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Dermatology

Dermatology. Dr. M. Connolly Dermatology Department AMNCH. Dermatology. Focussed dermatological history Describe cutaneous findings (and other relevant findings) Formulate differential diagnosis and management plan. Dermatology Subspecialties. Paediatric dermatology Skin surgery

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Dermatology

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  1. Dermatology Dr. M. Connolly Dermatology Department AMNCH

  2. Dermatology Focussed dermatological history Describe cutaneous findings (and other relevant findings) Formulate differential diagnosis and management plan

  3. Dermatology Subspecialties Paediatric dermatology Skin surgery Contact Dermatitis Phototherapy Lasers Dermatopathology

  4. Dermatology - Introduction Skin is one of the largest organs ~1.8m2 , 16% body weight Structure and thickness vary with site Epidermis 0.1-1.4mm Dermis 0.6 – 3mm Barrier function

  5. Structure of the skin

  6. Dermatological terms Flat or raised Macule Patch Papule Nodule Plaque Wheal Filled with fluid Vesicle Bulla(e) Pustule

  7. www.dermatology.org/morphology

  8. Dermatological terms Colour Hyperpigmented Hypopigmented Depigmented (post-inflammatory hyper or hypopigmentation) Erythema Telangiectasia Purpura/petechiae Ecchymosis Haematoma

  9. Dermatological terms Secondary changes Scale Hyperkeratosis Crust Lichenification Excoriation Fissure Scar Erosion Ulceration

  10. Eczema • Types • Atopic • Discoid • Seborrhoeic dermatitis • Hand and Feet • Hyperkeratotic/fissured • Vesicular (pompholyx)

  11. Eczema Types • Allergic contact dermatitis • Irritant contact dermatitis • Asteatotic eczema/ eczema craquelé (crazy paving) • Stasic (varicose) • Neurodermatitis (lichen simplex chronicus)

  12. Eczema/Dermatitis • History • Duration • Areas affected • Precipitating/ aggravating factors • History of atopy • Family History • Previous treatments • Occupation • Hobbies

  13. Examination • Sites • Describe: wet & weepy / or dry & scaly • Any lichenification • Any evidence of infection • Bacterial infection or herpes simplex

  14. Management ANY IDEAS ?

  15. Management • Topical emollients • Topical steroids • Topical tacrolimus (protopic) • Antihistamines • Treat any evidence of infection • Phototherapy • Systemic agents: immunosuppressants

  16. Emollients • Aqueous cream • E45 cream • Oilatum cream • Silcock’s base • Aveeno • Diprobase cream • Emusifying ointment • Paraffin gel (WSP/LP)

  17. Soap Substitutes • Aqueous cream • Silcock’s base • Emulsifying ointment • Bath emollients Oilatum plus Emsulsiderm

  18. Topical Steroids • 1% hydrocortisone ointment • Eumovate ointment • Betnovate RD ointment • Betnovate ointment • Elocon ointment • Locoid ointment • Dermovate ointment

  19. Combination steroid & antibiotic • Fucidin H • Fucibet • Betnovate C • When? • How long?

  20. Bandages • Viscopaste: zinc impregnated bandages • Icthopaste: icthammol bandages

  21. Tacrolimus • Protopic 0.03% • Protopic 1% • 0.03% only licensed from 2 years upwards • Avoid if infected or herpes infection • Long-term side effects unknown • Useful in areas where potent steroids can not be used • Recently licensed for maintenance therapy

  22. Antihistamines • Sedating antihistamines • Piriton • Vallergan • Phenergan • Hydroxyzine (Ucerax) syrup

  23. Other treatments • Phototherapy • Oral steroids • Systemic agents • Azathioprine • Methotrexate • Ciclosporin • MycophenolateMofetil

  24. Infection • Skin swab • Flucloxacillin: staph • Penicillin: Strept • Erythromycin: penicillin allergy • Herpes simplex infection: aciclovir IV

  25. Herpes Simplex Virus Highly contagious by direct contact (Primary infection) Penetrates the epidermis or mucous membrane Epidermal cell destruction Virus hides latent in the dorsal root ganglia (Sensory) Reactivation – Recurrence is the hallmark

  26. Herpes viruses (DNA) Simplex (HSV types I & II) primary: skin oral genital recurrence: lips (cold sore) I genitals II Zoster (VZV) primary: varicella (chicken pox) recurrence: zoster (shingles)

  27. Primary HSV I infection(Herpesvirus hominis type 1) Usually childhood Subclinical or an acute gingivostomatitis

  28. Recurrent HSV 1 Vesicles on the lip - ‘cold sores’ Herpetic whitlow

  29. Complications of HSV Infection Disseminated herpes simplex (Immunocompromised) Eczema herpeticum Herpes encephalitis Keratoconjunctivitis and corneal ulceration

  30. Psoriasis • Types • Guttate • Chronic plaque • Palmar plantar pustulosis • Nail • Pustular psoriasis • Erythrodermic • Psoriatic arthropathy • Acrodermatitis continua of Hallopeau

  31. Management ANY IDEAS ?

  32. Management • Topical emollients • Tar • Dithranol (Dithrocream) • Vitamin-D analogues (Dovonex, Dovobet) • Topical steroids • TLO1 phototherapy • PUVA • Systemic agents

  33. ACNE

  34. Acne • Closed comedones or “whiteheads” (small non-inflamed papules) • Open comedones or “blackheads” • Papules -small, red, inflammed follicular spots • Pustules • Scars: atrophic are ice-pick scars (face) hypertrophic or keloid back/chest

  35. Management ANY IDEAS ?

  36. Management • Topical • Benzoyl peroxide (Brevoxyl, panoxyl) • Topical antibiotics (Zineryt, Dalacin-T) • Retinoic acid (Isotrex) • Adapelene (Differin) • Antibiotics • Dianette • Isotretinoin (Roaccutane)

  37. Scabies Scabies mite (Sarcoptes scabei) Spread by direct physical contact. Takes 4-6 weeks to become sensitised Burrows are definitive lesions Mites can sometimes be extracted for diagnosis

  38. Treatment Topical permethrin 5% left on for 12- 24 hours applied to neck down reapplied to hands after washing repeated after 1 week Contacts must be treated to prevent re infestation. Infants and elderly need scalp treating

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