Introduction To Dermatology

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Introduction To Dermatology

• Dr D J Barker
• St Lukes Hospital, Bradford

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What Are the Functions of the Skin?

• Temperature regulation
• Water conservation
• Protection (mechanical, UV, microbes)
• Sensation
• Synthesis storage
• Psycho-sexual

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Why Refer to a Dermatologist?

• Diagnostic difficulty
• Management advice
• Failure of agreed treatment protocol
• Patient counselling or education
• Increasing use of potent topical steroids
• Special treatment e.g. PUVA
• Special investigation e.g. Patch Tests

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In-patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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In-patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Infections - Erysipelas

• Fever Rigor
• Defined erythematous rash
• Leg gt face gtelsewhere
• Haemolytic streptococcus
• Mild pre-existing skin disease
• IV Benzyl penicillin
• Lymphoedema and relapse

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Infections Herpes simplex

• Severe primary infection
• Kaposis varicelliform eruption
• Atopic eczema
• Cutaneous T-cell lymphoma
• Dariers disease
• IV Aciclovir
• Anti-staphylococcal antibiotic

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Infections - Herpes Zoster

• Varicella Zoster virus
• Pain confined to a single dermatome
• Vesicles confined to single dermatome
• Patients are infectious
• IV Aciclovir

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In-Patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Urticaria

• May be associated with angioedema
• Vasoactive amine release from mast cells
• Acute attacks frightening, not dangerous
• Most attacks have no simple cause
• Antihistamines

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Anaphylaxis

• Urticaria angioedema
• Bronchospasm, Laryngeal obstruction
• Hypotension
• Penicillin, peanuts, latex, insect stings
• Adrenaline
• Hydrocortisone antihistamines
• Oxygen IV fluids

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In-Patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Drug eruptions - 1

• Morbilliform
• Toxic epidermal necrolysis
• Fixed drug eruption
• Stevens-Johnson syndrome
• Lichenoid drug rash
• Acneiform

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Drug eruptions - 2

• Any drug, any rash, any time
• Likely sulphonamides, penicillins
• Unlikely digoxin, insulin
• Suspect recent agents
• Stop inessential drugs
• A dermatologist may not solve your problem

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In-Patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Connective tissue diseases

• Lupus erythematosus
• Dermatomyositis
• Systemic sclerosis
• PAN Wegeners granulomatosis

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In-Patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Erythema nodosum

• Sarcoidosis
• Post-streptococcal
• TB
• Inflammatory bowel disease
• Leprosy
• Histoplasmosis, coccidiomycosis

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Erythema multiforme

• Oral, Ano-genital Cutaneous
• Target lesions are acral
• Often follows herpes simplex
• Lasts 10-14 days
• May be recurrent

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In-Patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Cutaneous markers

• Neoplasia
• Acanthosis nigricans, Dermatomyositis
• Secondaries infiltrates
• Non-neoplastic
• Sarcoidosis and xanthomas,
• Endocrine e.g. necrobiosis, PTM
• Inherited conditions
• Neurofibromatosis
• Tuberous sclerosis

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In-Patient Dermatology

• Infections
• Urticaria angioedema
• Drug eruptions
• Connective tissue diseases
• Erythema nodosum multiforme
• Cutaneous marker of systemic disease
• Severe pre-existing skin disease

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Severe pre-existing skin disease

• Erythroderma
• Extensive eczema
• Acute pustular psoriasis
• Leg ulcers venous eczema
• Photosensitivity

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Introduction To Dermatology

• Department of Dermatology (D2F4)
• St Lukes Hospital, Bradford
• Derek Barker Andrew Wright
• Kate London Suzanne Hatfield