psoriasis is a skin disease that causes a rash with itchy,
scaly patches, most commonly on the knees, elbows,
trunk and scalp.
 Psoriasis is a common, long-term (chronic) disease with
no cure. It can be painful, interfere with sleep and make
it hard to concentrate. The condition tends to go through
cycles, flaring for a few weeks or months, then subsiding
for a while. Common triggers in people with a genetic
predisposition to psoriasis include infections, cuts or
burns, and certain medications.
 Treatments are available to help you manage symptoms.
And you can try lifestyle habits and coping strategies to
help you live better with psoriasis.

5. Etiopathogenesis
 In Psoriasis pathogenic T-cell production and
activation causes proliferation of psoriatic epidermal
cells at a rate faster than normal epidermal cells.
 Psoriasis is apparently associated with interaction
between environmental factors and a specific genetic
factors.

6.  There are two main hypotheses about the development of
psoriasis.
 The first hypothesis considers psoriasis as primarily a
disorder of excessive growth and reproduction
of skin cells, in which psoriasis is a manifestation of a
fault of the epidermis and its keratinocytes.
 The second hypothesis views the disease as an immune-
mediated disorder in which the excessive reproduction of
skin cells is secondary to factors produced by
the immune system.
 T cells (which normally help protect the body
against infection) become active, migrate to the dermis,
and trigger the release of cytokines (tumor necrosis
factor-alpha [TNFα] in particular), which
cause inflammation and the rapid production of skin
cells.
 It is not known what initiates the activation of the T cells.

7.  Environmental Factors

8.  Genetic Factors:
 Psoriasis is a genetically heterogeneous disease with different
genetic causes.
 A strong candidate gene for sequencing remains to be
identified.
 Most patient with psoriasis have at least one immediate
relative with the disorder.

9. Clinical Manifestation of Psoriasis
 A patchy rash that varies widely in how it looks from
person to person, ranging from spots of dandruff-like
scaling to major eruptions over much of the body
 Rashes that vary in color, tending to be shades of purple
with gray scale on brown or Black skin and pink or red
with silver scale on white skin
 Small scaling spots (commonly seen in children)
 Dry, cracked skin that may bleed
 Itching, burning or soreness
 Cyclic rashes that flare for a few weeks or months and
then subside

10.  There are several types of psoriasis, each of which
varies in its signs and symptoms:
 Plaque psoriasis: They usually appear on the
elbows, knees, lower back and scalp.
 Nail psoriasis. Psoriasis can affect fingernails and
toenails, causing pitting, abnormal nail growth and
discoloration.
 Guttate psoriasis. Guttate psoriasis primarily
affects young adults and children.
 Inverse psoriasis. Inverse psoriasis mainly affects
the skin folds of the groin, buttocks and breasts.

11.  Pustular psoriasis. Pustular psoriasis, a rare type,
causes clearly defined pus-filled blisters. It can occur
in widespread patches or on small areas of the palms
or soles.
 Erythrodermic psoriasis. The least common type
of psoriasis, erythrodermic psoriasis can cover the
entire body with a peeling rash that can itch or burn
intensely.

12. Diagnosis and Investigation of Psoriasis
 The diagnosis of Psoriasis is based primarily on
clinical findings but may also be confirmed with tests
(e.g. Auspitz sign) or skin biopsy of lesional skin.

13. Management of Psoriasis
 Psoriasis can be a lifelong relapsing and remitting
disease and treatment will only control the
symptoms but not cure it.
 Principles of Treatment:
 Selection of therapy should be individualized
 Mild or mild-moderate diseases can usually d by topical
therapy alone.
 Moderate-Severe or Severe disease usually requires systemic
therapy including biological agents and phototherapy.
 Therapy should be selected with careful consideration of long
term adverse effects, disease severity, the patients age and
concurrent associated disease.

