Derm table - Summary with pics PDF

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Summary

Summary with pics...

Description

Name Macule

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Description A flat area of altered colour Can't feel it Circumscribed lesion Change in colour or texture Macule is 1cm in diameter Image on right well defined hyperpigmented patch with irregular boarders

Patch

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Plaque

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Scaly raised lesion with a flat top Often white and red I.e. Psoriasis

Papules

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Raised off them skin Domed shaped lesion Usually 1cm With a deeper component Well defined erythematous nodule with a smooth surface

Vesicles

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Fluid filled lesions which are 5cm - Increasing size - Pain - Deep anatomical location - Characterised by papules on an erythematous base - Usually develops by early childhood and resolves during teenage years but may reoccur - Cause not fully understood - A primary genetic defect in skin barrier

ACNE VULGARIS

function - loss of function variants of protein filaggrin Exacerbating factors - Infections, allergens (chemicals, food, dust, pets), sweating, heat and severe stress - Commonly presents is an itchy erythematous dry scaly patch - More common on face and extensor aspects of limbs in infants - Common on flexor aspects in children and adults - Acute lesions are red, vesicular and weepy - Chronic scratching/rubbing can lead to excoriations & lichenification Mx - General measures avoid known exacerbating agents - Frequent emollients +/- bandages and bath wash substitute - Topical steroids for flare ups - Oral therapies - antihistamines for symptomatic relief - Abx for secondary bacterial infections (fluclox) and antivirals for secondary herpes infections - Phototherapy and immunosuppressant's e.g. Oral practise alone, azathioprine for severe non responsive cases - An inflammatory disease of the pilosebaceous follicle - Over 80% of teenagers aged 13-18 yrs - Non-inflammatory lesions (mild acne) – open & closed comedomes (white & black heads) - Inflammatory lesions (mod to severe acne) – papules & pustules - Face, neck and chest - Not normal & risk of scarring Mx - Topical therapies for mild acne – benzoyl peroxide & topical or oral Abx - Topical retinoids (anti-inflamm) - Oral therapies (mod to severe acne) – oral Abx & anti-androgens in females

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PSORIASIS

Oral retinoids for severe acne o Rooxetane or Accutane – best Tx but SEs o Teratogenic

Causes - Hormonal – androgens - A chronic inflammatory skin disease due to hyper proliferation of keratinocytes and inflammatory cell infiltration - Always ask about joint pain in newly diagnosed psoriasis - Chronic plaque psoriasis is the most common type - Guttate = raindrop lesion see 2nd pic o Usually in children & young adults o Usually after strep infection Lesions are small, round or oval (2 mm to 1 cm in diameter) scaly papules. o Usually first presentation in kids or young adults o They may be pink or red, but this can vary depending on the person's skin colour. o Lesions occur all over the body, usually in large numbers and particularly on the trunk and proximal limbs (although the distal limbs can also be involved). o Guttate psoriasis can occur on the face, ears, and scalp, but is rarely seen on the soles of the feet. o Responds well to light therapy - Seborrheic – nasolabial - Flexural – body folds Presentation - Well demarcated red scaly plaques - Lesions can sometimes be itchy, burning or paying for - Common on the extensor surfaces of the body and over the scalp - Capillary bleeding due to scratching and gentle removal of scales – auspitz sign Precipitating factors

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Trauma Infection i.e. Tonsilitis Drugs Stress Alcohol

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General measures avoid known precipitants Emollients to reduce scales Topical therapies for localised and mild psoriasis - vitamin d analogues, topical corticosteroids Phototherapy for extensive disease All therapies for extensive and severe psoriasis or psoriasis with systemic involvement – biologics o Methotrexate o Retinoids o Ciclosporin A blistering skin disorder which usually affects the elderly

Mx

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BULLOUS PEMPHIGOID

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Causes - Autoantibodies against antigens between the epidermis and dermis causing a sub epidermal splint in the skin Presentation - Tense, fluid filled blisters on an erythematous base - Lesions are often itchy knew line may be preceded by a non specific itchy rash - Usually affects the trunk and limbs Mx - Wound dressings where required common monitor for signs of infection - Topical steroids for localised disease - Oral therapies for widespread disease; steroids, combination of oral tetracycline and nicotinamide, anne immunosuppressive agents - Dermovate or steroids or doxycycline

PEMPHIGUS VULGARIS

VENOUS ULCER

ARTERIAL ULCER

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A blistering skin disorder which usually affects the middle aged

Causes - Autoantibodies against antigens within the epidermis causing an intraepidermal splint in the skin Presentation - Flaccid, easily ruptured blisters forming erosions & crusts - Lesions are often painful - Usually affects the mucosal areas Mx - Admit as risk of infection - Oral therapies - high dose oral steroids, immunosuppressive agents e.g. Methotrexate, azathioprine - Often painful - Worse standing - Large commercial oh irregular ulcer - Acts you dative and granulating base Associated features - Warm skin - Normal peripheral pulses - Leg oedema - Hemosiderin - Melanin deposition (brown pigment) - Lipodermatosclerosis - Atrophie blanche (white scarring with dilated capillaries) RF - History of venous disease e.g. Varicose veins, DVT Site - Malleolar area more common over medial and lateral malleolus Ix - ABPI 0.8-1 Mx - Compression bandage o Exclude arterial insufficiency first - Painful especially at night - Worst one when legs elevated - History of arterial disease e.g. Atherosclerosis - Small, sharply defined deep ulcer - Necrotic base Site

Pressure and trauma sites e.g. Pretibial, supramalleolar and distal points like the toes Associated features - Cold skin - Weak or absent peripheral pulses - Shiny pale skin - Loss of hair Ix - ABPI...