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Dermatology as dermatology is a really bigger topic, but hopefully we'll cover the main aspects that will be tested in your exams. Um So the main topics that we're going to cover is acute dermatology. So that includes urticaria, Steven Johnson syndrome, toxic epidermal necrolysis, erythema, eczema herpeticum. In terms of inflammatory skin conditions, we'll be doing the very common eczema psoriasis acne, which is your bread and butter in dermatology that should probably most likely definitely come up in your exams, then cutaneous skin infections, including bacterial viral fungal infections and malignancy as well. So, looking at your squamous cell carcinoma, your basal cell carcinoma, your melanomas, um the precursor which is actinic keratosis and the differential factors between those. So, first of all dermatology terms and the descriptive words is really important when you're speaking to a dermatologist, it's really key that they know exactly what you're talking about. So, so you have to use describing words, for example, if you're talking about the distal end or the center of it flexor extensor. So this is really common when you're talking about rashes and eczema because eczema will typically happen in the flexor region. Is it localized or is it in one specific region or is it more generalized? Is it across the whole body? Is it dermatomal? So for example, shingles that is in a dermatomal region, is it follicular or seborrheic? Now, when we're also talking about describing you want to talk about shape, edge and elevation and the secondary factors. So in terms of the shape, we're talking about circular. So is the rash, circular or linear, is it in like a line pattern, annular, meaning ring and irregular? Now, onto edge and elevation is the rash well demarcated. That means that does it have a sort of, can you tell is it, can you tell where the rash is on the body because of the outline of it? Is it well demarcated that you can almost just pick it off? It's not sort of spread into the skin if that makes sense, is it ill defined, raised or flat? Those are self explanatory. Now, the secondary features, once you've initially described what it looks like. So you wanted to talk about where it is in the body, the shape of it, if it's raised or flat. And then the other secondary factors, which is, is it crusty? Is there any pigment to it? Other scales? Is there lots of dry, flaky skin, keratosis, other erosions, ulcerations, things like that. Now, there are also descriptive words which um I'll go through now. So if you have a rash that's less than 0.5 centimeters and it's flashed flat. We describe that as a macule. That's just a standard word that we use if it's raised and we call it a papule. And if it's fluid filled vesicle, and if it's, um if it's also fluid filled, we call it pustule as well. Um They probably won't ask you to differentiate the two, but these are just other describing words. Now, if it's more than 0.5 centimeters and it's flat, we can also use patch and plaque to describe it. And if it's raised and 0.5 centimeters, then we can describe it as nodules and buller as well. So moving on to the acute dermatological presentations, we'll start off with the question. So, Senna is a 45 year old female, newly diagnosed with essential hypertension. Her GP has prescribed her Ramipril to control her BP. Within the first week of you. She begins to experience some swelling around her lips on examination her lips look swollen, but she has no other skin abnormalities or erythema. What is the most likely diagnosis? So I'll wait for a few moments. I don't think I can see the chart from here. OK. So if you thought about what it could be, I'll just move on to the answer now. So the answer is I was just gonna say, can you see the chat? Uh No, I don't think I can. If you, if you go at the bottom, can you see participants chat, share? You know the, did you use the, how you know that when you were, when you were sharing the slides, there's like options at the bottom and you can mute yourself or turn your video off and on. Do you have that on the bottom screen? You know, to those? So I think I can just move across and check the chart from there. Yeah. So it's just because I think people are answering and I would just like you to really see it because people are saying c right now. Um OK, but it just, it should be at the bottom. So if you kind of, if you are on the zoom, if you, if you got full screen, you can try and like make a smaller exit, full screen and make it a smaller screen um of the zoom, not the powerpoint. Um And then you'll be able to see the chat. Mm Yeah, I don't think for some reason the chat function isn't working on the same screen of the powerpoint. So you might just have to call it out for me. If I can't get it to work time, we chat with them. Let me try and see what, what people are saying. OK. Well, OK, I'll try and we'll see we'll see how it goes with the other questions. Um So yes, so the answer for this question is drug induced angioedema and we'll go on to it shortly um during this topic. Um And then I can explain why the answer is is this. So urticaria um is the overall descriptive term for it. And this is, is a hypersensitivity reaction caused by mast cell degranulation and release of histamine and vasoactive mediators. So how it presents is you can have wheels which are just erythematous plaques on the with smooth surface or you can have angioedema, which is noted in the last photo and that's deep dermal swelling with no redness. And that is a very common side effect that occurs with ramipril. So that's something that you need to know and you must switch the medication if this occurs. Urticarial vasculitis can occur as well and that's just pura lasting more than 24 hours and these typically sting. So these can be acute where they last six weeks and your main um triggers are, you know, food drugs, allergens, infections. And this is usually due to an I GE response which is non allergic. And this is what happened in this question right here because it was due to the Ramipril and you can also have chronic urticaria where it will last more than six weeks. And this is more of an an autoimmune picture and this is non allergic. So, investigations that you want to do are blood blood tests such as FBC ESR. Um, specific tests like complement levels would be useful because that will give you a good indicator that this actually is urticaria hepatitis and HIV are also um conditions that are associated with it at times. Um but just your standard blood tests as well. Um And in terms of the management, you wanna give antihistamines if it's an offending agent, for example, in the previous question, it was Ramipril, you wanna take it away. Um Most of the time these are self limiting if they are acute. Um and you can consider steroids as well. So, moving on to Eryth erythema, eryth, sorry erythroderma. So, erythroderma is just a generalized erythema covering more than 90% of the surface body area. As you can see in the photos, it looks very dry, erythematous skin. Um it's sort of flaking, the whole arm looks very swollen. And patients that have erythroderma tend to get a bit as septic as well. So there's a risk of sepsis where you can get um tachycardic hypo hyperthermia. And because you're very dehydrated because there's a lot of fluid and protein loss from the skin, your skin barrier is completely damaged. So patients like this, the whole immune body, the whole body just shuts down. Um So you wanna admit to hospital straight away. Um the cause is this is multifactorial. Again, it's idiopathic and up to 30% of cases. But other times drug reactions such as medications like phenytoin and antiepileptics, um can cause it, eczema, psoriasis, cutaneous T cell lymphoma. Um in terms of the treatment, you want to again withdraw any offending drugs, you want to treat the underlying cause. For example, if it's eczema psoriasis, you want to give those topical creams for it. And if the patient is septic, you want to immediately admit to the hospital, give lots of fluids, replace their electrolytes if they're diminished. And emollients and topical steroids and antibiotics can help with supportive management that will help regenerate that skin barrier and make it strong. So, moving on to Steven Johnson syndrome and toxic epidermal necrolysis. So these are conditions that often get confused between each other, but it's a uh rare but also life threatening skin condition that um that dermatologists need to know about. So how it presents is it presents like.