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PLE

PLE. Common, photosensitivity eruption Adult females 20- 40 yrs, 10% women holidaying in the med! Rash takes many forms but tends to be the same for an individual

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PLE

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  1. PLE • Common, photosensitivity eruption • Adult females 20- 40 yrs, 10% women holidaying in the med! • Rash takes many forms but tends to be the same for an individual • crops of 2-5 mm pink or red raised spots occurring on the arms. Also chest and lower legs, but the face is usually spared. Burning/itch • May be blistered/dry or e.multiforme like • May be confined to ears

  2. Settles with sun avoidance, but recurs • Can deteriorate if not allowed to settle – extensive • hardening as the summer progresses and more sun can be tolerated • some very sensitive individuals even develop PMLE in the winter • immune reaction to a compound in the skin which is altered by exposure to ultraviolet radiation • short wavelength UVB but also longer wavelength UVA • Occurs through glass, sunblockers may be ineffective

  3. Prevention • Cover all affected areas • Choose UPF 40+ clothing • Broad Spectrum Sun Protection Factor 30+ semi-opaque sunscreen • Stay in the shade • Treatment • Short course of oral steroids e.g. to cover a summer holiday. • Polypodiumleucotomos extract (PLE)(Heliocare™) • Beta carotene. • Hydroxychloroquine • UVA or PUVA

  4. PLE

  5. Juvenile Spring Eruption Juvenile Spring Eruption

  6. Localised from of PLE • Sun induced, exposed areas esp skin of ears • Occurs 8-24 hrs after exposure lasting some 2 wks • Affects young males in spring (!) • Itchy red lumps forming blisters and crusts • Resolves after several weeks • Steroids/emollients

  7. Solar elastosis

  8. Melasma

  9. Blotchy pigmentation due to overproduction of melanin • Pregnancy – will resolve with time • Drugs • OCP • Sun • Sun blockers • Stop offending drugs • Azalaic acid may prevent new pigment • Salicylic acid creams • Await resolution

  10. Erosive PustularDermatosis • Rare disorder, but do see it! • Unknown aetiology • Clinical diagnosis • Sterile crusting erosions and pustules • Seen in atrophic skin sec to actinic or other damage incl cryotherapy • Yellow/brown crusts, erosions, pustules, purulent leakage and lakes of pus. • Oedema, erythema, lymphadenopathy absent

  11. Erosive Pustular Dermatosis

  12. Treatment • Remove crust with oil • Treat with potent/ultrapotent topical steroid ie dermovate • Review at 3 wks Investigations - nil

  13. Quizz: Max 20 What lesions are demonstrated? What is the condition? Closed comedones Acne

  14. 1 – what lesions are demonstrated? 2 – name the condition Pustules Acne

  15. 1 – what lesion is demonstrated? 2 – can it occur alone? Open comedone Yes Giant/senile comedone

  16. 1 - Would you refer this patient? 2 - What treatment would be considered? Yes Roaccutane

  17. 1 – What is the diagnosis? 2 – What are the two diagnostic clues? Perioral dermatitis Perioral  Vermillion area spared

  18. Nasolabial sparing Erythema Telangiectasiae Pustules Papules Rosacea 1 – Give three diagnostic features 2 – and the diagnosis

  19. 1 – Give a name to the complication affecting his nose? 2 – Name two ocular manifestations Rhinophyma Blepharitis Keratitis

  20. Seborrhoeic eczema Pityrosporum ovale 1 - Diagnosis please? 2 – What microorganism is implicated?

  21. Scarring Alopecia CDLE 1 – List two classical features of this process 2 – Give the diagnosis

  22. 1 – Name the process? 2 – Give two precipitants? Melasma Pregnancy Drugs

  23. Diagnosis? Lick eczema

  24. ?Delayed hypersensitivity reaction to oil ?PLE acquired during a recent beach holiday in Libya Or a bad case of photoshop! http://youtu.be/JlmEc8rd_Nw

  25. Thankyou!

  26. paracetamoxyfrusbendroneomycin

  27. Bacterial infections of skin • Impetigo, cellulitis/erysipelas • Folliculitis • Furuncle, carbuncle, abscess • Cutaneous Leishmaniasis • Leprosy • TB (Lupus vulgaris) • Anthrax

  28. Cellulitis

  29. Staphylococcal Folliculitis

  30. Erysipelas

  31. P

  32. Impetigo • superficial skin infection of the epidermis • characterized by translucent (“honey”) crusts • caused by S. aureus and strep. pyogenes (GABHS) • Flucloxacillin • Bactroban topical

  33. Impetigo • Two variations of impetigo • Bullous impetigo is more often caused by S. aureus • Ecthyma has a ulcerated “punched-out” base

  34. Ecythma • Ecthyma begins as a vesicle or pustule overlying an inflamed area of skin that deepens into a dermal ulceration with overlying crust. • The crust of ecthyma lesions is gray-yellow and is thicker and harder than the crust of impetigo. • A shallow, punched-out ulceration is apparent when adherent crust is removed. • The deep dermal ulcer has a raised and indurated surrounding margin. • Ecthyma lesions can remain fixed in size (sometimes resolving without treatment) or can progressively enlarge to 0.5-3 cm in diameter. • Ecthyma heals slowly and commonly produces a scar. • Regional lymphadenopathy is common, even with solitary lesions

  35. CutaneousLeishmaniasis

  36. TB (Lupus vulgaris)

  37. Viral • HSV1 • Herpes • Varicella/Zoster • Molluscum contagiosum • Exanthems

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