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dermatology module dr rangitha allan gp with special interest in dermatology. coventry tpct march 2007

Structure of the Skin. Largest organ of the body, consists of:epidermisdermis subcutaneous fat skin appendages. Functions of the skin. Protective barrier against the environmentThermo regulationMetabolismSensationInflammation. . A skin problem is the fourth most commonreason for consultations in primary care.70% of consultations arise from seven conditionsAcneEczemaPsoriasisViral warts and other skin infectionsTumoursVascular lesionsLeg ulcers.

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dermatology module dr rangitha allan gp with special interest in dermatology. coventry tpct march 2007

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    1. DERMATOLOGY MODULE

    3. Functions of the skin Protective barrier against the environment Thermo regulation Metabolism Sensation Inflammation

    4. A skin problem is the fourth most common reason for consultations in primary care. 70% of consultations arise from seven conditions Acne Eczema Psoriasis Viral warts and other skin infections Tumours Vascular lesions Leg ulcers

    5. What is this? Psoriases Eczema Scabies Tinea Corporis

    6. Eczema Eczema is characterised by erythema and pruritis In the acute phase there are characteristically vesciles or small blisters In the chronic phase there is lichenification cracking or fissuring of the skin

    7. Is it Eczema ? Tinea infections can mimic eczema Tenia pedis on the feet Tinea corporis Tinea of the hand - unilateral and in manual workers -scaling is pronounced in the palmar creases Psoriasis – atypical form Scabies can trigger an eczema reaction

    8. Tinia Corporsis

    9. Standard dermatological terms used in and around eczema Erythema: redness due to increased skin perfusion e.g. eczema, drug reactions

    10. Vesicles a fluid-filled circumscribed elevated lesion less than 1 cm in diameter

    11. Eczema is classified into Endogenous eczema e.g. atopic eczema seborrhaic eczema Exogenous eczema which could be divided into a) irritant contact – carried by external chemicals b) allergic contact – metal, fragrance, lanolin

    12. As a general rule Endogenous eczemas are diagnosed by the distribution and morphology of the rash Allergens through patch testing Irritants by the history

    13. Treatment of Eczema Avoiding irritants / allergens Triple therapies: emollients washing advice/aids topical steroids Adjunct therapies: bandaging/wet wraps antibiotics antihistamines 4. Other therapies: dietary manipulation complimentary therapies systemic therapies

    14. Psoriasis Occurs in 1-3% of the population. Aetiology of psoriasis is unknown, -the focus is on immunopathogenisis Psoriasis has typical characteristic features and presentations. The most common presentation is chronic plaque psoriasis.

    15. Chronic plaque psoriasis presents with Well demarcated Raised Salmon pink coloured Scaly Patches on the extensor aspects of the limbs Elbows Knees Lower back and scalp

    16. Another common presentation is Guttate Psoriasis Presents in childhood and adolescents Usually follows a streptococcal sore throat Self limiting in 8-10 weeks

    17. Flexural psoriasis Axillae Groins Inframammary grooves

    18. Psoriatic nail

    19. Arthropathic psoriasis

    20. Which of the pictures below are showing acne? Top picture

    21. Acne May affect up to 40% of the population at some time in their lives. Aetiology: True cause is unknown A combination of factors are responsible A high rate of sebum secretion micro-comedone formation Sebum inspissation inflammation

    22. Distributions: Face Chest Shoulders Back

    23. Severities Mild - comedones Papules

    24. Moderate More papules Few pustules

    25. Severity of acne – face

    26. Psychological effect Psychosocial effect

    27. Management recommendations Treat early Show empathy with positive approach Use topicals Anti comedonal e.g. adapalene Antibiotics Topical retinoids Use oral antibiotics Review therapeutic effect after 2-3 months Refer for systemic retinoids in all severe acne

    28. Skin infections Viral infections Warts – human papilloma virus Herpes labialis Herpes zoster

    29. Zoster

    30. Bacterial Infections Superficial cutaneous infections Erythrasma – corynebacturium minutissimum Intertrigo = in opposing skin sites gp A, B streptococcus C minitissimum Pyodermas (on the epidermis) Impetigo – staph aureus Abscess, furuncle and carbuncle Caused by staph aureus

    31. Intertrigo

    32. Soft tissue infections Erysipelus Gp A B – haemolytic streptococci rarely staphylococcus Cellulitis

    33. Mycobacterial infections Leprosy – lupus pernio TB – lupus vulgaris

    34. Lupus Vulgaris

    35. Infestations and Bites Scabies: mites transmitted by close contact itchy specially at night Diagnosis – look for burrows / mites Distrubutions Finger webs Genitals Breasts Umbilicus Axillae / groin

    36. Rash

    37. Mite

    38. Management of Scabies Permethrin 5% cream (lyclean) Malathion 0.5% aquous lotion Treat all close contacts Wash beddings/towels/clothing at 60oC Advise regarding administration of topicals properly Inform patients that the itching will not subside for 4-6 weeks

    39. Lice Body lice Head lice Diagnosis by identifying the lice/eggs Management Personal care Wet combing/bug busting Permethrin 5% Malathion carberyl 1% aquous solution

    40. Head Lice

    41. Bites Fleas Bed bugs Ticks Itchy, linear lesions often on legs.

    42. Managment Antihistamine Antibiotics if infected Eurax cream Bite repellent sprays

    43. What is this? Tinea Corporis Annular Eczema Psoriasis Erythema annulare

    44. Dermatology Reading List Core Text: 1 ABC of Dermatology 4th edition Paul K Buxton BMJ Publishing Gp Ltd. Roxburghs common skin diseases. Mark R. Arnold, A Hodder Headline Grp publications Clinical Medicines. Kumar & Clarke Differential Diagnosis in Dermatology. 3rd edition Richard Ashton & Barbara Leppard

    45. Recommended Reading: Oxford Textbook of Medicine Weatherall, Ledingham & Worrell Reference: Textbook of Dermatology Rook, Wilkinson & Ebling Blackwell Science Ltd

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