Common Dermatological Problems
Download as PPSX, PDF15 likes3,721 views
This document provides information on the presentation, diagnosis, and management of various dermatological conditions. It discusses atopic dermatitis, contact dermatitis, seborrheic dermatitis, varicose dermatitis, and other conditions. For each, it describes key characteristics, assessments to perform, treatment options including emollients, topical steroids, and oral medications. It also covers bacterial, fungal, and viral skin infections, infestations like scabies and lice, vascular and autoimmune conditions, precancers and skin cancers. Management involves identifying causative agents, using topical or oral antimicrobials, and considering referral for complex cases.
Common Dermatological Problems
- 1. 1
- 2. • 2
- 3. (Atopic, Irritant, Seborrhoeic, varicose) 3
- 4. Atopic Dermatitis Presentation itchy condition. If no itching then it’s not eczema. Infants Itchy vesicular eczema on face ± hands. May cause sleep disturbance. Children >18mo Involves antecubital and popliteal fossae, neck, wrists, and ankles. Lichenification, excoriation, and dry skin. Adults Most commonly hand dermatitis in a person with past history of atopic eczema. A few continue to have generalized atopic eczema. Exacerbated by stress. Associated with other atopic conditions, e.g. asthma, hay fever. 4
- 5. Assessment Ask about: • Family and personal history • distribution of the disease • Aggravating factors (pets, irritants, e.g. soaps/detergents, allergens) • Impact on quality of life (school work, career, social life) Diagnosis Itchy skin plus ≥3 of: • Itching in skin creases • History of asthma or hay fever • Generally dry skin • Visible flexural eczema • Onset in the first 2y of life Complications • Skin thickening and scaling • Bacterial infection Secondary infection (usually with Staph. aureus) • Viral infection, e.g. viral warts, molluscum. Eczema herpeticum • Cataracts Rarely occur in young adults with very severe eczema • Growth retardation Children with severe eczema, cause unknown. A growth chart should be kept for children with chronic severe eczema 5
- 6. 6
- 7. Non Pharmalogical Management • Advise—loose cotton clothing; avoid wool (exacerbates eczema); avoid excessive heat; keep nails short; gloves in bed • If a specific irritant is identified (e.g. house dust mite, pets) then avoid Pharmalogical Management • Emollients Topical creams/ointments and bath emollients—use as soap substitutes, even if skin is clear. May Ideally apply 3–4x/d • Topical steroids least potent strength that is effective. Use od or bd. Ointments are preferable on dry, scaly eczema; creams on wet, exudative eczema. • Antibiotics For infected eczema—topical (alone or in combination with steroid, e.g. Fucidin) or oral (e.g. flucloxacillin or erythromycin qds for 2wk). Swab if antibiotic treatment is ineffective • Oral steroids Rescue therapy •Sedative antihistamines • Bandages Excoriated or lichenified eczema—zinc and calamine. Bandages can be applied at night on top of steroid ointment. 7
- 8. Contact Dermatitis • Irritant (water, abrasives, chemicals, detergent), or • Allergic (nickel; chrome; rubber) site and knowledge of occupation, hobbies, sports, help find the cause. • Acute itchy erythema and skin oedema, papules, vesicles, or blisters • Chronic lichenification, scaling, and fissuring Management • Identification of the allergen or irritant Consider referral for patch testing • Exclusion of the offending allergen or irritant from the environment Although this may be impossible. There is some evidence that nickel avoidance diets can help patients with nickel sensitivityG. • Hand care • Emollients • Topical steroids 8
- 9. 9
- 10. Seborrhoeic Dermatitis Scalp and facial involvement Most common in young men. Excessive dandruff, itchy scaly erythematous eruption affecting sides of the nose, eyes, ears, hairline. Petaloid Dry, scaly eczema over the pre-sternal area Pityrosporum folliculitis Erythematous follicular eruption with papules/pustules over the back Flexural Most common in the elderly. Axillae, groins, and submammary areas. Moist intertrigo. Associated with s candida infection Infantile 10
