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Welcome to the third lecture of our Dermatology Series. Today, we'll be covering the following four conditions. Seric dermatitis, cellulitis, necrotizing fasciitis, and eczema herpeticum. So, the first condition is seber dermatitis. This is caused by Melas furfur which is a yeast and a type of fungus. The infection causes shiny scales to form on the skin that can appear flaky and often coalesces to look erythematous and oily. Patients experiencing SD often report the pain is minimal in the form of an itch and the problem ar the problem areas in adults and infants are similar but not the same with adults typically experiencing symptoms in um the eyebrows, the hairline and the nasolabial folds. While infants experience a form called cradle cap, which is typically asymptomatic. So cradle cap often presents at 12 months of age appearing as a yellow greasy scale that forms plaques that are typically located on the scalp. The armpit and groin are also reported to be problematic areas for infants experiencing SD diagnosing SD is mostly clinical with further tests, revolving starting systemic treatment. However, blood tests and skin biopsies are often taken if the patient is suspected to have a differential diagnosis or if they're in, invest in the investigation of a cause such as HIV, infantile SD is usually self limiting, but the patient can be prescribed a topical emollient, an infant brush to loosen the scales formed as well as using emollient as a soap substitute and a topical imidazole cream if appropriate. However, in adults SD is chronic, meaning that whilst it responds well to treatment, it may relapse and remit over time. Thus, um like a topical imidazole and antifungal shampoo is often used. Uh In addition, a short course of corticosteroids such as hydrocortisone can be used in flare ups to settle the inflammation. Um moving on to the second condition. This is necrotizing fasciitis. Um This is a life threatening infection that is characterized by necrosis of the fascia and the subcutaneous tissue. In addition to inflammation that quickly progresses, the most common causes are infection with group A streptococcus or staph oris bacteria or gas forming organisms. Symptoms include disproportionate pain to what is seen clinically edema that extends beyond the area of erythema. Um and pain that subsidizes because the nerves become destroyed um as well as system systemic illness and skin changes that include blistering and dark discoloration. Um So, for necrotizing fasciitis, blood tests show raised inflammatory markers including um raised white cell count and c reactive protein. This indicates infection and sepsis. Blood tests may also show evidence of organ dysfunction depending on the progression of the necrotizing fasciitis. Uh other methods of investigating include bacteria cultures to guide antibiotic therapy, um or CT or MRI scans, which are particularly useful if the necrotizing fasciitis is caused by the gas causing organisms. Um As you can visualize the gas in the tissues through imaging to manage necrotizing fasciitis, we use broad spectrum antibiotics. So IV Clindamycin, meropenem and Vancomycin surgery is often urgent and needed in order to remove the tissue that has necrosis and to control the infection. Um but a wide margin must be used to ensure that there's no infection left behind in the skin and the tissue underneath, controlling systemic illness is often via IV fluids and other supportive care that is necessary. Um But in extreme cases, the patient might need to be amputated. So, an M CQ um A 77 year old female presents to the hospital with left leg redness and pain. She is diagnosed with cellulitis and oh, we have not covered cellulitis. I'll come back to this one. Eczema herpeticum is the third condition. Um This is a condition that affects people with inflammatory skin diseases such as atopic dermatitis and is caused by the infection of HSV one into large areas of the skin. The presentation of eczema herpeticum is ordinary clusters of itchy and often ooze filled discolored blisters which you can see in the picture that's on the right. Patients also often experience systemic symptoms alongside the dermatological ones including a high fever, malaise and swollen lymph nodes So the diagnosis of eczema herpeticum is also clinical, but there is an additional bacteria. If there's an additional bacteria infection or like a severe eczema flare up, then further investigations can be taken such as a viral and bacterial swab from one of the blisters to confirm infection. The treatment for eczema herpeticum is usually with antiviral meds such as aciclovir. Um this can be oral liquid form. Um if the patient is able to swallow, but if they're severely unwell, it can be IV uh if a secondary bacterial infection occurs, antibiotics are also added to their management plan. Um It's also important to note that because eczema hepaticum is highly infectious. Patients should avoid