Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Common RashesLearning Aims 1. Describe the configuration and morphology of skin rashes 2. Recognise the clinical and diagnostic features of common rashes 3. Explore the clinical management and potential complications of common rashes in children and adultsSkin LayersShape & OutlineSize & ConsistencyDisclaimerSpot the Diagnosis: One Multifactorial Genetic: HLA-B13 Abnormal T-cell activity Environmental Psoriasis Clinical Features Complications Management • Chronic Plaque Psoriasis Regular Emollients • Psoriatic Arthropathy o Silvery scale • Psychological distress o Well-demarcated 1. Vitamin D Analogues OD + TopicalSteroids OD o Extensor surfaces Exacerbating Factors: • Trauma 2. Vitamin D Analogues BD + • Flexural Psoriasis • Alcohol TopicalSteroids BD o Smooth skin • Drugs 3. + Tar Preparations /  Beta-blockers Dithranol • Guttate Psoriasis  Lithium o Multiple, red teardrops  ACE Inhibitors Extensive Psoriasis o Transient  NSAIDs • Phototherapy o Streptococcal infection  Antimalarials • Methotrexate  Steroid withdrawal • Ciclosporin • Pustular Psoriasis • Biologics - InfliximabSpot the Diagnosis: Two Sarcoptes scabei Prolonged skin-to-skin contact Children & Young Adults Scabies Clinical Features Complications Management Linear Burrows Crusted (Norwegian) Scabies 1. Permethrin 5% • Side of fingers • Immunosuppressed 2. Malathion 0.5% • Interdigital webs patients • Flexor aspects of the wrist • Widespread pruritus • Oral Ivermectin & Topical Insecticide Infants Patient Guidance • Palms and soles of the feet • Pruritus persists up to 4- • Isolation 6 weeks • Avoid close physical contact • Household items treatedSpot the Diagnosis: Three Release of histamine from mast cells causing leaky blood vessels DrugsNSAIDs, Opiatescillins, Urticaria (Hives) Clinical Features Complications Management Wheals Angioedema 1. Antihistamines • Superficial swelling • Subcutaneous tissues • Widespread • Eyes • Varying size • Lips Investigations • Spontaneously resolve • Pharynx • Symptom Diary • FBC: Eosinophilia / Low Anaphylaxis WBC • Swelling of the larynx & • Allergen blood tests tongue • Dermatology referral • Follow local guidelinesSpot the Diagnosis: Four Inflamed hair follicle Causes: Infection, occlusion, skin disease and irritation Folliculitis Clinical Features Complications Management Pustule Bacterial Folliculitis 1. Hygiene • Chest • Staphylococcus aureus 2. Antiseptic Cream • Face • Arms 3. Oral Antibiotics • Back • LegsSpot the Diagnosis: Five Trichophyton Spread: people, animals, soil Tinea Corporis (Ringworm) Clinical Features Complications Management • Pruritus Tinea Incognito • Advice to avoid spread • Erythema • Inappropriate use of • Well-demarcated steroids Anti-fungal medications: • Circular rings • Creams: Clotrimazole • Shampoo: Ketoconazole  Spread outwards • Dampens immune response and worsens • Oral: Fluconazole, Affected Areas fungal infection Terbinafine • Tinea capitis - scalp • Tinea pedis - athletes foot • Tinea cruris - groin • Tinea corporis -body • Onychomycosis - nail infectionSpot the Diagnosis: Six Drug reaction Drugs: Penicillin, sulphonamides, lamotrigine, carbamazepine, phenytoin, allopurinol, NSAIDs, COP Stevens-Johnson Syndrome Clinical Features Complications Management • Painful Mortality rate up to 10% • Stop causative agent • Maculopapular rash • Target lesions • Hospital Admission (ITU) • Vesicles / bullae • Dehydration • Skin infections • Supportive treatment • Mucosal involvement  Pain management • GI ulceration / perforation Systemic Symptoms • Disseminated Intravascular  Temperature maintenance • Fever Coagulation  Nutrition & Fluid • Arthralgia • Shock / Multi-organ failure replacementSpot the Diagnosis: Seven Drug reaction Drugs: Penicillin, sulphonamides, carbamazepine, phenytoin, allopurinol, NSAIDs Toxic Epidermal Necrolysis Clinical Features Complications Management • Painful Mortality rate up to 30% • Stop causative agent • Extensive area • Scalded appearance • IV Immunoglobulins • Dehydration Systemic Symptoms • Skin infections • Immunosuppressants (Ciclosporin) • Fever • GI ulceration / perforation • Tachycardia • Disseminated Intravascular • Hospital Admission (ITU) Coagulation • Shock / Multi-organ failure • Supportive treatment Nikolsky Sign • Blisters and erosions  Pain management  Temperature maintenance appear when the skin is  Nutrition & Fluid rubbed gently replacementSpot the Diagnosis: Eight Inherited predisposition to Eczema, Asthma & Hayfever Begins between 3 – 12 months By pubertpatients in 90% of Atopic Eczema Clinical Features Complications Management • Severe itching Eczema Herpeticum • Emollients • Herpes simplex virus 1 or 2 • Extensor surfaces • Cotton clothing • Painful rash • Merges with surrounding • Punched-out, ulcerated • Topical steroids lesions skin • Hospital admission • Antihistamines • Vesicles – oozing fluid • IV AciclovirQuestion TimeQuestion 1 Psoriasis is most likely to be worsened by which one of the following: A. Tricyclic Antidepressants B. ACE Inhibitors C. Furosemide D. Atypical antipsychotics E. CiclosporinQuestion 1: Answer Psoriasis is most likely to be worsened by which one of the following: A. Tricyclic Antidepressants B. ACE Inhibitors C. Furosemide D. Atypical antipsychotics E. CiclosporinQuestion 2 What is the infective agent associated in Ringworm? A. Streptococcus pyogenes B. Staphylococcus aureus C. Staphylococcus epidermidis D. Trichophyton E. Propionibacterium acnesQuestion 2: Answer What is the infective agent associated in Ringworm? A. Streptococcus pyogenes B. Staphylococcus aureus C. Staphylococcus epidermidis D. Trichophyton E. Propionibacterium acnesQuestion 3 This 3-year-old boy has been scratching a lot despite using antihistamines and emollients. There is a family history of both asthma and hayfever. Which medication should be considered next? A. Lidex ointment B. Temovate ointment C. Hydrocortisone 1% ointment D. Clobetasol 0.05% E. VaselineQuestion 3: Answer This 3-year-old boy has been scratching a lot despite regularly using antihistamines and a variety of emollients. There is a family history of both asthma and hayfever. Which medication should be considered next? A. Oral Flucloxacillin B. Temovate ointment C. Hydrocortisone 1% ointment D. Tacrolimus ointment E. Cetraben CreamQuestion 4 This 13-year-old male presents with itchy papules which have been worsening over the past month. What medication is the safest and most effective? A. Permethrin 5% Cream B. Lindane 20% solution C. Malathion powder D. Lindane 2% solution E. Hydrocortisone 1% ointmentQuestion 4: Answer This 13-year-old male presents with itchy papules which have been worsening over the past month. What medication is the safest and most effective? A. Permethrin 5% Cream B. Lindane 20% solution C. Malathion powder D. Lindane 2% solution E. Hydrocortisone 1% ointmentQuestion 5 This patient was misdiagnosed s having dermatitis and was given a topical steroid to apply. The area became progressively worse. A skin scraping revealed a fungal growth. Given the appearance of the lesion it is best treated with: A. Miconazole cream B. Ketoconazole shampoo C. Clotrimazole cream D. Itraconazole E. TerbinafineQuestion 5: Answer This patient was misdiagnosed s having dermatitis and was given a topical steroid to apply. The area became progressively worse. A skin scraping revealed a fungal growth. Given the appearance of the lesion it is best treated with: A. Miconazole cream B. Ketoconazole shampoo C. Clotrimazole cream D. Prednisolone E. TerbinafineOverview of Topics 1. Psoriasis 2. Scabies 3. Urticaria / Hives 4. Folliculitis 5. Tinea Corporis 6. Stevens-Johnson Syndrome 7. Toxic Epidermal Necrolysis 8. Atopic EczemaSummary of Key Points • Morphology and configuration of the skin rash • Exacerbating factors • Potential complications • Targeted managementReferences • CKS | NICE • https://dermnetnz.org/ • Generalized and Localized Rashes | Concise Medical Knowledge (lecturio.com) • https://www.cppe.ac.uk/learningdocuments/pdfs/dermatology.pdf