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Hakam Faris & Saif Abbas Chatoo Warning ! Use of Graphic Images Outline ❖ Acute dermatology ➢ Urticaria - SJS/ TEN - Erythroderma - Eczema herpeticum ❖ Inflammatory skin conditions ➢ Eczema - Psoriasis - Acne ❖ Cutaneous skin infections ➢ Bacterial - Infestations - Viral - Fungal ❖ Malignancy and other lesions ➢ Melanoma - SCC - BCC - Actinic keratosis DERM TERMS ! & Description - Acral (distal) - SHAPE – circular, linear , annular , irregular - Central - flexor/extensor - EDGE & ELEVATION – well demarcated , ill defined, raised - localised/generalised or flat - Dermatomal - Follicular - SECONDARY – crust , scale , pigment . Keratosis , - Seborrheic latensification , erosion , excoriation , fissure, ulceration < 0.5 cm > 0.5 cm FLAT - Macule - Patch - Plaque (palpable) RAISED - Papule - Nodule - Vesicle ( fluid filled) - Bulla (fluid filled) - Pustule (fluid filled) Acute DermatologySenna is a 45-year-old female newly diagnosed with essential hypertension. Her GP has prescribed her Ramipril to control her blood pressure. Within the first week of use, she begins to experience a 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? A. Vascular occlusion B. Cheilitis glandularis C. Drug-induced angioedema D. Melkersson-Rosenthal syndrome E. Drug-induced photosensitivity Source: MedicineNetSenna is a 45-year-old female newly diagnosed with essential hypertension. Her GP has prescribed her Ramipril to control her blood pressure. Within the first week of use, she begins to experience a 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? A. Vascular occlusion B. Cheilitis glandularis C. Drug-induced angioedema D. Melkersson-Rosenthal syndrome E. Drug-induced photosensitivity Source: MedicineNet Urticaria Aetiology: A hypersensitivity reaction caused by mast cell degranulation + release of histamine and vasoactive mediators Presentation ● Weals: pruritic erythematous plaques with smooth surface lasting <24 hours ● Angioedema: deep dermal swelling with no redness ● Urticarial vasculitis: weals/ purpura lastings >24 hours which sting Causes: ● Acute: lasting <6 weeks - induced by allergens, food, drugs, or infections. Non- allergic or allergic mechanisms (IgE response) ● Chronic: lasting >6 weeks - autoimmune or combined aetiology. Non-allergic (IgG antibodies) Investigations: Blood tests (FBC, ESR, TFT, C4 levels), Hepatitis/ HIV Management: Self-limiting if acute. Avoid offending agent. Antihistamines. Systemic steroids Erythroderma Presentation ● Generalised erythema covering >90% of body surface area ● Systemic sx due to skin function impairment ○ Tachycardia ○ Hypo/ hyperthermia ○ Risk of sepsis ○ Odema ○ Fluid and protein-loss Causes: ● Multiple: drug reactions, eczema, psoriasis, cutaneous T cell lymphoma - Sezary syndrome, idiopathic (up to 30% of cases) Management: ● Treat underlying cause (treat eczema/ psoriasis, withdraw offening drug) ● Hospital admission if systemically unwell ○ IV fluids and electrolytes and manage body temperature ● Supportive: emollients +/- topical steroids +/- abxSteven-Johnson Syndrome/ Toxic Epidermal Necrolysis Rare but potentially life-threatening skin reaction. SJS and TEN are variants of same condition Presentation ● Sheet-like loss of skin + mucosa - <2-3 days ● Prodrome: flu-like symptoms ● Sudden onset of lesions mostly affecting trunk ● Macules - blisters - erythema (atypical targetoid lesions) ● Merging of blisters → sheets of epidermal detachment ● Nikolsky sign +ve Causes: ● Cell-mediated, cytotoxic reaction against epidermal cells ● Drugs - most common culprit (>80% of cases) ○ Abx, antiepileptics, allopurinol, NSAIDs SCORTEN - scoring criteria to assess severity and mortalitySteven-Johnson Syndrome/ Toxic Epidermal Necrolysis SJS and TEN are variants of same condition. SJS can progress → TEN Management: ● No treatment if mild ● Treat underlying cause if identified ○ Withdrawal of offending drug if appropriate ○ Antivirals or abx for if infection ● Supportive mx: ○ Emollients + topical steroids (for itching) +/- non-adherent dressing ○ Leave on detached epidermis (biological dressing) ● Admission in severe cases for IV hydration and skin protection Complications: 30% mortality, blindness, dehydration, hypo/hyperthermia, organ failure Eczema herpeticum Disseminated viral infection caused by Herpes simplex virus 1 or 2 Presentation ● Abrupt deterioration in eczema ● Clusters of monomorphic blisters - appear like early cold sores ● Punched out skin lesions → pain and ++ itching ● +/- severe systemic illness (fever, lethargy, vomiting, anorexia, diarrhoea) ● +/- lymphadenopathy Investigations: Blood tests (culture, FBC, U+Es, CRP), viral swabs, bacterial swabs Management: ● Prompt treatment w/ aciclovir PO or IV (if patient too ill) ● Consider abx if secondary bacterial infection (Ceftriaxone or clarithromycin if penicillin allergic) ● Refer to ophthalmology if lesions near eye!Inflammatory Skin Diseases Atopic Eczema Aetiology: Caused by barrier dysfunction which has a genetic association Presentation ● Itchy, chronic, and inflammatory skin disease with a remitting and relapsing course ● Acute: erythematous, crusted lesions +/- blisters (vesicles/ bullae) ● Chronic: mildly erythematous but lichenified and scaly ● Allergic march: rhinitis, asthma, allergies (e.g. hayfever) ● Affects flexural surfaces and face (in infants) Causes: ● Common - inhalant allergies (e.g. pollens, house dust mites) ● Food allergies e.g. milk eggs (5% of cases) ● Irritants (soap, detergents) ● Contact allergens ● Infections Investigations: Bacterial/ viral swab to r/o infection Atopic Eczema Management: ● Address and treat suspected cause (e.g. infection) ● Generally emollients +/- steroids ● Adherence to skin regime ● Treated based on severity: ○ Steroid ointments: ○ Mild eczema (areas of dry skin w/ infrequent itching: → hydrocortisone 1-2% ○ Moderate (areas of skin w/ frequent itching and redness +/- excoriations) → Eumovate/ Betnovate-RD ○ Severe (diffuse areas of dry skin, ++ itching and redness +/- excoriations, lichenification, bleeding, cracking) → Elcon/ Betnovate ○ 7-14 days BD ● Manage infections ○ Bacterial → Oral co-amoxiclav/ ceftriaxone (if widespread) ● Topical calcineurin inhibitors (e.g. tacrolimus) ● UVB phototherapy (for severe cases) Psoriasis Chronic inflammatory skin condition - immune-mediated disease → skin hyperproliferation Presentation ● Well-demarcated red, scaly plaques ● Symmetrical distribution ● “Silvery” white scale ● Commonly affects extensor surfaces ● Different types: ○ Plaque psoriasis - most common, classic description ○ Flexural psoriasis - skin is smooth and shiny with white peeling surface ○ Guttate psoriasis - common in children, transient psoriatic rash (erythematous “tear-drop” lesions”)caused by strep infection ○ Pustular psoriasis - affects palms and soles ○ Scalp psoriasis ● Nail signs - pitting and onycholysis ● Can be associated with arthritis Psoriasis Causes: ● Multifactorial ● Genetic association - HLA-B13, -B17, and cw6 ● Immunological: abhorrent T-cell activity → keratinocyte proliferation ● Environmental: ○ Worsened by skin trauma/ stress ○ Triggered by Strep infection ○ Improved by sunlight exposure Investigations: Clinical diagnosis - PASI score to assess severity Management: ● Topical therapy - emollients, coal tar preparations, vitamin D analogues (calcipotriol), topical corticosteroids, calcineurin inhibitors (tacrolimus) ● Phototherapy - NB UVB, BB UVB, photochemotherapy (psoralen UVA) ● Systematic - methotrexate, ciclosporin (calcineurin inhibitor) ● Biologics - tumor necrosis factor inhibitors (e.g. infliximab) Acne Vulgaris Skin disorder commonly affecting adolescents - characterised by obstruction of pilosebaceous units/ follicles with keratin plugs → comedones, inflammation and pustule formation Presentation ● Comedones - non-inflammatory lesions caused by dilated sebaceous follicle ○ Closed - whiteheads ○ Open - blackheads due to oxidation ● Papules and pustules - inflammatory lesions occurring