Dermatology

1. Dermatology Common Problems and their Treatment 2010

2. Common Terminology Macule - Flat, circumscribed non-palpable lesion

3. Papule - Small palpable circumscribed lesion <0.5cm

4. Nodule – Large papule > 0.5cm

5. Plaque - Large flat topped elevated palpable lesion

6. Vesicle – fluid filled blister

7. Bulla – large fluid filled blister

8. Acne

9. Management Mild – • Cleansing usually followed by preparations such as benzoylperoxide Moderate - • Topical antibiotics (tetracycline, oxytetracycline), plus benzoylperoxide

10. Severe – • Tetracycline 250mg bd • Doxycyline: a single 50mg capsule once a day

11. Acne Rosacea

12. Management Mild to Moderate - • Topical metronidazole 1% od • Topical azelaic acid 15% bd for patients not responding to metronidazole Severe - • Oral tetracycline or oxytetracycline. Erythromycin if allergic.

13. Eczema

14. Management • Avoid woollen fabrics, house dust, grass pollen • Emollients – • E45 to combat dry skin • Soap substitutes eg aqueous cream • Topical steroids – • Use a potent steroid and drop down to a less potent one • Dermovate should not be used by GP’s and should never be applied to the face • Oral antihistamines – reduce itching and help sleep • Antibiotics – flucloxacillin or erythromycin if penicillin allergic

15. Second Line Management • Admit • Phototherapy • Immunosuppressants – prednisolone, azathioprine, ciclosporin etc

16. Psoriasis

17. Pustular Psoriasis

18. Management General measures - • Use of a soap substitute, e.g. aqueous cream, and a bath additive e.g. Polytar emollient For localised plaque psoriasis • Dithranol

19. Mollusum

20. Management • None

21. Shingles

22. Management • Mild attacks require symptomatic treatment only • Acyclovir 800mg 5 x a day for 7/7

23. Impetigo

24. Management • Topical fusidic acid or mupirocin • Systemic treatment - oral flucloxacillin

25. Pityriasis Versicolor

26. Management • Selenium sulfide 2.5% shampoo applied neat to the rash once a week for 8 weeks, must be washed off 4-5hrs after application • Miconazole cram od for 3/52

27. Scabies

28. Management • The patient as well as the family should be treated • Anti-scabetic cream - permethrin.

29. Basal Cell Carcinoma

30. Management • Refer non urgently • Small lesions are treated by excision & biopsy • Large superficial lesions respond to cryotherapy

31. Squamous Cell Carcinoma

32. Management • Refer under the two week wait. Excision in primary care should be avoided • Excision or radiotherapy. • Metastasis is uncommon but can occur

33. Malignant Melanoma

34. Management • Refer under the two week wait. Excision in primary care should be avoided • Excision (excise 1cm of normal skin around the melanoma for every mm in depth up to 3cm) • Radiotherapy for follow up

35. Assessing Melanomas/Lesions • Major Features = 2 points each – change in size, irregular shape, irregular colour • Minor Features = 1 point each – largest diameter 7mm or more, inflammation, oozing, change in sensation • Score of 3 or more – refer urgently

36. Bullous Pemphigoid

37. Management • Seek immediate advice from dermatology • The disease is uaully self limiting and remits within 5 yrs • Corticosteroids, prednisolone 30-60mg/day • Dermovate • Potassium permanganate • Antibiotics eg tetracycline

38. The End! Thank you!