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Dermatology made easy
- 3. 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
- 4. PSORIASIS • Koebner phenomenon - development of lesions at sites of trauma • Rx Topical tar, anthralin , salicylic acid Systemic retinoids,methotrexate,photochemotherapy
- 6. LICHEN PLANUS • Pruritic, flat topped , polygonal violaceous papules • Symmetrical on volar aspects of forearms, wrists, legs, thighs and feet • Koebner phenomenon • Types- Follicular, hypertrophic, atrophic, bullous , actinic, annular, linear, nails, mucosa, macular
- 7. LICHEN PLANUS • Complication – SCC on hypertrophic and mucosal types • Treatment – steroids – systemic / topical
- 9. 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 collarette scales • Back of trunk – Lesions along the lines of rib – ‘inverted fur tree’ appearance
- 10. PITYRIASIS ROSEA • Types- papular , vesicular, linear, localised, inverse • Secondary syphilis mimic PR • Self limiting , course 4-8 weeks • Rx- Application of bland oils
- 12. 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
- 13. 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
- 14. Complications - MOF • Fluid and electrolyte imbalance • Hypoalbuminemia • Renal failure • Infections • Hypothermia • High output cardiac failure • Mortality – 5% SJS, 30-40% TEN
- 15. Treatment • IVIg • Steroids- controversial • Fluid and electrolyte correction • Mucosal care • High protein diet • Care of infection
- 17. STAPHYLOCOCCAL SCALDED SKIN SYNDROME • Mainly in children • Staph.aureus gp II phage type 71 • Epidermolytic exotoxin • Distant foci of Staph, URTI precedes
- 18. 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.
- 20. 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’
- 21. 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
- 23. 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
- 24. 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
- 26. 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
- 27. 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
- 29. 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”
- 30. VARICELLA • Centripetal pattern • 3-5 crops – crust in 1- 2 weeks • First trimester of pregnancy- congenital varicella syndrome • Complication- infection,septicemia,pneumonia,encephalitis, myocarditis
- 31. 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
- 33. 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 maculo papules- vesicles-pustules-crusting 7- 10 days
- 34. 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
- 36. 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
- 37. 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
- 39. 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
- 40. 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
- 42. 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
- 43. 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
- 45. 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,oxyconazole Systemic Fluconazole 400mg stat Ketoconazole 200mg 1 OD x 5days
- 47. KERION Kerion ( M.canis,M.gypseum) Inflammatory Favus ( T.schonleinii) Tinea capitis Black dot ( T.tonsurans) Non-inflammatory Grey patch( M.audonii)
- 48. Kerion • Boggy , indurated swelling studded with broken hairs , vesicles , pustules , • sinus formation • lymphadenopathy • secondary infection • scars on healing • Diagnosis - direct microscopic examination • Culture
- 49. 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
- 51. IMPETIGO • Primary pyoderma • Superficial contagious skin infection • 2 types Bullous Crusted (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
- 52. IMPETIGO • Bullous- Staph aureus Neonates and infants Thick walled bullae • Topical /systemic antibiotics
- 54. MOLLUSCUM CONTAGIOSUM • Pox virus • Skin to skin contact • I.P - 14-50 days • Shiny pearly white hemispherical umbilicated papule • 1-10mm diameter • Regress 6-9 months • Marker of HIV infection - extensive MC - adults • Patchy eczema , secondary infection
- 55. MOLLUSCUM CONTAGIOSUM • Rx - To reduce autoinoculation,transmission • Extraction • Phenol • Imiquimod 5% cream
- 57. VERRUCA VULGARIS • Warts – Human Papilloma Virus • Types- common,filiform,digitate,plantar,plane • Koebner phenomenon , autoinoculation • Might resolve spontaneously • Rx Keratolytics Phenol/TCA Electrosurgery
- 59. 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
- 61. 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
- 62. 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
- 63. TINEA CORPORIS TINEA INCOGNITO
- 64. THANK YOU