newborn babies, the immunosuppressed and those with atopic eczema to avoid the spread. So the fourth condition is cellulitis. Um This is an infection of the dermis layer of the skin as well as the subcutaneous tissue beneath. Whilst cellulitis can occur anywhere in the body, but it's most common in the limbs. Um and presents unilaterally so often on one leg, one limb and is most commonly caused by staph aureus, bacteria presentations that are bilateral. So they look the same on both limbs are ordinarily caused by another differential. So at that point, healthcare professionals would look to think of what else it could be. The features of cellulitis are typically warm, erythematous affected skin area with blisters and patients can also experience local lymphadenopathy to investigate cellulitis. We do blood tests to check for raised inflammatory markers as well as cultures from sites of infection and from abscesses and blisters. If the underlying bone is thought to be involved, then imaging in the form of X ray MRI or CT can be carried out too to manage cellulitis. Uh limb elevation, analgesia. Oh I have not moved on. Yeah. To manage cellulitis, limb elevation, analgesia and antipyretics are needed. Um And to treat the infection. Gluco axonin is the antibiotic of choice. Um with Benz benzylpenicillin added if the cellulitis is severe, but there are patients with penicillin allergies. In which case, we would substitute this with Clarithromycin or Clindamycin. If the patients are experiencing systemic upset or also have comorbidities in addition to the cellulitis, then we would also have to admit them into hospital. So those are the four conditions I can see a question in the chart. What is the appearance of cellulitis in non caucasian skin tones? And when you pimples in that areas and on a background of vitiligo? Thank you. Um for the question. Um So I think the image that I had included was on darker skin. However, this patient does not have vitiligo. So it probably would appear different um in burn areas or in those with the background of the togo. But I do think that's probably an important, important point to look up because for dermatology, I guess all the conditions look completely different depending on. Um I guess the patient's background and the parents will create a cap and Sebo dermatitis. Yes, I can one moment. Yeah. So with Sebo dermatitis, it's often extremely flaky and can appear a bit oily. Um, over time, those flakes can um coalesce meaning they kind of group together and form plaques um in adults. Um whereas for cradle cap on the next slide, it is typically yellow um and is a bit diffuse and greasy and also forms scales that will group together in the form of plaques. And this is typically on the hairline, on the scalp or on the armpit, groin area could go back to that question on cellulitis. Actually. Now, here we go. A 77 year old female presents to the hospital with left leg redness and pain. She's diagnosed with cellulitis and given intravenous fluids. She has a background of asthma and heart failure and additionally, has a known penicillin allergy. What is the most appropriate management plan? A Fluxil B, Clindamycin C, Benzyl methyl penicillin or D Coamoxiclav. Yup. Yup. So the answer is B Clindamycin. So that was it for the conditions of today. If there are any questions I can stay behind and I'm more than happy to answer them. But thank you all for listening. Hi. May. Um So keeping your leg elevated um in cellulitis is to help reduce the swelling and healing. Yes. Fia's gangrene is related to necrotizing fasciitis. It's also like a rare deadly infection, but it's for the perineum. So if it's necrotizing fasciitis of the perineum and the genitalia, then that's fia's gangrene. Hi, Ashok. Um I believe that the other lecture series are recorded. So if you go to the K CL African Caribbean Medical Society me page, they should all be there. No worries. So for gas gangrene, um surgery is also the number one treatment similar to necrotizing fasciitis. So sometimes you can just skip even the diagnosis process um and go straight for removal and then you would also do the broad spectrum antibiotics. Um So it's basically the same. However, if you have some um sepsis or anything, you will get additional medications to reduce your risk of blood clotting, you might also get reconstructive surgery afterwards. And uh oxygen therapy. Do we have any further questions? Hi. Um So to differentiate between cellulitis and necrotizing fasciitis, um with necrotizing fasciitis, it tends to be like patchy discoloration of the skin and it's very painful and it's swelling and oftentimes the patient will describe a pain that looks worse um than what medical professionals can see. But with cellulitis, um you'd expect um erythema. So it's a bit more red and there's minimal blistering compared to necrotizing fasciitis. I think that's the last question. So, thank you all for listening. Um to the third Dermatology lecture of this series.