This document provides an outline for a course on skin conditions. It begins by listing common skin conditions categorized by symptoms such as itching, pigmentation, crusts, vesicles, pustules, and macules. It then defines dermatology as the study of skin, nails, and hair and discusses the functions and facts about skin. The document outlines important aspects of dermatologic history taking and examination, including describing different types of skin lesions and how their configuration, texture, location, and distribution can provide clues to diagnosis.

1. LECTURER :EXTON M ZOKERMPH (PUBLIC HEALTH MEDICINE)

2. COURSE OUTLINE
SKIN CONDITION
 ITCHING: Scabies, onchocerciasis, fungal infection, urticaria,
wormy line: larva migrans
 PIGMENTATION: Vitiligo, Albino CRUSTS: Eczema
 VESICLES: Herpes simplex, Herpes zoster, chickenpox
 PUSTULES: Impetigo, infected scabies, chickenpox
 MACULES: Leprosy, fungal infections (light macules), syphilis.
Allergies, drug rashes, infections (dark macules), Kaposi
Sarcoma (AIDS)
 PAPULES: Measles, Onchocerciasis, Pimple, Acne, Warts. RED
LINE: Cellulitis, lymphangitis
 THICK SKIN: Friction, Elephantiasis, Onchocerciasis, Keloids

3. WHAT IS DERMATOLOGY
 Dermatology: is the branch of medicine concerned with
the diagnosis, treatment and prevention of diseases of the
Skin, Nails and Hair .
 Literally is the study of the Skin.
 Derived from ancient Greek δέρμα, derma which means
skin and λογία, logia
 It is a specialty with both medical and surgical aspects.
 A Dermatologist treats diseases, and some cosmetic
problems of the skin, scalp, hair, and nails.

4. SKIN FACTS
 Often referred to as the largest organ in the body
 Average adults skin:
- Spans 21 square feet
- Weighs nine pounds
- Contains more than 11 miles of blood vessels
 Sheds 50,000 cells every minute.

5. REMEMBER
 S- sensation
 H- heat regulation
 A- absorption
 P- protection
 E-excretion
 S-secretion
 V-vitamin D production

6. Dermatologic history
Important information to obtain from history includes:
 Personal or family history of atopy (suggesting atopic
dermatitis)
 Occupational exposures (contact dermatitis)
 Long-term exposure to sunlight or other forms of
radiation (benign and malignant skin tumors)

7.  Systemic disease (diabetes and Candida or tinea,
hepatitis C, and cryoglobulinemia)
 Sexual history (syphilis and gonorrhea)
 Use of drugs (Stevens-Johnson syndrome, toxic
epidermal necrolysis)
 Travel history (Lyme disease, skin infections)

8.  A negative history is as important as a positive history.
The history of the particular skin lesions is also
important, including time and site of initial
appearance, spread, change in appearance, and
triggering factors.

9. Dermatologic examination
 Visual inspection is the central evaluation tool; many
skin disorders are diagnosed by the characteristic
appearance or morphology of the lesions.
 A full skin examination, including examination of the
scalp, nails, and mucous membranes, is done to screen
for skin cancers and to detect clues to the diagnosis of
a widespread eruption.


10.  Magnification with a hand lens can help reveal
morphologic detail.
 A hand-held dermatoscope with built-in lighting is
particularly useful in evaluating pigmented lesions.

11.  An extensive language has been developed to
standardize the description of skin lesions, including
 Lesion type (sometimes called primary morphology)
 Lesion configuration (sometimes called secondary
morphology)
Texture
Distribution
Color
Rash is a general term for a temporary skin eruption.

12. Lesion Type (Primary Morphology)
 Papules are elevated lesions usually < 10 mm in
diameter that can be felt or palpated. Examples
include nevi, warts, lichen planus, insect bites,
seborrheic keratoses, actinic keratoses, some lesions of
acne, and skin cancers. The term maculopapular is
often loosely and improperly used to describe many
red skin rashes; because this term is nonspecific and
easily misused, it should be avoided.

13. Skin Lesion (Papule)

14.  Plaques are palpable lesions > 10 mm in diameter that
are elevated or depressed compared to the skin
surface. Plaques may be flat topped or rounded.
Lesions of psoriasis and granuloma annulare
commonly form plaques

15. Psoriasis Plaque

16.  Nodules are firm papules or lesions that extend into
the dermis or subcutaneous tissue. Examples include
cysts, lipomas, and fibromas.

17.  Vesicles are small, clear, fluid-filled blisters < 10 mm
in diameter. Vesicles are characteristic of herpes
infections, acute allergic contact dermatitis, and some
autoimmune blistering disorders (eg, dermatitis
herpetiformis).

