Dermatology made easy
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Transcript of Dermatology made easy
DERMATOLOGY MADE EASY
PSORIASIS
• Papulosquamous disorder
• Accelerated epidermal proliferation
• Types- c/c plaque , guttate , exfoliative , pustular , unguis , mucous membrane , arthritis
• Classical - red scaly plaques
• Abundant loose silvery white scales on extensor aspects
• Auspitz sign – bleeding points on scraping
PSORIASIS
• Koebner phenomenon - development of lesions at sites of trauma
• Rx
Topical
tar, anthralin , salicylic acid
Systemic retinoids,methotrexate,photochemotherapy
LICHEN PLANUS
• Pruritic, flat topped , polygonal violaceouspapules
• Symmetrical on volar aspects of forearms, wrists, legs, thighs and feet
• Koebner phenomenon
• Types- Follicular, hypertrophic, atrophic, bullous , actinic, annular, linear, nails, mucosa, macular
LICHEN PLANUS
• Complication – SCC on hypertrophic and mucosal types
• Treatment – steroids – systemic / topical
PITYRIASIS ROSEA
• Acute disorder , self limiting , uncertain etiology
• On bathing suit areas of the body
• Eruption preceded by a large scaly annular plaque - Herald patch
• Abrupt onset of symmetrical numerous oval papules and macules with peripheral collarettescales
• Back of trunk – Lesions along the lines of rib –‘inverted fur tree’ appearance
PITYRIASIS ROSEA
• Types- papular , vesicular, linear, localised, inverse
• Secondary syphilis mimic PR
• Self limiting , course 4-8 weeks
• Rx- Application of bland oils
STEVENS – JOHNSON SYNDROME
• Dermatological emergency
• Might progress to life threatening acute skin failure
• Abrupt onset
• Fever , malaise , arthralgia
• Multiple bullae leading to painful erosions in oral /genital/nasal mucosa ,lips
• Conjunctivitis and corneal ulcers
SJS
• Bullous /maculo papular eruptions – peeling of skin.
• <10% SJS , >30% TEN , 10-30%-SJS-TEN overlap
• Common causes- Drugs>95% - 10-20 days after starting the drug
( phenytoin,sulphonamides,Carbamazepine)
Infections(HSV), Internal malignancy
Complications - MOF
• Fluid and electrolyte imbalance
• Hypoalbuminemia
• Renal failure
• Infections
• Hypothermia
• High output cardiac failure
• Mortality – 5% SJS, 30-40% TEN
Treatment
• IVIg
• Steroids- controversial
• Fluid and electrolyte correction
• Mucosal care
• High protein diet
• Care of infection
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
• Mainly in children
• Staph.aureus gp II phage type 71
• Epidermolytic exotoxin
• Distant foci of Staph, URTI precedes
ssss
• Fever,Tender red skin, face( perioral), flexures-generalise
• Shrinking & fall of erythematous skin - potato chip desquamation
• Mucosae spared
• 2-3% mortality, Rx- Antistaph drugs.
SCABIES
• Highly contagious disease
• Caused by Sarcoptes scabiei var hominis(itch mite)
• Pruritis, worse at night
• Family history
• Papules , vesicles, pustules, excoriation, crusts and burrows
• Interdigital spaces, wrists, axillae, abdomen, breast, genitals- ‘circle of Hebra’
SCABIES
• Secondary bacterial infection
• Eczematisation, a/c glomerulonephritis
• Types- clean scabies, crusted scabies, nodular scabies, scabies incognito
• Rx- contacts also
• Topical - permethrin , GBHC, benzyl benzoate, tetmesol, sulphur
systemic- Ivermectin
CUTANEOUS LARVA MIGRANS
• Creeping eruption
• Larval nematode that wanders in the s/c tissue
• Exposure of skin to infective larvae of non human hookworm or Strongyloides
• Unable to complete their life cycle , so continues to migrate in skin
• Site of penetration - red itchy papule
CUTANEOUS LARVA MIGRANS
• Wander a few mm - cm/day
• Itchy skin colored tortuous tract
• Usually self limiting , larva dies in 4 weeks
• Treatment- Albendazole
Mebendazole
Ivermectin
ALOPECIA AREATA
• Single or multiple, round /oval patches of non cicatricial alopecia on scalp or elsewhere
• Asymptomatic, no s/o inflammation
• Smooth and shiny
• Whole scalp - alopecia totalis
• Whole body hair- alopecia universalis
• Nail changes- roughening and pitting
ALOPECIA AREATA
• Associations – Autoimmune diseases - vitiligo, LE, thyroiditis, hemolytic anemia
• Spontaneous regrowth in most cases
• TREATMENT
Local irritants - salicylic acid, anthralin, phenol
Topical corticosteroids/IL/systemic
Topical minoxidil
VARICELLA(Chicken Pox)
• Varicella zoster virus
• Droplet infection- epidemic
• Infectious period- 1-2 days before the rash to 1 week after eruption (until all vesicles crusted)
• I.P- 2 weeks
• ± Prodrome – fever, malaise, myalgia
• Crops of vesicles – “dew drop on a rose petal”
VARICELLA
• Centripetal pattern
• 3-5 crops – crust in 1- 2 weeks
• First trimester of pregnancy- congenital varicella syndrome
• Complication-infection,septicemia,pneumonia,encephalitis,myocarditis
Treatment
• In healthy symptomatic• Oral acyclovir 800mg 5 times/day for 5-7 days
• Given within 24 – 48 hrs of exanthem-Shorten duration accelerates healing decrease no of skin lesions decrease scarring• Usually life long immunity
