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Dermatology in General Practice

Dermatology in General Practice . Dr Lynne Rees. Description of skin lesions. Papule Macule Nodule Patch Vesicle Bulla Plaque. Papule . Small palpable circumscribed lesion <0.5cm. Macule. Flat, circumscribed non-palpable lesion. Pustule . Yellowish white pus-filled lesion. Nodule.

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Dermatology in General Practice

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  1. Dermatology in General Practice Dr Lynne Rees

  2. Description of skin lesions • Papule • Macule • Nodule • Patch • Vesicle • Bulla • Plaque

  3. Papule • Small palpable circumscribed lesion • <0.5cm

  4. Macule • Flat, circumscribed non-palpable lesion

  5. Pustule • Yellowish white pus-filled lesion

  6. Nodule • Large papule >0.5cm

  7. plaque • Large flat topped elevated palpable lesion

  8. patch • Large macule

  9. vesicle • Small fluid filled blister

  10. Bulla • A large fluid filled blister

  11. ECZEMA • Synonymous with dermatitis • Large proportion of skin disease in developed world • 10% of population at any one time • 40% of population at some time

  12. Features of eczema • Itchy • Erythematous • Dry • Flaky • Oedematous • Crusted • Vesicles • lichenified

  13. Types of eczema • Atopic • Discoid eczema • Hand eczema • Seborrhoeic eczema • Varicose eczema • Contact and irritant eczema • Lichen simplex

  14. Atopic eczema • Endogenous • Atopic i.e asthma, hay fever • 5% of population • 10-15% of all children affected at some time

  15. Exacerbating factors • Detergents • Infection • Teething • Stress • Cat and dog fur • ???? House dust mite • ???? Food allergens • Theory of protection from parasite

  16. Clinical features • Itchy erythematous scaly patches • Flexures of knees and elbows • Neck • Face in infants • Exaggerated skin markings • Lichenification • Nail – pitted ridged

  17. complications • Bacterial infection • Viral infections – warts, molluscum, herpes • Keratoconjunctivitis • Retarded growth

  18. investigations • Clinical • ??IgE • ??RAST

  19. Prognosis • Most grow out of it! • 15% may come back – often very mildly

  20. Treatment • Avoid irritants especially soap • Frequent emollients • Topical steroids • Sedating antihistamines – oral hydroxyzine • Treat infections • Bandages • Second line agents

  21. Triple combination of therapy • Topical steroid bd as required • Emollient frequently • Bath oil and soap substitute

  22. Principles of treatments • Creams • Ointments • Amounts required • Potential side effects • Soap substitutes

  23. creams • Cosmetically more acceptable • Water based • Contain preservatives • Soap substitutes

  24. ointments • Oil based • Don’t contain preservative • Feel greasy • Good for hydrating

  25. Topical steroids • Mild – “hydrocortisone • Moderate – “eumovate” • Potent – “betnovate” • Very potent – “dermovate”

  26. Amounts required • Emollients – 500g per week for total body • FTU – steroids • Bath oils – 2-3 capfuls per bath

  27. Discoid eczema • Variant of eczema • Atopic and non atopic • Easily confused with psoriasis • Well demarcated scaly patches • Limbs • Often infective component (staph aureus)

  28. Hand eczema • Pompholoyx – itchy vesicles or blisters of palm and along fingers • Diffuse erythematous scaling and hyperkeratosis of palms • Scaling and peeling at finger tips

  29. Hand eczema • Not unusual in atopic • More common in non atopics • Cause often uncertain • Irritants • Chemicals • Occupational history • Consider patch testing – 10% positive

  30. Seborrhoeic eczema • Over growth of yeast (pityrosporum ovale, hyphal form malassezia furfur) • Strong cutaneous immune response • More common in Parkinson’s and HIV

  31. Clinical features • Affects body sites rich in sebacceous glands • Infancy – cradle cap, widespread rash, child unbothered, little pruritus • Young adults – erythematous scaling eyebrows, nasolabial folds, forehead scalp • Elderly – more extensive

  32. Treatment • Suppressive • Mild steroid and antifungal combination • Ketoconazole shampoo • Emollients • Soap substitutes

  33. Venous eczema • Lower legs • Venous hypertension • Endothelial hyperplasia • Extravasation of red and white cells • Inflammation • Purpura • pigmentation

  34. Clinical features • Older women • Past history DVT • Haemosiderin deposition

  35. treatment • Emollients • Topical moderately potent steroids • Soap substitutes • Compression – check arterial supply first • Leg elevation

  36. Asteatotic eczema • Dry skin • Repeated soaping • Worse in winter • Hypothyroidism • Avoid soap • Emollients • Bath oils

  37. Contact and irritant eczema • Exogenous • Unusual • Worse at workplace • History of exacerbations

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