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Common skin problems
- 1. Common Skin Problems Dr. Sanjeeva Hulangamuwa Consultant Dermatologist GH Chilaw
- 2. ECZEMA
- 3. Acute eczema
- 4. Dry Eczema
- 7. Contact Dermatitis to rubber slippers
- 8. Acute Contact Dermatitis to Vicks
- 11. Eczema Symptoms and Signs • Itchy skin patches • Oozing ( weeping ) – acute stage • Pigmentary changes • Dry thick patches in chronic stages • Recurrent attacks • Can associated with asthma and allergic rhinitis • Family members may have atopy • Common sites – face and flexures – infants and children legs – adults • Worsen with exposure to certain chemicals, dust, cement, fur,etc
- 12. Eczema (cont.) Management • Weepy areas - Condys ( potassium permangenate ) wash or compression • Steroid creams – hydrocortisone, betamethasone, clobetasol • Moisturizers – aquous cream, emulsifying ointment • Oral antibiotics for acute infective eczemas • Antihistamines for itching – chlorpheniramine, cetirizine, loratidine • Avoid frequent washing and soaps • Severe and resistant cases – prednisolone, azathioprine, methotrexate, ciclosporin • Rule out immunodeficiency syndromes in severe eczemas in infants
- 13. Photodermatitis
- 24. Flexural Psoriasis in a baby
- 26. Psoriasis • Thick scaly erythematous plaques • Common sites - elbows, knees, umbilicus, scalp In some pts. whole body is involved • Scalp – scaling as in dandruff but severe • Nail changes and arthritis occur in some patients • Itching may or may not present • Family history may be positive • Rare presentations – pustular psoriasis and erythrodermic psoriasis • Diagnosis - clinically
- 27. Psoriasis • Topical application – steroid creams – hydrocortisone, betamethasone, clobetasol coal tar dithranol moisturizers – aquous cream, emulsifying ointment, liquid paraffin • Light therapy PUVA ( Psoralen tablets + ultraviolet A ) Ultraviolet B Solar PUVA – Expose to early morning sunlight 2h after taking the psoralen tablet
- 28. Psoriasis • Systemic treatment methotrexate, acitretin, ciclosporin,etc • Newer therapies Biological agents ( expensive )
- 29. INFECTIONS
- 31. Secondary bacterial infection of chicken pox scars
- 32. Staphylococcal scalded skin syndrome
- 35. Staphylococcal scalded skin syndrome • Common below 4y of age • Irritable • Refuse feeds • Febrile • Erythema and scaling around mouth, genital region and flexures • Skin is tender • Treatment flucloxacillin cloxacillin
- 36. Furuncles
- 37. Furuncles • Common in preschool children • Painful pustules and papules • Some rupture and discharge pus • Fever may occur • Common on face and scalp • Can be recurrent • Treatment oral – cloxacillin, erythromycin topical – soframycin ( framycetin ), fucidic acid, mupirocin
- 38. Impetigo
- 41. Bullous impetigo
- 42. Impetigo • Common in children • Honey colored crusted plaques • Sometimes blisters may occur ( bullous impetigo ) • Commonly occur peri-orificial ( around mouth, nose ) • Painful • Appears suddenly in a few days • Treatment Oral – cloxacillin Topical – soframycin, fusidic acid, mupirocin creams
- 43. Other bacterial infections • Eg; gram negative bacterial infections ( eg; pseudomonas ) anaerobic infections MRSA ( methicillin resistant staphylococcus aureas ) secondary bacterial infection of skin lesions ( eg; chicken pox scars, eczema, scabies )
- 44. VIRAL INFECTIONS
- 46. Herpes simplex infection • Common in immuno – compromised patients Eg; AIDS, Diabetes, malnourished, etc • Common sites – lips, genital area • Presents with sudden eruption of painful grouped vesicles • Genital herpes is a sexually transmitted disease • Can be recurrent in some patients Treatment • Aciclovir • Topical or oral antibiotics to prevent secondary infections
- 47. Chicken pox
- 49. Chicken pox • Fever • Body aches and pains • Vesicular skin eruption • Starts from head and gradually spreads to trunk and limbs • Crusting occurs in 7-10 days Complications • Common in adults and in immuno suppressed individuals eg; pneumonia, secondary bacterial infection, myocarditis, thrombocytopenia, encephalitis, osteomyelitis, hepatitis Treatment • Aciclovir • Antibiotics if needed
- 50. Chicken pox • Chicken pox in pregnancy ( 1st trimester ) may lead to foetal abnormalities Prevention varicella vaccine
- 51. Herpes zoster
- 53. Herpes Zoster • Treatment aciclovir antibiotics if necessary for the secondary bacterial infection
- 55. • Treatment spontaneously resolves sometimes larger lesions – prick with a sterile needle and extrude the contents trichloroacetic acid electro cautery
- 56. Viral warts
- 57. Plantar warts
- 58. Plane warts
- 59. Treatment • Cryotherapy • Electrocautery – in a few occasions • 5% imiquimod – genital warts • Wart implantation • Hypnotherapy
- 60. Hand foot mouth disease
- 63. Tinea corporis
- 64. Tinea corporis
- 66. Tinea incognito
- 67. Tinea capitis
- 68. Kerion - due to zoophilic fungal infection
- 70. Tinea infections • Reddish or skin colored patches • Common sites – groins, buttocks, submammary areas, etc • Annular or polycyclic • Elevated edge • Can be itchy Treatment • Topical antifungals – miconazole, clotrimazole, terbinafine • Oral antifungals – griseofulvin, terbinafine
- 72. Treatment • Ketoconazole – oral and topical • Itraconazole – oral • Fluconazole - oral
- 73. Candidiasis
- 76. Candidiasis • Common sites Oral mucosa, genital mucosa, flexural areas ( neck, groins ), periungual ( around the nails ) • Precipitating conditions Diabetes mellitus, AIDS, other immuno suppressed pts, Patients on prednisolone and broad spectrum antibiotics Treatment miconazole oral paste 2% ketoconazole cream oral fluconazole, itraconazole