18. Skin Lesion (Vesicle)

19.  Bullae are clear fluid-filled blisters > 10 mm in
diameter. These may be caused by burns, bites, irritant
or allergic contact dermatitis, and drug reactions.
Classic autoimmune bullous diseases include
pemphigus vulgaris and bullous pemphigoid. Bullae
also may occur in inherited disorders of skin fragility.

20. Skin Lesion (Bullae)

21.  Pustules are vesicles that contain pus. Pustules are
common in bacterial infections and folliculitis and
may arise in some inflammatory disorders including
pustular psoriasis.

22. Skin Lesion (Pustule)

23.  Urticaria (wheals or hives) is characterized by
elevated lesions caused by localized edema. Wheals
are pruritic and red. Wheals are a common
manifestation of hypersensitivity to drugs, stings or
bites, autoimmunity, and, less commonly, physical
stimuli including temperature, pressure, and sunlight.
The typical wheal lasts < 24 h.

24. Skin Lesion (Urticaria)

25.  Scale is heaped-up accumulations of horny epithelium
that occur in disorders such as psoriasis, seborrheic
dermatitis, and fungal infections. Pityriasis rosea and
chronic dermatitis of any type may be scaly.

26. Skin Lesion (Scale)

27.  Crusts (scabs) consist of dried serum, blood, or pus.
Crusting can occur in inflammatory or infectious skin
diseases (eg, impetigo).
 Erosions are open areas of skin that result from loss of
part or all of the epidermis. Erosions can be traumatic
or can occur with various inflammatory or infectious
skin diseases. An excoriation is a linear erosion caused
by scratching, rubbing, or picking.

28.  Ulcers result from loss of the epidermis and at least
part of the dermis. Causes include venous stasis
dermatitis, physical trauma with or without vascular
compromise (eg, caused by decubitus ulcers or
peripheral arterial disease), infections, and vasculitis.

29.  Petechiae are nonblanchable punctate foci of
hemorrhage. Causes include platelet abnormalities
(eg, thrombocytopenia, platelet dysfunction),
vasculitis, and infections (eg, meningococcemia,
Rocky Mountain spotted fever, other rickettsioses).

30.  Purpura is a larger area of hemorrhage that may be
palpable. Palpable purpura is considered the hallmark
of leukocytoclastic vasculitis. Purpura may indicate a
coagulopathy. Large areas of purpura may be called
ecchymoses or, colloquially, bruises.

31.  Atrophy is thinning of the skin, which may appear dry
and wrinkled, resembling cigarette paper. Atrophy
may be caused by chronic sun exposure, aging, and
some inflammatory and neoplastic skin diseases,
including cutaneous T-cell lymphoma and lupus
erythematosus. Atrophy also may result from long-
term use of potent topical corticosteroids.

32.  Scars are areas of fibrosis that replace normal skin
after injury. Some scars become hypertrophic or
thickened and raised. Keloids are hypertrophic scars
that extend beyond the original wound margin.

33.  Telangiectases are foci of small, permanently dilated
blood vessels that may occur in areas of sun damage,
rosacea, systemic diseases (especially systemic
sclerosis), or inherited diseases (eg, ataxia-
telangiectasia, hereditary hemorrhagic telangiectasia)
or after long-term therapy with topical fluorinated
corticosteroids.

34. Telangiectasia

35. Lesion Configuration (Secondary
Morphology)
Configuration is the shape of single lesions and the
arrangement of clusters of lesions.
 Linear lesions take on the shape of a straight line and
are suggestive of some forms of contact dermatitis,
linear epidermal nevi, and lichen striatus.
Traumatically induced lesions, including excoriations
caused by the patient's fingernails, are typically linear.

36.  Annular lesions are rings with central clearing.
Examples include granuloma annulare, some drug
eruptions, some dermatophyte infections (eg,
ringworm), and secondary syphilis.

37. Skin Lesion (Annular)

38.  Nummular lesions are circular or coin-shaped; an
example is nummular eczema.

39.  Target (bull’s-eye or iris) lesions appear as rings
with central duskiness and are classic for erythema
multiforme.

40.  Serpiginous lesions have linear, branched, and
curving elements. Examples include some fungal and
parasitic infections (eg, cutaneous larva migrans).
 Reticulated lesions have a lacy or networked pattern.
Examples include cutis marmorata and livedo
reticularis.

41. papules or vesicles arranged like
those of a herpes simplex infection

42.  Zosteriformdescribes lesions clustered in a
dermatomal distribution similar to those of herpes
zoster

43. Texture
 Some skin lesions have visible or palpable texture that
suggests a diagnosis.
 Verrucous lesions have an irregular, pebbly, or rough
surface. Examples include warts and seborrheic
keratoses.
 Lichenification is thickening of the skin with
accentuation of normal skin markings; it results from
repeated scratching or rubbing.

