Dermatology

1
Dermatology

• Dr. M. Connolly
• Dermatology Department
• AMNCH

2
Dermatology

• Focussed dermatological history
• Describe cutaneous findings (and other relevant
  findings)
• Formulate differential diagnosis and management
  plan

3
Dermatology Subspecialties

• Paediatric dermatology
• Skin surgery
• Contact Dermatitis
• Phototherapy
• Lasers
• Dermatopathology

4
Dermatology - Introduction

• Skin is one of the largest organs 1.8m2 , 16
  body weight
• Structure and thickness vary with site
• Epidermis 0.1-1.4mm
• Dermis 0.6 3mm
• Barrier function

5
Structure of the skin
6
Dermatological terms

• Flat or raised
• Macule
• Patch
• Papule
• Nodule
• Plaque
• Wheal

• Filled with fluid
• Vesicle
• Bulla(e)
• Pustule

7
          Macule           Wheal Plaque
          Papule            Nodule Bulla Crust Scale
          Pustule           Vesicle           Cyst
          Fissure           Erosion          Ulcer
        Excoriation          Lichenification          Keloid
www.dermatology.org/morphology
8
Dermatological terms

• Colour
• Hyperpigmented
• Hypopigmented
• Depigmented
• (post-inflammatory hyper or hypopigmentation)
• Erythema

• Telangiectasia
• Purpura/petechiae
• Ecchymosis
• Haematoma

9
Dermatological terms

• Secondary changes
• Scale
• Hyperkeratosis
• Crust
• Lichenification
• Excoriation

• Fissure
• Scar
• Erosion
• Ulceration

10
Eczema

• Types
• Atopic
• Discoid
• Seborrhoeic dermatitis
• Hand and Feet
• Hyperkeratotic/fissured
• Vesicular (pompholyx)

11
Eczema

• Types
• Allergic contact dermatitis
• Irritant contact dermatitis
• Asteatotic eczema/ eczema craquelé (crazy paving)
• Stasic (varicose)
• Neurodermatitis (lichen simplex chronicus)

12
Eczema/Dermatitis

• History
• Duration
• Areas affected
• Precipitating/ aggravating factors
• History of atopy
• Family History
• Previous treatments
• Occupation
• Hobbies

13
Examination

• Sites
• Describe wet weepy / or dry scaly
• Any lichenification
• Any evidence of infection
• Bacterial infection or herpes simplex

14
Management

• ANY IDEAS ?

15
Management

• Topical emollients
• Topical steroids
• Topical tacrolimus (protopic)
• Antihistamines
• Treat any evidence of infection
• Phototherapy
• Systemic agents immunosuppressants

16
Emollients

• Aqueous cream
• E45 cream
• Oilatum cream
• Silcocks base
• Aveeno
• Diprobase cream
• Emusifying ointment
• Paraffin gel (WSP/LP)

17
Soap Substitutes

• Aqueous cream
• Silcocks base
• Emulsifying ointment
• Bath emollients
• Oilatum plus
• Emsulsiderm

18
Topical Steroids

• 1 hydrocortisone ointment
• Eumovate ointment
• Betnovate RD ointment
• Betnovate ointment
• Elocon ointment
• Locoid ointment
• Dermovate ointment

19
Combination steroid antibiotic

• Fucidin H
• Fucibet
• Betnovate C
• When?
• How long?

20
Bandages

• Viscopaste zinc impregnated bandages
• Icthopaste icthammol bandages

21
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

22
Antihistamines

• Sedating antihistamines
• Piriton
• Vallergan
• Phenergan
• Hydroxyzine (Ucerax) syrup

23
Other treatments

• Phototherapy
• Oral steroids
• Systemic agents
• Azathioprine
• Methotrexate
• Ciclosporin
• Mycophenolate Mofetil

24
Infection

• Skin swab
• Flucloxacillin staph
• Penicillin Strept
• Erythromycin penicillin allergy
• Herpes simplex infection aciclovir IV

25
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

26
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)

27
Primary HSV I infection (Herpesvirus hominis
type 1)

• Usually childhood
• Subclinical or an acute gingivostomatitis

28
Recurrent HSV 1

• Vesicles on the lip - cold sores
• Herpetic whitlow

29
Complications of HSV Infection

• Disseminated herpes simplex (Immunocompromised)
• Eczema herpeticum
• Herpes encephalitis
• Keratoconjunctivitis and corneal ulceration

30
Psoriasis

• Types
• Guttate
• Chronic plaque
• Palmar plantar pustulosis
• Nail
• Pustular psoriasis
• Erythrodermic
• Psoriatic arthropathy
• Acrodermatitis continua of Hallopeau

31
Management

• ANY IDEAS ?

32
Management

• Topical emollients
• Tar
• Dithranol (Dithrocream)
• Vitamin-D analogues (Dovonex, Dovobet)
• Topical steroids
• TLO1 phototherapy
• PUVA
• Systemic agents

33
ACNE
34
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

35
Management

• ANY IDEAS ?

36
Management

• Topical
• Benzoyl peroxide (Brevoxyl, panoxyl)
• Topical antibiotics (Zineryt, Dalacin-T)
• Retinoic acid (Isotrex)
• Adapelene (Differin)
• Antibiotics
• Dianette
• Isotretinoin (Roaccutane)

37
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

38
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