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DERMA TOLOGY 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 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 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 collarette scales • 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 CUT ANEOUS 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 CUT ANEOUS 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 AREA TA • 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 AREA TA • 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 maculo papules- 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 -1 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 GENIT ALIS • 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 GENIT ALIS • 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 • branny scales or hyperpigmented macules with • Upper trunk- common • Rx Topical ketoconozole,clotrimazole,miconazole,oxyconazole Systemic Fluconazole 400mg stat Ketoconazole 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 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 IMPETIGO • Bullous- Staph aureus Neonates and infants Thick walled bullae • Topical /systemic antibiotics MOLLUSCUM CONT AGIOSUM • 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 MOLLUSCUM CONT AGIOSUM • 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 KERA TOSIS • 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 antifungalsTINEA CORPORIS TINEA INCOGNITOTHANK YOU