44. Skin Lesion (Lichenification)

45.  Induration, or deep thickening of the skin, can result
from edema, inflammation, or infiltration, including
by cancer. Indurated skin has a hard, resistant feeling.
Induration is characteristic of panniculitis, some skin
infections, and cutaneous metastatic cancers.
 Umbilicated lesions have a central indentation and
are usually viral. Examples include molluscum
contagiosum and herpes simplex.
 Xanthomas, which are yellowish, waxy lesions, may
be idiopathic or may occur in patients who have lipid
disorders.

46. Location and Distribution
 It is important to note whether
 Lesions are single or multiple Particular body parts are
affected (eg, palms or soles, scalp, mucosal
membranes)
 Distribution is random or patterned, symmetric or
asymmetric
 Lesions are on sun-exposed or protected skin
 Although few patterns are pathognomonic, some are
consistent with certain diseases.

47.  Psoriasis frequently affects the scalp, extensor surfaces of
the elbows and knees, umbilicus, and the gluteal cleft.
 Lichen planus frequently arises on the wrists, forearms,
genitals, and lower legs.
 Vitiligo may be patchy and isolated or may group around
the distal extremities and face, particularly around the eyes
and mouth.
 Discoid lupus erythematosus has characteristic lesions
on sun-exposed skin of the face, especially the forehead,
nose, and the conchal bowl of the ear.
 Hidradenitis suppurativa involves skin containing a high
density of apocrine glands, including the axillae, groin, and
under the breasts.

48. Color
 Red skin (erythema) can result from many different
inflammatory or infectious diseases. Cutaneous
tumors are often pink or red. Superficial vascular
lesions such as port-wine stains may appear red.
 Orange skin is most often seen in hypercarotenemia,
a usually benign condition of carotene deposition after
excess dietary ingestion of beta-carotene.
 Yellow skin is typical of jaundice, xanthelasmas and
xanthomas, and pseudoxanthoma elasticum.

49.  Green fingernails suggest Pseudomonas aeruginosa
infection.
 Violet skin may result from cutaneous hemorrhage or
vasculitis. Vascular lesions or tumors, such as Kaposi
sarcoma and hemangiomas, can appear purple. A lilac
color of the eyelids or heliotrope eruption is
characteristic of dermatomyositis.

50.  Shades of blue, silver, and gray can result from
deposition of drugs or metals in the skin, including
minocycline, amiodarone, and silver (argyria).
Ischemic skin appears purple to gray in color. Deep
dermal nevi appear blue.
 Black skin lesions may be melanocytic, including
nevi and melanoma. Black eschars are collections of
dead skin that can arise from infarction, which may be
caused by infection (eg, anthrax, angioinvasive fungi
including Rhizopus,meningococcemia), calciphylaxis,
arterial insufficiency, or vasculitis.

51. THINK TANK!!!
 When describing a skin lesion, it is important to note the
following features:-
- SIZE
- TYPE
- SHAPE AND SYMMETRY
- SURFACE AREA
- DISTRIBUTION OVER BODY SURFACE

52. ICTCHING DEFINITION
 Itchy skin, also known as pruritus, is an irritating and
uncontrollable sensation that makes you want to
scratch to relieve the feeling.
 The possible causes for itchiness range from internal
illnesses, such as kidney or liver disease, to skin
rashes,...

53. SCABIES
 Scabies, previously known as the seven-year itch, is a
contagious skin infestation by the mite Sarcoptes
scabiei.
 The most common symptoms are severe itchiness and
a pimple-like rash.
 Occasionally tiny burrows may be seen in the skin.
When first infected, usually two to six weeks are
required before symptoms occur.
 If a person develops a second infection later in life,
symptoms may begin within a day.

54.  These symptoms can be present across most of the
body or just certain areas such as the wrists, between
fingers, or along the waistline.
 The head may be affected, but this is typically only in
young children.
 The itch is often worse at night. Scratching may cause
skin breakdown and an additional bacterial infection
of the skin.

55. Signs and symptoms
 The characteristic symptoms of a scabies infection
include intense itching and superficial burrows.
 The burrow tracks are often linear, to the point that a
neat "line" of four or more closely placed and equally
developed mosquito-like "bites" is almost diagnostic of
the disease.
 Because the host develops the symptoms as a reaction
to the mites' presence over time, there is typically a
delay of four to six weeks between the onset of
infestation and the onset of itching.

56.  Similarly, symptoms often persist for one to several
weeks after successful eradication of the mites.
 As noted, those re-exposed to scabies after successful
treatment may exhibit symptoms of the new
infestation in a much shorter period—as little as one
to four days.

