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Dermatiology PowerPoint Presentation

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Published on : Jul 06, 2017 | Views : 2916 | Downloads : 5

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Slide 1-

Dermatology Dr. M. Connolly Dermatology Department AMNCH
Slide 2-

Dermatology Focussed dermatological history Describe cutaneous findings (and other relevant findings) Formulate differential diagnosis and management plan
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Dermatology Subspecialties Paediatric dermatology Skin surgery Contact Dermatitis Phototherapy Lasers Dermatopathology
Slide 4-

Dermatology - Introduction Skin is one of the largest organs ~1.8m2 , 16% body weight Structure and thickness vary with site Epidermis 0.1-1.4mm Dermis 0.6 – 3mm Barrier function
Slide 5-

Structure of the skin
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Dermatological terms Flat or raised Macule Patch Papule Nodule Plaque Wheal Filled with fluid Vesicle Bulla(e) Pustule
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www.dermatology.org/morphology
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Dermatological terms Colour Hyperpigmented Hypopigmented Depigmented (post-inflammatory hyper or hypopigmentation) Erythema Telangiectasia Purpura/petechiae Ecchymosis Haematoma
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Dermatological terms Secondary changes Scale Hyperkeratosis Crust Lichenification Excoriation Fissure Scar Erosion Ulceration
Slide 10-

Eczema Types Atopic Discoid Seborrhoeic dermatitis Hand and Feet Hyperkeratotic/fissured Vesicular (pompholyx)
Slide 11-

Eczema Types Allergic contact dermatitis Irritant contact dermatitis Asteatotic eczema/ eczema craquelé (crazy paving) Stasic (varicose) Neurodermatitis (lichen simplex chronicus)
Slide 12-

Eczema/Dermatitis History Duration Areas affected Precipitating/ aggravating factors History of atopy Family History Previous treatments Occupation Hobbies
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Examination Sites Describe: wet & weepy / or dry & scaly Any lichenification Any evidence of infection Bacterial infection or herpes simplex
Slide 14-

Management ANY IDEAS ?
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Management Topical emollients Topical steroids Topical tacrolimus (protopic) Antihistamines Treat any evidence of infection Phototherapy Systemic agents: immunosuppressants
Slide 16-

Emollients Aqueous cream E45 cream Oilatum cream Silcock’s base Aveeno Diprobase cream Emusifying ointment Paraffin gel (WSP/LP)
Slide 17-

Soap Substitutes Aqueous cream Silcock’s base Emulsifying ointment Bath emollients Oilatum plus Emsulsiderm
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Topical Steroids 1% hydrocortisone ointment Eumovate ointment Betnovate RD ointment Betnovate ointment Elocon ointment Locoid ointment Dermovate ointment
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Combination steroid & antibiotic Fucidin H Fucibet Betnovate C When? How long?
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Bandages Viscopaste : zinc impregnated bandages Icthopaste : icthammol bandages
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Tacrolimus Protopic 0.03% Protopic 1% 0.03% only licensed from 2 years upwards Avoid if infected or herpes infection Long-term side effects unknown Useful in areas where potent steroids can not be used Recently licensed for maintenance therapy
Slide 22-

Antihistamines Sedating antihistamines Piriton Vallergan Phenergan Hydroxyzine (Ucerax) syrup
Slide 23-

Other treatments Phototherapy Oral steroids Systemic agents Azathioprine Methotrexate Ciclosporin Mycophenolate Mofetil
Slide 24-

Infection Skin swab Flucloxacillin: staph Penicillin: Strept Erythromycin: penicillin allergy Herpes simplex infection: aciclovir IV
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Herpes Simplex Virus Highly contagious by direct contact (Primary infection) Penetrates the epidermis or mucous membrane Epidermal cell destruction Virus hides latent in the dorsal root ganglia (Sensory) Reactivation – Recurrence is the hallmark
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Herpes viruses (DNA) Simplex (HSV types I & II) primary: skin oral genital recurrence: lips (cold sore) I genitals II Zoster (VZV) primary: varicella (chicken pox) recurrence: zoster (shingles)
Slide 27-

Primary HSV I infection (Herpesvirus hominis type 1) Usually childhood Subclinical or an acute gingivostomatitis
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Recurrent HSV 1 Vesicles on the lip - ‘cold sores’ Herpetic whitlow
Slide 29-

Complications of HSV Infection Disseminated herpes simplex (Immunocompromised) Eczema herpeticum Herpes encephalitis Keratoconjunctivitis and corneal ulceration
Slide 30-

Psoriasis Types Guttate Chronic plaque Palmar plantar pustulosis Nail Pustular psoriasis Erythrodermic Psoriatic arthropathy Acrodermatitis continua of Hallopeau
Slide 31-

Management ANY IDEAS ?
Slide 32-

Management Topical emollients Tar Dithranol (Dithrocream) Vitamin-D analogues (Dovonex, Dovobet) Topical steroids TLO1 phototherapy PUVA Systemic agents
Slide 33-

ACNE
Slide 34-

Acne Closed comedones or “whiteheads” (small non-inflamed papules) Open comedones or “blackheads” Papules -small, red, inflammed follicular spots Pustules Scars: atrophic are ice-pick scars (face) hypertrophic or keloid back/chest
Slide 35-

Management ANY IDEAS ?
Slide 36-

Management Topical Benzoyl peroxide (Brevoxyl, panoxyl) Topical antibiotics (Zineryt, Dalacin-T) Retinoic acid (Isotrex) Adapelene (Differin) Antibiotics Dianette Isotretinoin (Roaccutane)
Slide 37-

Scabies Scabies mite (Sarcoptes scabei) Spread by direct physical contact. Takes 4-6 weeks to become sensitised Burrows are definitive lesions Mites can sometimes be extracted for diagnosis
Slide 38-

Treatment Topical permethrin 5% left on for 12- 24 hours applied to neck down reapplied to hands after washing repeated after 1 week Contacts must be treated to prevent re infestation. Infants and elderly need scalp treating