- 11. • 11
- 12. Varicose Dermatitis • Associated with underlying varicose viens • haemosiderin deposition around the ankles over prominent veins >>Later signs Eczema ± fibrosis of the dermis and subcutaneous tissue ± ulceration • Management Emollients ± mild or moderate steroid ointment (avoid long-term use) . Treat venous disease 12
- 13. • 13
- 14. 14
- 15. • • ASSOCIATIONS: • CAUSE 15
- 16. Erthrodermic psoriasis >> Admit as an emergency 16
- 17. 17
- 18. 18
- 19. 19
- 20. 20
- 21. 21
- 23. Management Frequent emollients ± • Salicylic acid decrease surface scale. • Coal tar Anti-inflammatory + anti-scaling. The thicker the patch the stronger the preparation needed. • Vitamin D analogue (e.g. calcipotriol, tacalcitol). • Dithranol Plaque psoriasis—apply to lesion only. • Topical retinoids Mild/moderate plaque psoriasis • Topical steroids Can be used on localized plaques. 23
- 24. 24
- 25. 25
- 26. 26
- 27. 27
- 28. (Impetigo, erysipelas, cellulitis, folliculitis, carbuncle) 28
- 29. Impetigo Erysipelas Cellulitis Folliculitis Furuncle Carbuncle Epidermis Dermis Hair 29
- 30. Bullous Non-Bullous Caused by Staph A. Very common in children Caused by Staph A. and Strept. Common in all ages Management: Non pharmalogical: Avoid spreading to other children—no sharing of towels, face flannels. Reassure that non-scarring Pharmalogical: Localized Treat with topical antibiotics (e.g. fusidic acid cream) Widespread Treat with oral flucloxacillin or clarithromycin 30
- 31. CELLULITIS ERYPSIPELAS They infect the dermis and manifest as areas of skin erythema, edema, and • cellulitis involves the deeper dermis and subcutaneous fat >> lesions will not raise • Systemic symptoms after few days • involves the upper dermis and superficial lymphatics >>> lesions are raised above the level of surrounding skin, and there is a clear line of demarcation between involved and uninvolved tissue • Acute systemic symptoms warmth 31
- 32. Management: • SEVERE INFECTION ADMIT FOR IV ANTIBIOTICS • IF SYSTEMICALLY WELL MARK THE AREA BEFORE STARTING FLUCLOXACILLIN OR CLARITHROMYCIN FOR 7–14D. ADVISE TO SEEK HELP IF INFECTION IS SPREADING OR BECOMING SYSTEMICALLY UNWELL • FACIAL INFECTION TREAT WITH PENICILLIN V QDS OR CLARITHROMYCIN BD • RECURRENT INFECTIONS (>2 EPISODES AT ONE SITE) MAY NEED PROPHYLACTIC LONG-TERM PENICILLIN WITH ATTENTION TO SKIN CARE 32
- 33. FURUNCLE CARBUNUCLE • Occurs when a group of hair follicles become deeply infected with Staph. aureus. • May be associated with fever ± malaise • Swollen, painful area discharging pus from several points. • Acute infection of a hair follicle with Staph. aureus. Occasionally associated with fever ± malaise • A hard, tender, red nodule surrounding a hair follicle becomes larger and fluctuant after several days.. Later may discharge pus and a central ‘core’ before healing; may leave a scar. 33
- 34. Management: • • • 34
- 35. • • • • 35
- 37. 37
- 38. 38
- 39. 39
- 40. 40
- 41. 41
- 42. 42
- 43. 43
- 44. 44
- 45. 45
- 46. 46
- 47. 47 Management of Fungal infections: Mouth lesions Remove tongue deposits with a toothbrush by brushing 2x/d. Treat with oral suspensions or gels (e.g. nystatin, miconazole). Genital lesions Imidazole cream or pessaries • Nail infections amorolfine Avoid nail varnish/articifial nails during treatment • Skin lesions Imidazole cream, spray, or powder; terbinafine cream
- 48. • TINEA VERSICOLOR • PINKISH BROWN • • 48
- 49. (Warts, HSV) 49
- 50. 50
- 51. Viral Warts Genital warts Presentation in women asymptomatic but may be associated with itching or vaginal discharge. Warts enlarge during pregnancy. Presentation in men Warts are usually found on the penis or perianally. Common Warts Dome-shaped papules with papilliferous surface. Usually >1. Most common on hands but may affect other areas. Plantar warts On soles of feet. Pressure makes them grow into the dermis, painful. Characterized by dark punctate spots on the surface Plane warts Smooth, flat-topped papules often slightly brown in colour. Most common on face/backs of hands 51