57. Itching
 In the classic scenario, the itch is made worse by
warmth, and is usually experienced as being worse at
night, possibly because there are fewer distractions.
 As a symptom, it is less common in the elderly.

58. Rash
 The superficial burrows of scabies usually occur in the area
of the finger webs, feet, ventral wrists, elbows, back,
buttocks, and external genitals.
 Except in infants and the immunosuppressed, infection
generally does not occur in the skin of the face or scalp.
 The burrows are created by excavation of the adult mite in
the epidermis.
 In most people, the trails of the burrowing mites are linear
or s-shaped tracks in the skin often accompanied by rows
of small, pimple-like mosquito or insect bites.
 These signs are often found in crevices of the body, such as
on the webs of fingers and toes, around the genital area, in
stomach folds of the skin, and under the breasts of women.

59. Hives
 itchy, raised welts
 red and painful to the touch
 can be small, round, and ring-shaped or large and
randomly shaped

60.  Symptoms typically appear two to six weeks after
infestation for individuals never before exposed to
scabies.
 For those having been previously exposed, the
symptoms can appear within several days after
infestation.
 However, it is not unknown for symptoms to appear
after several months or years. Acropustulosis, or
blisters and pustules on the palms and soles of the
feet, are characteristic symptoms of scabies in infants.

62. Transmission
 Scabies is contagious and can be contracted through
prolonged physical contact with an infested person.
 This includes sexual intercourse, although a majority
of cases are acquired through other forms of skin-to-
skin contact.
 Less commonly, scabies infestation can happen
through the sharing of clothes, towels, and bedding,
but this is not a major mode of transmission;
individual mites can only survive for two to three days,
at most, away from human skin at room temperature.

63.  As with lice, a latex condom is ineffective against
scabies transmission during intercourse, because
mites typically migrate from one individual to the next
at sites other than the sex organs.
 Healthcare workers are at risk of contracting scabies
from patients, because they may be in extended
contact with them.

64. Diagnosis
 Scabies may be diagnosed clinically in geographical
areas where it is common when diffuse itching
presents along with either lesions in two typical spots
or there is itchiness of another household member.
 The classical sign of scabies is the burrows made by
the mites within the skin.
 To detect the burrow, the suspected area is rubbed
with ink from a fountain pen or a topical tetracycline
solution, which glows under a special light. The skin is
then wiped with an alcohol pad.

65.  If the person is infected with scabies, the
characteristic zigzag or S pattern of the burrow will
appear across the skin; however, interpreting this test
may be difficult as the burrows are scarce and may be
obscured by scratch marks.
 A definitive diagnosis is made by finding either the
scabies mites or their eggs and fecal pellets.
 Searches for these signs involve either scraping a
suspected area, mounting the sample in potassium
hydroxide and examining it under a microscope, or
using dermoscopy to examine the skin directly.

66. Differential diagnosis
 Symptoms of early scabies infestation mirror other
skin diseases, including dermatitis, syphilis, erythema
multiforme, various urticaria-related syndromes,
allergic reactions, ringworm related diseases and other
ectoparasites such as lice and fleas.

67. Prevention
 Mass treatment programs that use topical permethrin
or oral ivermectin have been effective in reducing the
prevalence of scabies in a number of populations.
 No vaccine is available for scabies.
 The simultaneous treatment of all close contacts is
recommended, even if they show no symptoms of
infection (asymptomatic), to reduce rates of
recurrence.

68.  Since mites can survive for only two to three days
without a host, other objects in the environment pose
little risk of transmission except in the case of crusted
scabies, thus cleaning is of little importance.
 Rooms used by those with crusted scabies require
thorough cleaning.

69. Management
 A number of medications are effective in treating
scabies.
 Treatment should involve the entire household, and
any others who have had recent, prolonged contact
with the infested individual.
 Options to control itchiness include antihistamines
and prescription anti-inflammatory agents.
 Bedding, clothing and towels used during the previous
three days should be washed in hot water and dried in
a hot dryer.

70. Permethrin
 Permethrin is the most effective treatment for scabies, and
remains the treatment of choice.
 It is applied from the neck down, usually before bedtime, and
left on for about eight to 14 hours, then washed off in the
morning. Care should be taken to coat the entire skin surface,
not just symptomatic areas; any patch of skin left untreated can
provide a "safe haven" for one or more mites to survive.
 One application is normally sufficient, as permethrin kills eggs
and hatchlings as well as adult mites, though many physicians
recommend a second application three to seven days later as a
precaution.
 Crusted scabies may require multiple applications, or
supplemental treatment with oral ivermectin (below).
 Permethrin may cause slight irritation of the skin that is usually
tolerable.

71. Ivermectin
 Oral Ivermectin is effective in eradicating scabies,
often in a single dose. It is the treatment of choice for
crusted scabies, and is sometimes prescribed in
combination with a topical agent.
 It has not been tested on infants, and is not
recommended for children under six years of age.