after follicle rupture causing irritation ● Nodules and cysts - due to ++ inflammatory response ● Scarring - ice-pick scars, hypertrophic scars, pigmentation Management: ● Topical therapy (topical retinoids, benzoyl peroxide, topical antibiotic) ● Oral antibiotics and COCP (for women) ● Isotretinoin - final resortSalim is a 14-year-old boy who has recently had a Streptococcus infection. He has presented to the GP surgery with a widespread psoriatic rash. On examination, there were erythematous tear-drop lesions covering his back. What is the most likely diagnosis? A. Plaque psoriasis B. Guttate psoriasis C. Flexural psoriasis D. Scalp psoriasis E. Pustular psoriasisSalim is a 14-year-old boy who has recently had a Streptococcus infection. He has presented to the GP surgery with a widespread psoriatic rash. On examination, there were erythematous tear-drop lesions covering his back. What is the most likely diagnosis? A. Plaque psoriasis B. Guttate psoriasis C. Flexural psoriasis D. Scalp psoriasis E. Pustular psoriasis Bacterial InfectionsSahib is a 8 year old male with golden Honey Coloured lesions on the corner of his mouth but no where else , as shown in the image below. He apyrexial , hasn’t had severe pain or changes in bowel movement. What is the best management for this patient? A. Exclude from School B. Fusidic Acid C. Flucloxacillin PO D. Dettol Antiseptic E. No treatment neededSahib is a 8 year old male with golden Honey Coloured lesions on the corner of his mouth but no where else , as shown in the image below. He apyrexial , hasn’t had severe pain or changes in bowel movement. What is the best management for this patient? A. Exclude from School B. Fusidic Acid C. Flucloxacillin PO D. Dettol Antiseptic E. No treatment needed Impetigo Impetigo is an acute superficial bacterial skin infection usually caused by Staph Aureus. Presentation ● 'golden, honey coloured', crusted skin lesions (pustules and erosions) typically found around the mouth (also flexures and limbs) ● very contagious- spreads by direct contact with discharge from scabs of infected person Factors that pre-dispose to impetigo: ● Atopic eczema ● Scabies ● Skin trauma: chickenpox, insect bite, dermatitis, laceration Diagnosis ● Diagnosed clinically - confirmed with bacterial swabs sent for MC&S ● If widespread, neutrophils raised Management ● Uncomplicated (without systemic illness): 1% hydrogen peroxide cream, topical antibiotic creams like fusidic acid or mupirocin ● Extensive disease: Flucloxacillin PO, erythromycin if allergic to penicillins ● Advice: 1) Students should be excluded from school until lesions have crusted or healed OR 48 hours after commencing antibiotics treatment 2) Avoid close contact with others: use separate towels and flannels, laundry daily 3) Cleanse the wound; use moist soaks to remove crusts gently 4) Apply antiseptic (hydrogen peroxide, chlorhexidine) 2-3 times daily for 5 days 5) Cover the affected areas 6) Wash daily with antibacterial soap 7) Cut nails and keep hands cleanSabira is a 36 year old female who is G2 P1 , in her third trimester. You note Unilateral erythematous inflammation of the skin around her thigh . She is systemically unwell and shivering, and has a pmHx of gestational diabetes. WCC and CRP are raised . Blood cultures come back +ve . She has no allergies. You initiate an ABCDE approach What is the most appropriate first step. A. Flucloxacillin PO for 5-10 days B. Erythromycin IV C. Co-amoxiclav IV D. NSAID E. Topical imiquimod creamSabira is a 36 year old female who is G2 P1 , in her third trimester. You note Unilateral erythematous inflammation of the skin around her thigh . She is systemically unwell and shivering, and has a pmHx of gestational diabetes. WCC and CRP are raised . Blood cultures come back +ve . She has no allergies. You initiate an ABCDE approach What is the most appropriate first step. A. Flucloxacillin PO for 5-10 days B. Erythromycin IV C. Co-amoxiclav IV D. NSAID E. Topical imiquimod cream Cellulitis / Erysipelas Cellulitis= Inflammation