15. Non-Pharmacological Management
 Avoid stress
 Regular Exercise
 No to alcohol
 Smoking Cessation
 Identify and avoid triggering factors
 Maintain ideal body weight
 Avoid beta blockers and chloroquine
 Phototherapy
 Balneotherapy
 Climatotherapy

16. Pharmacological Management

17. SCABIES

18.  Scabies is an itchy skin rash caused by a tiny
burrowing mite called Sarcoptes scabiei. Intense
itching occurs in the area where the mite burrows.
The need to scratch may be stronger at night.
 Scabies is contagious and can spread quickly through
close person-to-person contact in a family, child care
group, school class, nursing home or prison. Because
scabies spreads so easily, health care providers often
recommend treating the entire family or any close
contacts.

19.  Scabies is easily treated. Medicated skin creams or
pills kill the mites that cause scabies and their eggs.
But itching may not stop for many weeks after
treatment.

20. Scabies symptoms include:
 Itching, often severe and usually worse at night
 Thin, wavy tunnels made up of tiny blisters or bumps
on the skin

21. Scabies is often found in the skin folds. But scabies can
appear on many parts of the body. In adults and older
children, scabies is most often found:
 Between the fingers and toes In the armpits
 Around the waist On the inner elbows
 On the soles of the feet On the chest
 Around the nipples On the buttocks
 Around the belly button Around the genitals
 In the groin area
 Along the insides of the wrists

22. In infants and young children, common sites of
scabies usually include the:
 Fingers
 Face, scalp and neck
 Palms of the hands
 Soles of the feet

23. Etiopathogenesis
 Scabies is caused by a tiny, eight-legged mite. The female
mite burrows just under the skin and makes a tunnel
where it lays eggs.
 The eggs hatch, and the mite larvae travel to the surface
of the skin, where they mature. These mites can then
spread to other areas of the skin or to the skin of other
people. Itching is caused by the body's allergic reaction to
the mites, their eggs and their waste.
 Close skin-to-skin contact and, less often, sharing
clothing or bedding with a person who has scabies can
spread the mites.

24.  Pets don't spread scabies to humans. The scabies
mites that affect animals don't survive or reproduce
in people.
 However, coming in contact with an animal that has
scabies may cause brief itching if the mite gets under
the skin. But within a few days, the mite will die. So
treatment isn't needed.

25. Complications
 Scratching too much can break your skin and cause
an infection, such as impetigo. Impetigo is an
infection on the skin's surface that's caused most
often by staph bacteria (staphylococci) or sometimes
by strep bacteria (streptococci).

26.  A more severe type of scabies, called crusted scabies,
may affect certain people, including:
 Young children
 People with developmental disabilities
 People with weakened immune systems, such as
those with HIV or lymphoma, or people who have
had organ transplants
 People who are very sick, such as people in hospitals
or nursing facilities
 Older people in nursing homes

27. Prevention
 To prevent scabies from coming back and to keep the mites
from spreading to other people, take these steps:
 Wash all clothes and linen. Heat kills the mites and their
eggs. Use hot, soapy water to wash all clothing, towels and
bedding used in the last three days before beginning
treatment. Dry with high heat. Dry-clean items you can't wash
at home.
 Starve the mites. Place items you can't wash in sealed
plastic bags and leave them in an out-of-the-way place, such
as your garage, for a week. Mites die after a few days without
food.
 Clean and vacuum. It's a good idea to clean your home to
prevent scabies from spreading. This is especially true for
people with crusted scabies. Vacuum furniture, carpets and
floors to remove scales and crusts that may have scabies
mites.

28. Pharmacological Management

29. ECZEMA
(DERMATITIS)

30.  Definition:
Eczema is a term for several different types of skin
swelling. Eczema is also called dermatitis. Most
types cause dry, itchy skin and rashes on the face,
inside the elbows and behind the knees, and on the
hands and feet. Scratching the skin can cause it to
turn red, and to swell and itch even more.