72.  Topical ivermectin preparations have been shown to
be effective for scabies in adults, though only one such
formulation is available in the United States at
present, and it is not FDA approved as a scabies
treatment.
 It has also been useful for sarcoptic mange (the
veterinary analog of human scabies).

73. Others
 Other treatments include lindane, benzyl benzoate,
crotamiton, malathion, and sulfur preparations.
 Lindane is effective, but concerns over potential
neurotoxicity has limited its availability in many
countries.
 It is banned in California, but may be used in other
states as a second-line treatment.

74.  Sulfur ointments or benzyl benzoate are often used in
the developing world due to their low cost; 10% sulfur
solutions have been shown to be effective, and sulfur
ointments are typically used for at least a week, though
many people find the odor of sulfur products unpleasant.
 Crotamiton has been found to be less effective than
permethrin in limited studies.
 Crotamiton or sulfur preparations are sometimes
recommended instead of permethrin for children, due to
concerns over dermal absorption of permethrin.

75. Dermatologic Manifestations of
Onchocerciasis (River Blindness)
Background
 Onchocerciasis is a common, chronic, multisystemic
disease caused by the nematode Onchocerca volvulus.
 The disease characteristically includes dermatologic (see
the image below), lymphatic, ophthalmologic, and
systemic manifestations.
 Human transmission of the disease is caused by a bite
from the intermediate host, the black fly (genus
Simulium).


76.  Black flies breed along waterways, which can vary
from small streams to broad rivers.
 Affected individuals usually live or work within a few
kilometers of these sites.
 Onchocerciasis has long been associated with a high
incidence of detrimental effects on socioeconomic
development and public health in endemic areas.

77. Dermatitis associated with
microfilaria.

78.  Skin involvement typically consists of intense itching,
swelling, and inflammation.
 A grading system has been developed to categorize the
degree of skin involvement:
 Acute papular onchodermatitis – scattered pruritic
papules
 Chronic papular onchodermatitis – larger papules,
resulting in hyperpigmentation

79.  Lichenified onchodermatitis – hyperpigmented
papules and plaques, with edema, lymphadenopathy,
pruritus and common secondary bacterial infections
 Skin atrophy – loss of elasticity, the skin resembles
tissue paper, 'lizard skin' appearance
 Depigmentation – 'leopard skin' appearance, usually
on anterior lower leg
 Glaucoma effect – eyes malfunction, begin to see
shadows or nothing

80. Classification
 Onchocerciasis causes different kinds of skin changes,
which vary in different geographic regions; it may be
divided into the following phases or types:
 Erisipela de la costa An acute phase, it is characterized by
swelling of the face, with erythema and itching. This skin
change, erisípela de la costa, of acute onchocerciasis is
most commonly seen among victims in Central and
South America.
 Mal morando This cutaneous condition is characterized
by inflammation accompanied by hyperpigmentation.

81.  Sowda A cutaneous condition, it is a localized type of
onchocerciasis. Additionally, the various skin changes
associated with onchocerciasis may be described as
follows:
 Leopard skin The spotted depigmentation of the skin
that may occur with onchocerciasis Elephant skin The
thickening of human skin that may be associated with
onchocerciasis Lizard skin The thickened, wrinkled
skin changes that may result with onchocerciasis

82. Treatment
Ivermectin
 Ivermectin kills the parasite by interfering with the
nervous system and muscle function, in particular, by
enhancing inhibitory neurotransmission.
 The drug binds to and activates glutamate-gated
chloride channels.
 These channels, present in neurons and myocytes, are
not invertebrate-specific, but are protected in
vertebrates from the action of ivermectin by the
blood–brain barrier.

83.  Ivermectin is thought to irreversibly activate these
channel receptors in the worm, eventually causing an
inhibitory postsynaptic potential.
 The chance of a future action potential occurring in
synapses between neurons decreases and the
nematodes experience flaccid paralysis followed by
death.
 Ivermectin is directly effective against the larval stage
microfilariae of O. volvulus; they are paralyzed and can
be killed by eosinophils and macrophages.

84.  It does not kill adult females (macrofilariae), but does
cause them to cease releasing microfilariae, perhaps by
paralyzing the reproductive tract.
 Ivermectin is very effective in reducing microfilarial
load and reducing number of punctate opacities in
individuals with onchocerciasis.

85.  Antibiotics
 For the treatment of individuals, doxycycline is used to
kill the Wolbachia bacteria that live in adult worms.
 This adjunct therapy has been shown to significantly
lower microfilarial loads in the host, and may kill the
adult worms, due to the symbiotic relationship
between Wolbachia and the worm.