of the skin, lower dermis and subcutaneous tissues, typically due to infection by Streptococcus pyogenes (2/3) or Staphylococcus aureus (1/3). Presentation ● Unilateral, if bilateral consider other causes (e.g. cardiac failure) ● Most commonly occurs on shins ● Redness, pain and swelling ● Sometimes: Associated systemic upset e.g. fever, chills ● Can occur by itself or complicate an underlying skin condition ● Erysipelas affects the upper dermis and extends into the superficial cutaneous lymphatics ● Diagnosis is clinical. WCC, CRP, wound/erosions/crusts swabs, blood culture Management ● Lifestyle: avoid trauma, keep skin clean and moisturised, treat fungal infections early, keep swollen limbs elevated ● Classification system: Eron classification to guide medical management ● Uncomplicated (no signs of systemic illness): 1) Flucloxacillin PO for 5-10 days. Clarithromycin, erythromycin (pregnancy) and doxycycline in penicillin allergy. 2) Analgesia 3) Adequate fluid intake 4) Rx of coexisting skin conditions ● Complicated (with systemic illness): ABCDE, Intravenous antibiotics (co-amoxiclav, cefuroxime) Folliculitis Inflammation of hair follicles bacterial , yeast , fungal and viral ● Affects anywhere there is hair incl. chest, back, buttocks, arms and legs. ● Presentation: tender red spots, often with a surface pustule ● Can be due to: 1) infection (bacterial, yeast, fungal and viral), 2) irritation from regrowing hairs (shaving), 3) contact reactions: paraffin-based ointments, irritant chemicals and topical steroids, 4) immunosuppression, 5) inflammatory skin diseases (Lichen planus, discoid lupus erythematosus) 6) Acne Management Treat infection if present (e.g. bacterial with antiseptic, fungal with acyclovir), treat acne, avoid triggers (like shaving, topical steroids)InfestationsAyo is a 9 year old male patient who presents to the GP with his mum with itchy marks between his fingers and silver lines. There is widespread excoriation. They currently do not have a fixed permanent address . What is the first line management for this condition? A. Malathion 0.5% for all family members B. Malathion 5% for all family members C. Permethrin 5% for all family members D. Permethrin 0.5% for Patient only E. Imidazole for patientAyo is a 9 year old male patient who presents to the GP with his mum with itchy marks between his fingers and silver lines. There is widespread excoriatioThey currently do not have a fixed permanent address . What is the first line management for this condition? A. Malathion 0.5% for all family members B. Malathion 5% for all family members C. Permethrin 5% for all family members D. Permethrin 0.5% for Patient only E. Imidazole for patient Scabies Caused by the mite Sarcoptes scabiei and is spread by prolonged skin contact. It typically affects children and young adults. Presentation ● Widespread itching ● Linear burrows on sides of fingers, interdigital webs and flexor aspects of the wrist in infants, face and scalp can be affected ● Generalised rash, red papules on trunk and limbs, often follicular. Vesicles on palms and soles. ● Excoriations, infections Itch occurs 4-6 weeks after infestation, more severe at night - disturbs sleep, affects the trunk and limbs, sparing scalp. Diagnosis: Dermatoscopy (mite has jet plane or hand glider appearance Management 1 line : Management: Permethrin 5% cream (scabicide) 2ndline : malathion 0.5% for 24 hours ● Repeat 8-10 days after first application to catch mites that have newly hatched. ● Crotamiton cream used to decrease itch. ● Avoid close physical contact with others until treatment is complete ● All household and close physical contacts should be treated at the same time, even if asymptomatic ● Laundry on first day to kill off mites ● Apply the insecticide to all areas, including the face and scalp ● Pay close attention to areas between fingers and toes, under nails, armpit area, creases of the skin such as at the wrist and elbow ● Allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off ● Reapply if insecticide is removed during the treatment period Progress test tip: Risk factors that increase risk of scabies infestation: poverty and overcrowding conditions, institutional care like hospitals and prisons, refugee camps, immune deficiency Pediculosis (lice) ● Head, body and pubic hair ● Very prevalent amongst school children- transmission by head contact, sharing hats ● Mature live lice are 3mm in length, their egg are called nits (1mm in length) Presentation ● Intense itching in affected area (allergic reaction to lice) DDx: seborrheic dermatitis, psoriasis Management ● For lice: Application of insecticide (like permethrin 5% or malathion 0.5% ) shampoo to scalp ● For nits: wet hair with vinegar to loosen attachment to hair ● Vigorous and repeated combing using fine toothed comb. Viral InfectionsA 14 year old girl , Najma , comes for her HPV vaccination. She wants to be a doctor in the future , but worried herself when she read about how HPV can cause certain cancers. Which combination are linked to malignancy? A. 6 , 18 & 33 B. 16 & 18 C. 6 & 11 D. 16, 18 & 33 E. 6, 11 & 33A 14 year old girl , Najma , comes for her HPV vaccination. She wants to be a doctor in the future , but worried herself when she read about how HPV can cause certain cancers. Which combination are linked to malignancy? A. 6 , 18 & 33 B. 16 & 18 C. 6 & 11 D. 16, 18 & 33 E. 6, 11 & 33 Viral Warts HPV (Human Papilloma Virus) infection HPV 6 & 11: anogenital warts, HPV 16 & 18 & 33: linked to cancers (e.g. cervical, anal, vulval, mouth and throat) ● Types: Common wart, plantar wart (on soles - verrucas), filiform (on long stalk), mucosal (lips, inside of cheeks), anogenital ● Koebner phenomenon: new skin lesions secondary to trauma occurs in pts with warts (also seen in psoriasis, lichen planus, vitiligo, m. contagiosum) ● Risk factors: school aged children, eczema, immunosuppression ● Vaginal/anal/oral sex – But also close skin contact ● Pinpoint dots (clotted capillaries) when top of wart removed ● Can be diagnosed clinically, with dermatoscopy, and/or skin biopsy 1) If not troublesome, left alone and will regress Management 2) Topical: paint containing salicylic acid 3) Cryotherapy: repeated at one to two week intervals 4) Electrosurgery (curettage and cautery) for large resistant wartsAnogenital warts ● Common presentation in GUM clinics ● Caused primarily by HPV 6 & 11 (non carcinogenic) ● HPV 16, 18 & 33: linked with cervical cancer ● Features: small fleshy pigmented protruding lesion, may bleed or itch Management 1) Topical podophyllum - for multiple, non-keratinised warts 2) Cryotherapy- for single, keratinised warts 3) 2nd line: Imiquimod cream 4) Genital warts are often resistant to treatment- clear in 1-2 years Immunisation: HPV vaccination (Gardasil) given to girls and boys. Suspect sexual abuse in children presenting with anogenital warts.Albert is a 3 year old who has just started nursery. His mum brings him in because she is very worried about what she describes as a “Bumpy Rash” on his trunk. You see pearly white papules with central umbilication. What is the condition? A. Molluscum Contagiosum B. Basal cell carcinoma C. Chicken pox VZV D. Herpes Simplex E. Lichen planusAlbert is a 3 year old who has just started nursery. His mum brings him in because she is very worried about what she describes as a “Bumpy Rash” on his trunk. You see pearly white papules with central umbilication. What is the condition? A. Molluscum Contagiosum B. Basal cell carcinoma C. Chicken pox VZV D. Herpes Simplex E. Lichen planus Molluscum Contagiosum Skin infection caused by molluscum contagiosum virus ● Transmission occurs directly by close personal contact and sharing contaminated surfaces (like towels) ● Prevalent in preschool children aged 1-4 years Presentation: ● Pinkish, pearly white papules with central umbilication (up to 5mm in diameter) ● Appear in clusters anywhere on body except palms and soles ● Lesions commonly occur on trunk and in flexures, can be anogenital (spread by sexual