Dermatology Dr. M. Connolly Dermatology Department AMNCH
Download
Report
Transcript Dermatology Dr. M. Connolly Dermatology Department AMNCH
Dermatology
Dr. M. Connolly
Dermatology Department
AMNCH
Dermatology
Focussed
dermatological history
Describe cutaneous
findings (and other
relevant findings)
Formulate differential
diagnosis and
management plan
Dermatology Subspecialties
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
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
Fissure
Scar
Erosion
Ulceration
Eczema
Types
Atopic
Discoid
Seborrhoeic dermatitis
Hand and Feet
• Hyperkeratotic/fissured
• Vesicular (pompholyx)
Eczema
Types
Allergic contact dermatitis
Irritant contact dermatitis
Asteatotic eczema/ eczema craquelé (crazy
paving)
Stasic (varicose)
Neurodermatitis (lichen simplex chronicus)
Eczema/Dermatitis
History
•
•
•
•
•
•
•
•
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
•
•
•
•
Azathioprine
Methotrexate
Ciclosporin
Mycophenolate Mofetil
Infection
Skin
swab
Flucloxacillin: staph
Penicillin: Strept
Erythromycin: penicillin allergy
Herpes simplex infection: aciclovir IV
Herpes Simplex Virus
Highly contagious by direct contact (Primary infection)
Penetrates the epidermis or mucous membrane
Epidermal cell destruction
Virus hides latent in the dorsal root ganglia (Sensory)
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
Benzoyl peroxide (Brevoxyl, panoxyl)
Topical antibiotics (Zineryt, Dalacin-T)
Retinoic acid (Isotrex)
Adapelene (Differin)
Antibiotics
Dianette
Isotretinoin
(Roaccutane)
Scabies
Scabies mite (Sarcoptes scabei)
Spread by direct physical contact.
Takes 4-6 weeks to become sensitised
Burrows are definitive lesions
Mites can sometimes be extracted for diagnosis
Treatment
Topical permethrin 5%
left on for 12- 24 hours
applied to neck down
reapplied to hands after washing
repeated after 1 week
Contacts must be treated to prevent re infestation.
Infants and elderly need scalp treating