86.  In four separate trials over 10 years with various dosing
regimens of doxycycline for individualized treatment,
doxycycline was found to be effective in sterilizing the
female worms and reducing their numbers over a period
of four to six weeks.
 Research on other antibiotics, such as rifampicin, has
shown it to be effective in animal models at reducing
Wolbachia both as an alternative and as an adjunct to
doxycycline.
 However, doxycycline treatment requires daily dosing for
at least four to six weeks, making it more difficult to
administer in the affected areas.

87. FUNGAL INFECTIONS
 Fungal infections are infections caused by a fungus, a
type of microorganism. Two common causes of fungal
infections are a fungus called tinea and yeast infections
caused by the fungus Candida albicans.

88. Some very common types of fungal infections caused by
tinea include:
 Athlete’s foot
 Jock itch
 Ringworm
Common yeast infections, also called candida and
candidiasis, can infect other areas of the body
including:

89.  Esophagus
 Digestive tract (gastroenteritis)
 Lungs
 Mouth (oral thrush)
 Urinary tract
 Vagina (vaginal yeast infection, vaginal thrush)

90. What is tinea?
 Tinea, commonly referred to as ringworm, is a broad
term used to describe a fungal infection of the skin
(dermatophyte), whether affecting the body (tinea
corporis), the scalp (tinea capitis), the groin (tinea
cruris, or jock itch), the feet (tinea pedis, or athlete’s
foot), or the nails (tinea unguium, or onychomycosis).
While tinea is seen most frequently in children, it
occurs in all age groups.

91.  Although ringworm is the term most frequently
encountered, the infecting agent is actually a fungus
that thrives in warm, moist areas and is most likely to
occur with constant moisture from perspiration or as a
complication of minor injuries to your nails, scalp or
skin.
 The name ringworm comes from a ring-like pattern
frequently seen with tinea, the development of red
patches on the skin that are often redder around the
outside (forming the ring), with a more normal skin
color in the center.

92. Ringworm facts
 Ringworm is a common fungal infection of the skin
and is not due to a worm.
 The medical term for ringworm is tinea. The skin
disease is further named for the site of the body where
the infection occurs.
 Some types of ringworm infection include tinea
corporis, tinea capitis, tinea pedis ("athlete's foot"),
and tinea cruris ("jock itch").

93.  Ringworm causes a scaly, crusted rash that may appear
as round, red patches on the skin.
 Other symptoms and signs of ringworm include
patches of hair loss or scaling on the scalp, itching, and
blister-like lesions.
 Ringworm is contagious and can be passed from
person to person.
 Ringworm can be successfully treated with antifungal
medications used either topically or orally.

94.  Ringworm can spread by direct contact with infected
people or animals. It also may be spread on clothing or
furniture. Heat and humidity may help to spread the
infection.

95. Symptoms of Ringworm?
 Ringworm appears as a red, circular, flat sore that is
sometimes accompanied by scaly skin. There may be
more than one patch of ringworm on the skin, and
patches or red rings of rash may overlap. It is possible
to have ringworm without having the common red
ring of rash.

96. How Is Ringworm Diagnosed?
 A CHO can diagnose ringworm based on the
appearance of the rash or reported symptoms. He or
she will ask about possible exposure to people or
animals with ringworm.
 The CHO may take skin scrapings or samples from the
infected area and look at them under a microscope to
confirm the diagnosis.

97. How Is Ringworm Diagnosed?
 A doctor can diagnose ringworm based on the
appearance of the rash or reported symptoms. He or
she will ask about possible exposure to people or
animals with ringworm. The doctor may take skin
scrapings or samples from the infected area and look
at them under a microscope to confirm the diagnosis.

98.  How Is Ringworm Treated?
 Treatment for ringworm usually consists of antifungal
medications that are applied to the skin. Many
ringworm infections respond well to over-the-counter
creams, including:

99. Yeast Infections
 Yeast infections of the skin are called cutaneous
candidiasis and are caused by yeast-like fungi called
candida.
 They occur when yeast on the skin grows more actively
and causes a red, scaling, itchy rash on the skin. Yeast
infections are not contagious.

100.  Yeast infections may affect nearly any skin surface on
the body, but are most likely to occur in warm, moist,
creased areas including the armpits and the groin.
 Candida infection is especially common among people
who are obese or who have diabetes.
 People taking antibiotics are also at risk.

101.  Candida can cause diaper rash in infants and can cause
infections of the nail. Oral thrush is a form of candida
infection that is found in the mouth. Candida also
causes vaginal yeast infections.