contact) ● Self limiting condition- resolution in 18 months ● Avoid sharing towels, clothing and baths with people (contagious) ● Avoid scratching the lesions - use emollients and hydrocortisone to alleviate itch ● Exclusion from school not necessary Management Herpes Simplex ● Recurrent genital or perioral infection ○ Type 1 HSV - oral and facial infections ■ Mainly occurs in children ○ Type 2 HSV - rectal and genital infections ■ Mainly occurs after puberty ● Transmission via direct/ indirect contact ● Signs: Grouped painful vesicles on erythematous base ● Ix: clinical diagnosis - but viral swab can be sent for culture + PCR Herpes Simplex ● Mx: ○ Oral HSV - usually none ■ Topical aciclovir can be used, not beneficial ○ Genital Epithelial keratitis ■ Oral aciclovir 200mg 5x/day PO for 1 wk ■ Hygiene measures ■ Abstinence from sex until clearance ■ Prophylactic antiviral if >6 attacks/year ● Complications: ○ Eye and throat infections ○ Eczema herpticum ○ Disseminated infection Eczema herpticumHussain is a 55 year old man who comes to the GP clinic with a 2 day history of an uncomfortable sensation on his shoulder. He says its very painful especially when his clothes rub against it. but he hasn’t been able to see what is wrong What is the management of this condition. A. Admit to hospital B. Paracetamol C. IV Acyclovir D. Morphine E. Oral AcyclovirHussain is a 55 year old man who comes to the GP clinic with a 2 day history of an uncomfortable sensation on his shoulder. He says its very painful especially when his clothes rub against it. but he hasn’t been able to see what is wrong What is the management of this condition. A. Admit to hospital B. Paracetamol C. IV Acyclovir D. Morphine E. Oral Acyclovir Herpes Zoster (shingles) ● Reactivation of varicella zoster virus ● Signs: painful, blistering, vesicular rash ○ Dermatomal distribution ○ +/- superimposed yellow crusting (S. aureas superinfection) ● Ix: PCR is most useful ● Rx: ○ If mild → none ○ If > 50yrs, eye involvement, or severe → antiviral (e.g. aciclovir) ● Varicella-zoster vaccine for prevention in elderly ● Complications: encephalitis, meningitis, post-herpetic neuralgia Fungal Infections Candidiasis ● Yeast infection - mostly caused by Candida Albicans ● Manifests in many body parts: Oral candida (thrush) Angular chelitis Interdigital Vulvovaginal Balanitis Chronic paronychia Onychomycosis Flexural Candidiasis ● Ix - Hx + examination + swabs to confirm diagnosis ● Mx ○ Minimise risk factors ○ Keep the skin dry ○ Antifungals ■ Skin → imidazole ■ Mouth → nystatin or miconazole gel ■ Vagina → imidazole cream +/- pessary Dermatophytosis (Tinea) ● Caused by ringworm ● Indirect man to man transmission ● Trichophyton rubrum is one of the most common ● Infection is typically round, scaly, itchy lesion ● Infection is called tinea + (body part affected in latin) ● WELL ANNULATED Tinea Capitis ● Capitis = scalp ● Symptoms - hair loss, scaly areas, redness and itch ○ Kerion - fungal abscess ● Common in children ○ Preadolescent - peak age 3-7 ● Ix ○ Skin scrapings/ brushings for microscopy and culture ○ Contact tracing ● Rx ○ Oral antifungal (griseofulvin or terbinafine) ○ Ketoconazole shampoo Tinea Corporis ● Corporis = body ○ Tinea cruris = groin ○ Tinea pedis = foot Kerion ● Acute or chronic ● Oval, red, scaly patch +/- kerion (fungal abscess) ● Ix ○ Scrapings for microscopy and culture ● Rx ○ Topical antifungal creams (terbinafine or imidazole) ○ Escalate to oral antifungals if necessary Tinea Unguium ● Unguium = nails ● Increased risk with age ● Great or little toe nail commonly affected ● Ix ○ Nail clippings + scrapings for microscopy and culture ● Rx ○ Topical antifungal agent if mild (Amorolfine) ○ Oral antifungals (Terbinafine)Kaneez has been working towards a body building competition. When she was preparing for her competition, she saw something different in the pictures. She notices blanching of her skin (hypo pigmentation) from the nape of her neck down her back, with lots of patchy shades of skin colour. She