- 52. HSV Infection transmitted by direct contact with lesions. Lesions appear on around the mouth and on the lips, conjunctiva, cornea, and genitalia. Diagnosis is usually clinical. Primary HSV stomatitis After a prodromal period (<6h) of tingling, discomfort, or itching, small tense vesicles appear on an erythematous base. These burst to form multiple, small, painful mouth ulcers. Can be accompanied by systemic symptoms, e.g. fever, malaise, and tender lymph nodes.. Management Give symptomatic relief—analgesic mouthwashes, If seen <48h after onset give oral antivirals, e.g. aciclovir 5x/d for 5d Recurrent infection (cold sores) HSV remains dormant in the nerve ganglia so Recurrent eruptions can occur 52
- 53. Herpetic whitlow Swollen, painful, and erythematous lesion of the distal phalanx, results from inoculation of HSV through a skin break or abrasion and is most common in health workers. 53
- 54. • 54
- 56. Scabies Extremely contagious. The scabies mite (Sarcoptes scabei) is spread by direct physical contact Presentation Symptoms of intense itching appear 4–6wk after infection. Examination reveals burrows (irregular, tortuous, <1cm long) on the sides of fingers, wrists, ankles, and nipples. Management Pharmalogical: Treat with. permethrin 5% or malathion lotion. All close contacts need treatment simultaneously. Apply to whole body including scalp, neck, face, and ears. Ensure finger/toe webs are covered, and brush lotion under the ends of finger/toenails. Non Pharmalogical Advise patients to launder all worn clothing and bedding after application. Itching may persist for some time after elimination of infection . 56
- 57. 57
- 58. Pediculosis Symptoms/signs asymptomatic. Detected by contact tracing of other cases or routine inspection at home or school. Occasionally present as itchy scalp. Presence of ‘nits’ (eggshells—white dots attached to hair), a moving louse must be found to confirm active infection. Management Treat all household contacts simultaneously. • Dimeticone Lotion or spray. Coats lice and interferes with their water balance by preventing the excretion of water. Advise to rub into dry hair and scalp in the evening, allow to dry naturally, then shampoo off the next morning. Repeat after 7d • Insecticides. 4 types: malathion, phenothrin, permethrin, and carbaryl (prescription only). Malathion and phenothrin/permethrin are used as first-/second-line; carbaryl is reserved for third-line. 58
- 59. (Flushing, Nodusum, Multiforme, Rosacea, Lyme) 59
- 60. Flushing Cause: • Physiological: exertion, heat • Emotion: anger, anxiety, embarrassment • Foods: spices, chillies, alcohol • Endocrine: menopause, Cushing’s syndrome • Drugs: opioids, tamoxifen, danazol, GnRH analogues, nitrates, calcium channel blockers • Inflammatory SLE; dermatomyositis • Infection: slapped cheek syndrome (Fifth disease); cellulitis/erysipelas • Tumour :Pancreatic tumours, medullary thyroid cancer, carcinoid, phaeochromocytoma Management : Treat cause if possible (e.g. avoid alcohol, HRT). Embarrassing flushing may be helped with propranolol or clonidine If severe > refer 60
- 61. Erythema nodosum Tender erythematous nodules on extensor surfaces of limbs—especially shins ± fever. Resolves in <8wk, non-scarring. No treatment only analgesia Associations: • Streptococcal infection • Drugs, e.g. oral contraceptives, sulfonamides • Acute sarcoidosis • Inflammatory bowel disease— UC, Crohn’s • Malignancy • TB 61
- 62. Erythema Multiforme Immune-mediated disease characterized by target lesions on hands and feet Causes: • Idiopathic (50%) • Infective Streptococcal, HSV, hepatitis B, mycoplasma • Drugs Penicillin, sulfonamide, barbiturate • Other SLE, pregnancy, malignancy Presentation Target lesions on hands and feet. Frequently oral, conjunctival, and genital mucosa is affected—if severe termed Stevens–Johnson syndrome. Management Identification and removal of the underlying cause. Mild cases resolve spontaneously and require symptomatic measures only. Admit if extensive involvement. 62