103. Classification
 Candidiasis may be divided into these types:
 Mucosal candidiasis
 Oral candidiasis (thrush, oropharyngeal candidiasis)
 Pseudomembranous candidiasis
 Erythematous candidiasis
 Hyperplastic candidiasis
 Denture-related stomatitis— Candida organisms are involved in
about 90% of cases
 Angular cheilitis— Candida species are responsible for about
20% of cases, mixed infection of C. albicans and Staphylococcus
aureus for about 60% of cases.
 Median rhomboid glossitis

104.  Candidal vulvovaginitis (vaginal yeast infection)
 Candidal balanitis — infection of the glans penis, almost
exclusively occurring in uncircumcised males
 Esophageal candidiasis (candidal esophagitis)
 Gastrointestinal candidiasis
 Respiratory candidiasis

105.  Cutaneous candidiasis
 Candidial folliculitis
 Candidal intertrigo
 Candidal paronychia
 Perianal candidiasis, may present as pruritus ani
 Candidid
 Chronic mucocutaneous candidiasis
 Congenital cutaneous candidiasis
 Diaper candidiasis: an infection of a child's diaper area
 Erosio interdigitalis blastomycetica
 Candidial onychomycosis (nail infection) caused by Candida

106.  Systemic candidiasis
 Candidemia, a form of fungemia which may lead to
sepsis
 Invasive candidiasis (disseminated candidiasis) — organ
infection by Candida
 Chronic systemic candidiasis (hepatosplenic
candidiasis) — sometimes arises during recovery from
neutropenia
 Antibiotic candidiasis (iatrogenic candidiasis)

113. PIGMENTATION
 Skin Injury
 cut: line of damage that can go through the skin or
muscle tissues
 scratch: surface damage that doesn't penetrate the
lower tissues
 both cause bleeding, redness, swelling, and pain

114. ECZEMA
Allergic eczema is also known as:
 allergic dermatitis
 contact dermatitis
 allergic contact dermatitis
 contact eczema

115. WHAT IS IT?
 Eczema (atopic dermatitis) is a recurring, non-
infectious, inflammatory skin condition.
 The condition is most common in people with a family
history of an atopic disorder, including asthma or hay
fever.
 Atopic eczema is the most common form of the
disease .

116. PRESENTATION?
 The skin becomes red, dry, itchy and scaly, and in
severe cases, may weep, bleed and crust over, causing
the sufferer much discomfort.
 Sometimes the skin may become infected. The
condition can also flare and subside for no apparent
reason

117. WHO IS AFFECTED?
 Although eczema affects all ages, it usually appears in
early childhood (in babies between two-to-six months
of age) and disappears around six years of age.
 In fact, more than half of all eczema sufferers show
signs within their first 12 months of life and 20 per cent
of people develop eczema before the age of five.

118. WHAT CAUSES ECZEMA?
 The exact cause of eczema is unknown – it appears to be
linked to the following internal and external triggers:
Internal
 A family history of eczema, asthma or hay fever (the
strongest predictor): if both parents have eczema, there
is an 80 per cent chance that their children may also
develop eczema
 Some foods and alcohol: dairy and wheat products, citrus
fruits, eggs, nuts, seafood, chemical food additives,
preservatives and colourings
 Stress

119. CAUSES?........
 External Irritants: tobacco smoke, chemicals, weather
(hot and humid or cold and dry conditions) and air
conditioning or overheating
 Allergens : house dust mites, moulds, grasses, plant
pollens, foods, pets and clothing, soaps, shampoos and
washing

120. HOW DOES IT LOOK?
 Moderate-to-severely itching skin
 rash – maculo-papular dry, red, patchy or cracked skin.
Commonly it appears on the face, hands, neck, inner
elbows, backs of the knees and ankles, but can appear
on any part of the body.
 Skin weeping watery fluid
 Rough, "leathery," thick skin

121. How can you help?
 Counselling
 Drugs: cortisone creams, antibiotics, antihistamines
 Phototherapy
 Cold compresses

122. ACNE
 Acne, also known as acne vulgaris, is a long-term
skin disease that occurs when hair follicles are clogged
with dead skin cells and oil from the skin.
 It is characterized by blackheads or whiteheads,
pimples, oily skin, and possible scarring.
 It primarily affects areas of the skin with a relatively
high number of oil glands, including the face, upper
part of the chest, and back.

123. CAUSES?
 Genetics is thought to be the primary cause of acne in
80% of cases.
 The role of diet and cigarette smoking is unclear, and
neither cleanliness nor exposure to sunlight appear to
play a part.
 During puberty, in both sexes, acne is often brought
on by an increase in hormones such as testosterone.

124. CAUSES?....
 A frequent factor is excessive growth of the bacterium
Propionibacterium acnes, which is normally present
on the skin.


125. HOW WOULD IT LOOK?
 The severity of acne vulgaris can be classified as mild,
moderate, or severe as this helps to determine an
appropriate treatment regimen.
 Mild acne is classically defined by the presence of
clogged skin follicles (known as comedones) limited to
the face with occasional inflammatory lesions.