noticed it was worse In pictures of her at the beach in Morocco. What condition might she have ? A. Vitiligo B. Lichen planus C. Eczema D. Pityriasis Versicolor E. Pityriasis AlbaKaneez has been working towards a body building competition. When she was preparing for her competition, she saw something different in the pictures. She notices blanching of her skin (hypo pigmentation) from the nape of her neck down her back, with lots of patchy shades of skin colour. She noticed it was worse In pictures of her at the beach in Morocco. What condition might she have ? A. Vitiligo B. Lichen planus C. Eczema D. Pityriasis Versicolor E. Pityriasis Alba Pityriasis Vesicolor ● Yeast infection ● Caused by Malassezia species ● Risk factors: ○ Most commonly affects young adults (F > M) ○ Hot climates ● Presentation: hypopigmented scaly macules on upper trunk and back ○ Usually asymptomatic ● Ix : usually clinical diagnosis ● Rx: topical antifungals if mild (imidazole & ketoconazole shampoo) ○ Oral antifungals if extensive disease Malassezia microscopy Skin CancerSaleema is a 70 year old patient who recently moved to Cardiff from Bangladesh. She comes to the GP after having noticed a suspicious lesion on her forearm. When taking a derm Hx from her. She tells you that she very rarely burns in the sun but she tans very easily. What skin type does she have acorting to the Fitzpatrick scale. A. Type 2 B. Type 3 C. Type 4 D. Type 5 E. Type 6Saleema is a 70 year old patient who recently moved to Cardiff from Bangladesh. She comes to the GP after having noticed a suspicious lesion on her forearm. When taking a derm Hx from her. She tells you that she very rarely burns in the sun but she tans very easily. What skin type does she have acorting to the Fitzpatrick scale. A. Type 2 B. Type 3 C. Type 4 D. Type 5 E. Type 6Skin Types Melanoma What is it ? - Slow growing locally invasive malignant tumour of epidermal melanocytes - RISK – Type 1 skin , UV exposure , pmHx - Women – legs , Men – Trunk Major Criteria Minor Criteria - Change in Size - Diameter >7mm - Irregular shape - Inflammation - Irregular colour - Oozing - Change in sensation Melanoma Lentigo Management pathway NICE CKS & BAD Acral Malinga nodular Actinic Keratosis What is it? - PREMALIGNANT LESION - Chronic Sun exposure (e.g temples of heaf) - Risk of SCC 10% at 10 years Management - Sun avoidance - Fluorouracil cream (2-3 week course) + topical hydrocortisone for inflammation Rough erythematous /skin coloured papule with a white to yellow scale - Topical diclofenac Multiple Clustered at site of sun - Topical imiquimod exposure - Cryotherapy - Curettage and cautery Squamous Cell Carcinoma & Bowen’s What is it? Management - Surgical Excision - Locally invasive malignant tumour of the - Mohs Micrographic surgery for ill defined epidermal keratinocytes or its appendages , which has the potential to metastasise and large recurrent - Radiotherapy – non ressectable tumours - RISK : UV exposure , pre malig skin - BOWENS ( cryotherapy , imiquimod cream or fluorocil ) , curettage and condition (actinic keratosis) , leg ulcers , cautery , PDT wounds , scars, immunosuppression. Erythematous - Scaling patch or elevated plaque – ill defined Basal Cell Carcinoma What is it ? PAPULE - PEARLY ROLLED RAISED EDGE - TELANGIECTATIC - Slow growing locally invasive malignant tumour of epidermal keratinocytes - Nodular (most common) , Cystic , morphoeic (sclerosing), keratotic and pigmented. Risk Factors Management - UV exposure - Surgical excision - Frequent or severe childhood sunburn - Mohs micrographic surgery (high risk - Skin type 1 (always burns never tans) recurrent) - Age - Radiotherapy (if surgery not appropriate) - Male - Cryotherapy , curettage and cautery , - Immunosuppression topical photodynamic therapy, topical - Hx of skin cancer/genetic imiquimod Pyogenic Granuloma What is it ? - friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common. Management - Curettage and Cautery - Formal excision if diagnostic doubtFEEBACK FORM FOR SLIDES