dermatology made easy

DERMATOLOGY MADE EASY

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

PSORIASIS

• Koebner phenomenon - development of lesions at sites of trauma

• Rx

Topical

tar, anthralin , salicylic acid

Systemic retinoids,methotrexate,photochemotherapy

LICHEN PLANUS

• Pruritic, flat topped , polygonal violaceouspapules

• Symmetrical on volar aspects of forearms, wrists, legs, thighs and feet

• Koebner phenomenon

• Types- Follicular, hypertrophic, atrophic, bullous , actinic, annular, linear, nails, mucosa, macular

LICHEN PLANUS

• Complication – SCC on hypertrophic and mucosal types

• Treatment – steroids – systemic / topical

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 collarettescales

• Back of trunk – Lesions along the lines of rib –‘inverted fur tree’ appearance

PITYRIASIS ROSEA

• Types- papular , vesicular, linear, localised, inverse

• Secondary syphilis mimic PR

• Self limiting , course 4-8 weeks

• Rx- Application of bland oils

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

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

Complications - MOF

• Fluid and electrolyte imbalance

• Hypoalbuminemia

• Renal failure

• Infections

• Hypothermia

• High output cardiac failure

• Mortality – 5% SJS, 30-40% TEN

Treatment

• IVIg

• Steroids- controversial

• Fluid and electrolyte correction

• Mucosal care

• High protein diet

• Care of infection

STAPHYLOCOCCAL SCALDED SKIN SYNDROME

• Mainly in children

• Staph.aureus gp II phage type 71

• Epidermolytic exotoxin

• Distant foci of Staph, URTI precedes

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.

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’

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

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

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

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

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

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”

VARICELLA

• Centripetal pattern

• 3-5 crops – crust in 1- 2 weeks

• First trimester of pregnancy- congenital varicella syndrome

• Complication-infection,septicemia,pneumonia,encephalitis,myocarditis

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

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 maculopapules- vesicles-pustules-crusting 7- 10 days

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

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

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

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

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

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

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

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,oxyconazoleSystemic Fluconazole 400mg statKetoconazole 200mg 1 OD x 5days

KERION

Kerion ( M.canis,M.gypseum)

Inflammatory

Favus ( T.schonleinii)

Tinea capitis

Black dot ( T.tonsurans)

Non-inflammatory

Grey patch( M.audonii)

Kerion

• Boggy , indurated swelling studded with broken hairs , vesicles , pustules ,

• sinus formation

• lymphadenopathy

• secondary infection

• scars on healing

• Diagnosis - direct microscopic examination

• Culture

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

IMPETIGO

• Primary pyoderma• Superficial contagious skin infection• 2 types

BullousCrusted (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

IMPETIGO

• Bullous- Staph aureus

Neonates and infants

Thick walled bullae

• Topical /systemic antibiotics

MOLLUSCUM CONTAGIOSUM

• Pox virus

• Skin to skin contact

• I.P - 14-50 days

• Shiny pearly white hemispherical umbilicatedpapule

• 1-10mm diameter

• Regress 6-9 months

• Marker of HIV infection - extensive MC - adults

• Patchy eczema , secondary infection

MOLLUSCUM CONTAGIOSUM

• Rx - To reduce autoinoculation,transmission

• Extraction

• Phenol

• Imiquimod 5% cream

VERRUCA VULGARIS

• Warts – Human Papilloma Virus

• Types- common,filiform,digitate,plantar,plane

• Koebner phenomenon , autoinoculation

• Might resolve spontaneously

• Rx

Keratolytics

Phenol/TCA

Electrosurgery

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

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

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

TINEA CORPORIS TINEA INCOGNITO

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