126. LOOKS?.....
 Moderate severity acne is said to occur when a higher
number of inflammatory papules and pustules occur
on the face compared to mild cases of acne and are
found on the trunk of the body.
 Severe acne is said to occur when nodules (the painful
'bumps' lying under the skin) are the characteristic
facial lesions and involvement of the trunk is
extensive.

127. SO........
 Typical features of acne include increased secretion of
oily sebum by the skin, microcomedones, comedones,
papules, nodules (large papules), pustules, and often
results in scarring.
 The appearance of acne varies with skin color.
 It may result in psychological and social problems.

128. How can you help?
 Counselling: keep oily areas clean
 Many different treatments exist for acne
 Recommended therapies for first-line use in acne
vulgaris treatment include topical retinoids, benzoyl
peroxide, and topical or oral antibiotics.

129. Derm terms: Primary Lesions
1. Macule - A macule is a change in the color of the skin. It is flat, if you were to close your eyes
and run your fingers over the surface of a purely macular lesion, you could not detect it. A macule
greater than 1 cm. may be referred to as a patch.
2. Papule - A papule is a solid raised lesion that has distinct borders and is less than 1 cm in
diameter. Papules may have a variety of shapes in profile (domed, flat-topped, umbilicated) and
may be associated with secondary features such as crusts or scales.
3. Nodule - A nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis,
or subcutaneous tissue.
4. Tumor - A tumor is a solid mass of the skin or subcutaneous tissue; it is larger than a nodule.
(Please bear in mind this definition does not at all mean that the lesion is a neoplasm.)
5. Plaque - A plaque is a solid, raised, flat-topped lesion greater than 1 cm. in diameter. It is
analogous to the geological formation, the plateau.
6. Vesicle - Vesicles are raised lesions less than 1 cm. in diameter that are filled with clear fluid.
7. Bullae - Bullae are circumscribed fluid-filled lesions that are greater than 1 cm. in diameter.
8. Pustule - Pustules are circumscribed elevated lesions that contain pus. They are most
commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis).
9. Wheal - A wheal is an area of edema in the upper epidermis.
10.Burrow - Burrows are linear lesions produced by infestation of the skin and formation of
tunnels (e.g., with infestation by the scabitic mite or by cutaneous larva migrans).
11.Telangiectasia - Telangiectasia are the permanent dilatation of superficial blood vessels in the
skin and may occur as isolated phenomena or as part of a generalized disorder, such as ataxia
telangiectasia.
http://www.pediatrics.wisc.edu/education/derm/tutorials.html

130. Derm terms: Secondary Lesions
12.Scale - Scale consists of flakes or plates that represent compacted desquamated layers of stratum
corneum. Desquamation occurs when there are peeling sheets of scale following acute injury to the
skin.
13.Crust - Crusting is the result of the drying of plasma or exudate on the skin. Please remember that
crusting is different from scaling. The two terms refer to different phenomena and are not
interchangeable. One can usually be distinguished from the other by appearance alone.
14.Atrophy - Atrophy is thinning or absence of the epidermis or subcutaneous fat.
15.Lichenification - "Lichenification" refers to a thickening of the epidermis seen with exaggeration of
normal skin lines. It is usually due to chronic rubbing or scratching of an area.
16.Erosion - Erosions are slightly depressed areas of skin in which part or all of the epidermis has been
lost.
17.Excoriation - Excoriations are traumatized or abraded skin caused by scratching or rubbing.
18.Fissure - A fissure is linear cleavage of skin which extends into the dermis.
19.Ulceration - Ulcerations occur when there is necrosis of the epidermis and dermis and sometimes of
the underlying subcutaneous tissue.
20.Scar - Scars are the permanent fibrotic changes that occur on the skin following damage to the
dermis. Scars may have secondary pigment characteristics.
21.Eschar - An eschar is a hard plaque covering an ulcer implying extensive tissue necrosis, infarcts,
deep burns, or gangrene
22.Keloids - Keloids are an exaggerated connective tissue response of injured skin that extend beyond
the edges of the original wound.
23.Petechiae, Purpura, and Ecchymoses - Three terms that refer to bleeding that occurs in the
skin are petechiae, purpura, and ecchymoses. Generally, the term "petechiae" refers to smaller lesions.
"Purpura" and "ecchymoses" are terms that refer to larger lesions. In certain situations purpura may
be palpable. In all situations, petechiae, ecchymoses, and purpura do not blanch when pressed. If
there is any question, press on the lesions carefully with a glass slide. Don't break the slide or cut the
patient.
http://www.pediatrics.wisc.edu/education/derm/tutorials.html

131. UNA KABO FOR YERI