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Introduction To Dermatology

Introduction To Dermatology. Dr D J Barker St Luke’s Hospital, Bradford. What Are the Functions of the Skin?. Temperature regulation Water conservation Protection (mechanical, UV, microbes) Sensation Synthesis & storage Psycho-sexual. Why Refer to a Dermatologist?. Diagnostic difficulty

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Introduction To Dermatology

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  1. Introduction To Dermatology Dr D J Barker St Luke’s Hospital, Bradford

  2. What Are the Functions of the Skin? • Temperature regulation • Water conservation • Protection (mechanical, UV, microbes) • Sensation • Synthesis & storage • Psycho-sexual

  3. Why Refer to a Dermatologist? • Diagnostic difficulty • Management advice • Failure of agreed treatment protocol • Patient counselling or education • Increasing use of potent topical steroids • Special treatment e.g. PUVA • Special investigation e.g. Patch Tests

  4. In-patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  5. In-patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  6. Infections - Erysipelas • Fever & Rigor • Defined erythematous rash • Leg > face >elsewhere • Haemolytic streptococcus • Mild pre-existing skin disease • IV Benzyl penicillin • Lymphoedema and relapse

  7. Infections – Herpes simplex • Severe primary infection • Kaposi’s varicelliform eruption • Atopic eczema • Cutaneous T-cell lymphoma • Darier’s disease • IV Aciclovir • Anti-staphylococcal antibiotic

  8. Infections - Herpes Zoster • Varicella – Zoster virus • Pain confined to a single dermatome • Vesicles confined to single dermatome • Patients are infectious • IV Aciclovir

  9. In-Patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  10. Urticaria • May be associated with angioedema • Vasoactive amine release from mast cells • Acute attacks frightening, not dangerous • Most attacks have no simple cause • Antihistamines

  11. Anaphylaxis • Urticaria – angioedema • Bronchospasm, Laryngeal obstruction • Hypotension • Penicillin, peanuts, latex, insect stings • Adrenaline • Hydrocortisone & antihistamines • Oxygen & IV fluids

  12. In-Patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  13. Drug eruptions - 1 • Morbilliform • Toxic epidermal necrolysis • Fixed drug eruption • Stevens-Johnson syndrome • Lichenoid drug rash • Acneiform

  14. Drug eruptions - 2 • Any drug, any rash, any time • Likely: sulphonamides, penicillins • Unlikely: digoxin, insulin • Suspect recent agents • Stop inessential drugs • A dermatologist may not solve your problem

  15. In-Patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  16. Connective tissue diseases • Lupus erythematosus • Dermatomyositis • Systemic sclerosis • PAN – Wegener’s granulomatosis

  17. In-Patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  18. Erythema nodosum • Sarcoidosis • Post-streptococcal • TB • Inflammatory bowel disease • Leprosy • Histoplasmosis, coccidiomycosis

  19. Erythema multiforme • Oral, Ano-genital & Cutaneous • ‘Target lesions’ are acral • Often follows herpes simplex • Lasts 10-14 days • May be recurrent

  20. In-Patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  21. Cutaneous markers • Neoplasia • Acanthosis nigricans, Dermatomyositis • Secondaries & infiltrates • Non-neoplastic • Sarcoidosis and xanthomas, • Endocrine: e.g. necrobiosis, PTM • Inherited conditions • Neurofibromatosis • Tuberous sclerosis

  22. In-Patient Dermatology • Infections • Urticaria & angioedema • Drug eruptions • Connective tissue diseases • Erythema nodosum & multiforme • Cutaneous marker of systemic disease • Severe pre-existing skin disease

  23. Severe pre-existing skin disease • Erythroderma • Extensive eczema • Acute pustular psoriasis • Leg ulcers – venous eczema • Photosensitivity

  24. Introduction To Dermatology Department of Dermatology (D2:F4) St Luke’s Hospital, Bradford Derek Barker Andrew Wright Kate London Suzanne Hatfield

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