Download Dermatiology

Dermatology
Dr. M. Connolly
Dermatology Department
AMNCH
Dermatology
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Focussed
dermatological history
Describe cutaneous
findings (and other
relevant findings)
Formulate differential
diagnosis and
management plan
Dermatology Subspecialties
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Paediatric
dermatology
Skin surgery
Contact Dermatitis
Phototherapy
Lasers
Dermatopathology
Dermatology - Introduction
is one of the largest organs ~1.8m2 ,
16% body weight
 Structure and thickness vary with site
 Skin
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Epidermis 0.1-1.4mm
Dermis 0.6 – 3mm
 Barrier
function
Structure of the skin
Dermatological terms
Flat or raised
 Macule
 Patch
 Papule
 Nodule
 Plaque
 Wheal
Filled with fluid
 Vesicle
 Bulla(e)
 Pustule
Wheal
Plaque
Papule
Nodule
Bulla
Crust
Scale
Pustule
Vesicle
Cyst
Fissure
Erosion
Ulcer
Lichenification
Keloid
Macule
Excoriation
www.dermatology.org/morphology
Dermatological terms
Colour
 Hyperpigmented
 Hypopigmented
 Depigmented
(post-inflammatory
hyper or
hypopigmentation)
 Erythema

Telangiectasia
 Purpura/petechiae
 Ecchymosis
 Haematoma
Dermatological terms
Secondary changes
 Scale
 Hyperkeratosis
 Crust
 Lichenification
 Excoriation
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Fissure
 Scar
 Erosion
 Ulceration
Eczema
 Types
 Atopic
 Discoid
 Seborrhoeic dermatitis
 Hand and Feet
• Hyperkeratotic/fissured
• Vesicular (pompholyx)
Eczema
Types
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Allergic contact dermatitis
Irritant contact dermatitis
Asteatotic eczema/ eczema craquelé (crazy
paving)
Stasic (varicose)
Neurodermatitis (lichen simplex chronicus)
Eczema/Dermatitis
 History
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Duration
Areas affected
Precipitating/ aggravating factors
History of atopy
Family History
Previous treatments
Occupation
Hobbies
Examination
 Sites
 Describe:
wet & weepy / or dry & scaly
 Any lichenification
 Any evidence of infection
 Bacterial infection or herpes simplex
Management
ANY IDEAS ?
Management
 Topical
emollients
 Topical steroids
 Topical tacrolimus (protopic)
 Antihistamines
 Treat any evidence of infection
 Phototherapy
 Systemic agents: immunosuppressants
Emollients
 Aqueous
cream
 E45 cream
 Oilatum cream
 Silcock’s base
 Aveeno
 Diprobase cream
 Emusifying ointment
 Paraffin gel (WSP/LP)
Soap Substitutes
 Aqueous
cream
 Silcock’s base
 Emulsifying ointment
 Bath
emollients
Oilatum plus
Emsulsiderm
Topical Steroids
 1%
hydrocortisone ointment
 Eumovate ointment
 Betnovate RD ointment
 Betnovate ointment
 Elocon ointment
 Locoid ointment
 Dermovate ointment
Combination steroid
& antibiotic
 Fucidin
H
 Fucibet
 Betnovate
 When?
 How
long?
C
Bandages
 Viscopaste:
 Icthopaste:
zinc impregnated bandages
icthammol bandages
Tacrolimus
 Protopic
0.03%
 Protopic 1%
 0.03% only licensed from 2 years upwards
 Avoid if infected or herpes infection
 Long-term side effects unknown
 Useful in areas where potent steroids can
not be used
 Recently licensed for maintenance therapy
Antihistamines
 Sedating
antihistamines
 Piriton
 Vallergan
 Phenergan
 Hydroxyzine
(Ucerax) syrup
Other treatments
 Phototherapy
 Oral
steroids
 Systemic agents
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Azathioprine
Methotrexate
Ciclosporin
Mycophenolate Mofetil
Infection
 Skin
swab
 Flucloxacillin: staph
 Penicillin: Strept
 Erythromycin: penicillin allergy
 Herpes simplex infection: aciclovir IV
Herpes Simplex Virus
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Highly contagious by direct contact (Primary infection)
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Penetrates the epidermis or mucous membrane
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Epidermal cell destruction
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Virus hides latent in the dorsal root ganglia (Sensory)
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Reactivation – Recurrence is the hallmark
Herpes viruses (DNA)
Simplex
(HSV types I & II)
primary:
skin
oral
genital
recurrence: lips (cold sore) I
genitals
II
Zoster
(VZV)
primary:
varicella
(chicken pox)
recurrence: zoster
(shingles)
Primary HSV I infection
(Herpesvirus hominis type 1)
 Usually
childhood
 Subclinical
or an acute gingivostomatitis
Recurrent HSV 1
 Vesicles
on the lip - ‘cold sores’
 Herpetic
whitlow
Complications of HSV Infection

Disseminated herpes simplex (Immunocompromised)

Eczema herpeticum

Herpes encephalitis

Keratoconjunctivitis and corneal ulceration
Psoriasis
 Types
 Guttate
 Chronic plaque
 Palmar plantar pustulosis
 Nail
 Pustular psoriasis
 Erythrodermic
 Psoriatic arthropathy
 Acrodermatitis continua of Hallopeau
Management
ANY IDEAS ?
Management
 Topical
emollients
 Tar
 Dithranol
(Dithrocream)
 Vitamin-D analogues (Dovonex, Dovobet)
 Topical steroids
 TLO1 phototherapy
 PUVA
 Systemic agents
ACNE
Acne
 Closed
comedones or “whiteheads” (small
non-inflamed papules)
 Open comedones or “blackheads”
 Papules -small, red, inflammed follicular
spots
 Pustules
 Scars: atrophic are ice-pick scars (face)
hypertrophic or keloid back/chest
Management
ANY IDEAS ?
Management
 Topical
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Benzoyl peroxide (Brevoxyl, panoxyl)
Topical antibiotics (Zineryt, Dalacin-T)
Retinoic acid (Isotrex)
Adapelene (Differin)
 Antibiotics
 Dianette
 Isotretinoin
(Roaccutane)
Scabies
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Scabies mite (Sarcoptes scabei)
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Spread by direct physical contact.
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Takes 4-6 weeks to become sensitised
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Burrows are definitive lesions
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Mites can sometimes be extracted for diagnosis
Treatment
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Topical permethrin 5%
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left on for 12- 24 hours
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applied to neck down
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reapplied to hands after washing
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repeated after 1 week
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Contacts must be treated to prevent re infestation.
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Infants and elderly need scalp treating