- 63. Rosacea Relapsing-remitting chronic inflammatory facial dermatosis characterized by erythema and pustules No cure. Cause: unknown Presentation Earliest symptom is flushing. Erythema, telangiectasia, papules, pustules affect cheeks, nose, forehead, and chin Aggravating factors Sun exposure; emotional stress ; hot weather ; alcohol; spicy foods ; exercise; cold weather or wind; hot baths; hot drinks; cosmetics/ skin care products. Complications Rhinophyma ; eye involvement—blepharitis, dry eye, and conjunctivitis. Management • Avoid triggers • Antibiotics • Refer to dermatology if rhinophyma, ocular complications, or failure to respond to treatment. 63
- 64. Lyme Disease Cause: Borrelia burgdorferi. Spread: transmitted by ticks—usually from deer or sheep. Presentenation: • Erythema migrans: a red macule/papule on the upper arm, leg, or trunk 7–10d after a tick bite, which expands over days/weeks to form a ring with central clearing; • Flu-like illness • Lymphadenopathy ± splenomegaly • Arthralgia Symptoms are typically intermittent and changing. Complications: neurological abnormalities, aseptic meningitis, myocarditis, and arthritis. Management: Confirm diagnosis with serology. Treatment is usually with 2–3wk course of 64
- 65. 65
- 66. 66 (MM, SCC, BCC)
- 67. Malignant Melanoma Superficial spreading site: lower leg ; back Macular lesion with variable pigmentation Nodular on trunk. Pigmented nodule grows rapidly and ulcerate Lentigo maligna arises in sun damaged skin usually on the face— and melanoma develops many years after Acral lentiginous melanoma in black-skinned populations. Affects palms, soles, and nail beds. Often detected late. Poor prognosis 67
- 68. Risk factors Sun exposure; genetic; multiple benign moles (>50 of >2mm diameter); congenital naevus; previous malignant melanoma; immunosuppression; fair skin type (red hair, blue eyes); severe sunburn in childhood/adolescence. Check the ABCDEF criteria: • Asymmetry of outline • Border irregularity • Colour variation • Diameter • Evolution—changes in size, shape, colour, and/or elevation • Funny-looking’ mole—‘ugly duckling’ moles that stand out from the others are very discriminatory for nodular melanoma 68
- 69. Management: 69
- 70. Squamous cell carcinoma (SCC) • common >55y • Usually develops in sun-exposed sites, e.g. face, neck, hands. • May start within an solar keratosis or de novo as a nodule which progresses to ulcerate and crust • Causes Chronic sun damage, X-ray exposure, chronic ulceration and scarring (aggressive SCC may develop at the edge of chronic ulcers), smoking pipes and cigars , industrial carcinogens (tars, oils), wart virus, immunosuppression, genetic. • Management : Refer 70
- 71. Basal cell carcinoma (rodent ulcer, BCC) • Most common form of skin cancer—accounts for >75% of skin cancer. • Locally invasive, locally aggressive, locally destructive • multiple and appears mainly on light-exposed areas—most commonly the face. Nodular Most common. Starts as small pearly nodule. May necrose centrally leaving a small crusted ulcer with pearly, rolled edge Cystic Multicentric Plaque like, large superficial+/- central depression 71
- 72. 72
- 73. Urticaria (hives or nettle rash) 73 Superficial, itchy swellings of the skin or weals come and go in an attack giving the appearance of a shifting rash. Management of acute urticaria • antihistamines for itch—non-sedating for daytime ± sedative if interferes with sleep (e.g. chlorphenamine, hydroxyzine). • Topical menthol 1% cream is an alternative/adjunct to antihistamines • If severe, consider short-course steroids (e.g. prednisolon).
- 74. 74 angio-oedema Deeper longer-lasting swellings; painful rather than itchy. affect eyes, lips, genitalia, hands, and/or feet. May affect bowel (abdominal pain, nausea, vomiting, diarrhoea) or airway (tongue swelling, shortness of breath, wheeze). If airway compromise, consider Management of angio-oedema • If anaphylaxis is suspected, give adrenaline and admit • If any airway compromise, admit—even if anaphylaxis is not suspected • Otherwise treat as for acute urticaria; monitor for airway compromise
- 75. 75
- 76. 76
- 77. 77
- 78. 78
- 79. 79
- 80. 80
- 81. 81