HERPES ZOSTER
• Varicella- VZV-sensory nerve endings- ganglia-latent-reactivation-back along sensory afferent to skin
• Less contagious than varicella
• Recurrence rare
• Prodrome- paraesthesia/hyperaesthesia 2-4 days prior
• Unilateral group of erythematous maculopapules- vesicles-pustules-crusting 7- 10 days
HERPES ZOSTER
• 1 or more contiguous dermatome
• Thoracic most common
• Disseminated in immunocompromised
• Complications – scarring, ocular
• PHN – recurrent or persisting pain > than 2 months after zoster
• PHN - 30% in > 40 years
• Treatment- same as varicella
HERPES LABIALIS
• Most common HSV -1 infection
• Recurrent
• Stress, sunlight ,fever , trauma- ppt factors
• On lips- usually on the outer border
• Prodromal - tingling, itching, burning pain
• Grouped vesicles- ulcer, crust
• Heal in 7-10 days
• Infectious -1st 2 days of eruption
HERPES LABIALIS
Primary
• Acyclovir 400mg tid x 5-7days
200mg 5times x 5-7 days
• Val 1g BD x 5-7 days
Recurrent - Within 1 day of eruption - ↓severity
Acyclovir 400mg tid x 5days
200mg 5 times x 5days
Valacyclovir 1g OD x 5 days
HERPES GENITALIS
• HSV -2 infection
• One of the most common STDS
• I.P 3 -12 days
• Recurrent episodes
• Heals in 7-10 days
• Virus remains latent in sacral nerve root ganglia
• Triggers - stress,trauma,menstruation,infection
HERPES GENITALIS
• Over time-rate of recurrence lesser
Severity decreases
• Painful grouped,vesicles on genitalia erosions,edema,dysuria,purulent discharge
• R/c episodes- less severe, heals more quickly
• Rx- acyclovir,valacyclovir,local care
HAND, FOOT & MOUTH DISEASE
• Coxsackie virus type A 16, A5 ,A10 , Enterovirus 71
• Commonly in children
• Occur in epidemics
• Respiratory droplet spread
• IP 5-7days , lasts for 8-10 days
HFMD
• Fever , painful stomatitis , malaise
• Small vesicles , thin walled , pearly grey with red areola , oval/linear - MC on hands,feet
• Buttocks, knees, generalized
• Relapses – rare - c/c intermittent course
• Complications – dehydration, aseptic meningitis , encephalitis
TINEA VERSICOLOR
• Superficial fungal infection caused by Malassesia furfur• Usually asymptomatic , more of cosmetic importance• Hypopigmented or hyperpigmented macules with
branny scales• Upper trunk- common• Rx
Topical ketoconozole,clotrimazole,miconazole,oxyconazoleSystemic Fluconazole 400mg statKetoconazole 200mg 1 OD x 5days
KERION
Kerion ( M.canis,M.gypseum)
Inflammatory
Favus ( T.schonleinii)
Tinea capitis
Black dot ( T.tonsurans)
Non-inflammatory
Grey patch( M.audonii)
Kerion
• Boggy , indurated swelling studded with broken hairs , vesicles , pustules ,
• sinus formation
• lymphadenopathy
• secondary infection
• scars on healing
• Diagnosis - direct microscopic examination
• Culture
Treatment
• DOC- Griseofulvin 10-12mg/kg/day 4-6 weeks
Fluconazole 150mg once weekly 4-6 weeks
Terbinafine 250mg/day 4-6 weeks
• Oral ab – secondary infection
• Oral CS - to reduce incidence of scarring if severe infection
• Removal of matted crusts followed by shampooing
• Close contacts & pets
IMPETIGO
• Primary pyoderma• Superficial contagious skin infection• 2 types
BullousCrusted (non bullous ,impetigo contagiosa)
• Non Bullous – Gp B hemolytic streptococcus• Preschool and primary school children• Vesicles or pustules coalesce, thick crust and
erythema• Complication - AGN
IMPETIGO
• Bullous- Staph aureus
Neonates and infants
Thick walled bullae
• Topical /systemic antibiotics
MOLLUSCUM CONTAGIOSUM
• Pox virus
• Skin to skin contact
• I.P - 14-50 days
• Shiny pearly white hemispherical umbilicatedpapule
• 1-10mm diameter
• Regress 6-9 months
• Marker of HIV infection - extensive MC - adults
• Patchy eczema , secondary infection
MOLLUSCUM CONTAGIOSUM
• Rx - To reduce autoinoculation,transmission
• Extraction
• Phenol
• Imiquimod 5% cream
VERRUCA VULGARIS
• Warts – Human Papilloma Virus
• Types- common,filiform,digitate,plantar,plane
• Koebner phenomenon , autoinoculation
• Might resolve spontaneously
• Rx
Keratolytics
Phenol/TCA
Electrosurgery
SEBORRHEIC KERATOSIS
• Benign skin tumour• Brownish black , well defined plaque• Stuck on appearance , warty surface• Face, scalp, chest, back• Asymptomatic• Middle aged and elderly• Sudden onset of numerous lesions with pruritus - In
malignancy( adeno ca stomach & colon) – LESER TRELAT SIGN
• Otherwise only cosmetic concern• Rx - Electrocautery,cryosurgery,laser, shave excision
TINEA INCOGNITO
• Steroid modified tinea
• Topical steroid- due to mistaken diagnosis
• Systemic steroid - given for some other pathology
• Inflammatory response suppressed
• More susceptible to dermatophytic infection
• ↓Margin, ↓scaling, ↓inflammation- bruise like , brownish discolouration
TINEA INCOGNITO
• With chronic use- atrophy , telangiectasia , striae
• Initially satisfied - control of itching and inflammation
• On stopping- relapses
• Cycles repeated
• Fungal scraping - very few fungal elements
• Stop steroids
• Systemic & topical antifungals
TINEA CORPORIS TINEA INCOGNITO
THANK YOU