- 78. Madura foot
- 79. Fungal infections • There are so many other different fungal infections • Some are deep fungal infections • Needs skin biopsy and fungal cultures to diagnose them • Needs prolong oral antifungal treatment
- 81. Scabies
- 84. Crusted scabies
- 87. Scabies • Very itchy skin condition • Papular eruption • Common sites are finger webs, genital region, abdomen and thighs • Can lead to crusted scabies in neglected patients Investigation Skin scrapings – will reveal the parasite – Sarcoptes scabei • Treatment 5% Permethrin Sulphar ointment Benzyl benzoate Should treat the family members at the same time
- 88. LEPROSY • Caused by Mycobacterium Leprae • Very slow growing bacterium • Has a long incubation period before the onset of the clinical disease • Common in over crowded places with poor ventilation
- 94. Tuberculoid Leprosy • Presents with Hypopigmented patches Sensory impairment Enlarged superficial nerves Treatment • Multi drug treatment ( MDT – PB ) for 6months ( pauci bacillary ) Rifampicin Dapsone • However MDT ( MB ) for 12 months needed for some patients
- 96. Lepromatous Leprosy • Can be infective to others • Clinical Features skin colored and erythematous nodules Some have leonine facies Infiltration of the ears Peripheral neuropathy Trophic ulcers Certain internal organs could be involved • Treatment Multi drug treatment ( MDT – MB ) for 12months ( multi bacillary ) Rifampicin Clofazimine Dapsone
- 98. Ulnar claw hand
- 99. Trophic ulcers
- 100. Type 1 reaction
- 101. ENL (type 2) reaction
- 102. Treatment – Lepra reactions prednisolone azathioprine clofazimine thalidomide
- 103. Cutaneous Tuberculosis (Skin TB) • Long standing non healing skin patches • Various morphological patterns present Investigations • Skin biopsy • Mantoux test • Chest Xray • PCR studies • T spot test Treatment • Anti TB therapy
- 104. Verrucous TB
- 105. Scrofuloderma
- 106. Lupus vulgaris
- 117. Cutaneous Leishmaniasis • Non healing volcano like skin lesions • Occur on exposed areas of the body • Common in certain parts of the country North central province, southern province Investigations Skin smears to identify the parasite Skin biopsy for histology Treatment Liquid nitrogen Sodium stibo gluconate injection ( local / IM )
- 119. Zn deficiency
- 120. Zn deficiency
- 121. Zinc deficiency • Common below 2 years • Adults – in alcoholic pts. • Eczema like skin eruptions • Red, dry and scaly skin patches over the genital area, face and flexures • Child is irritable • Refuse feeds Investigations Serum Zn level, alkaline phosphatase Treatment Zinc replacement
- 122. Other nutritional deficiencies • There are many other nutritional deficiencies which cause skin manifestations Eg; Iron deficiency Protein energy malnutrition Biotin deficiency Essential fatty acid deficiency B12 deficiency
- 123. DRUG ERUPTIONS
- 124. Drug Eruptions • Drug eruptions can present with various patterns • Proper drug history is important in diagnosis • Some are mild and some can be life threatening • Internal organs can be affected in some drug reactions
- 126. Urticaria
- 127. Fixed drug eruption
- 128. Striae due to prolong application of topical steroids
- 136. Stevens johnson syndrome and toxic epidermal necrolysis Can be life threatening Management stop the offending drug immediately monitor the vital functions investigate to detect the internal organ involvement (liver and kidney) skin care oral care eye care – urgent eye referral if eyes are involved increase hydration and fluid balance chart antibiotics to prevent secondary infection prednisolone and IV immunoglobulins sometimes antiepileptics
- 140. EXFOLIATIVE DERMATITIS • More than 90% of the skin is involved • Itching • Erythema ( redness ) • Scaling • Dehydration • Low urine out put • Aetiology Common causes Eczema, Psoriasis, Drugs, Lymphomas, etc
- 141. Treatment Moisturizers – aquous cream, emulsifying ointment liquid paraffin Increase oral fluids and to maintain a fluid balance chart High protein diet Antibiotics if there are signs of infection Antihistamines ( eg; chlorpheniramine ) for itching skin biopsy Need to find the aetiology and treat the cause Needs regular follow up
- 142. ACNE
- 145. Punch out & Ice pick Scars
- 146. Acne • Very common skin problem • Starts around puberty • Chronic inflammation of the pilosebaceous units • Clinical features comedones, papules, pustules, cysts and scars face, chest and upper back are usually involved • Need to treat early to prevent unsighty scars
- 147. Treatment Depends on the sex, age, severity and extent of the disease • Topical benzoyl peroxide antibiotic creams and lotions – erythromycin, clindamycin retinoid creams and gels • Oral antibiotics – erythromycin, doxycyclines hormonal – cyproterone acetate with ethynyl estradiol isotretinoin ( most effective ) • Chemical peeling salicylic acid and trichloroacetic acid
- 148. vasculitis
- 149. Vasculitis • Inflammation of blood vessels • Hall mark is the ‘palpable purpura’ • Erythematous papules and patches on dependent parts of the body • Fever, arthralgia, abdominal pain, malaise, etc
- 150. Approach to the patient Suspect vasculitis Exclude non-vasculitic disorders that mimic vasculitis Investigate to establish vasculitis evaluate the extent of the systemic involvement look for underlying disorders
- 151. Sweets syndrome
- 152. Erythema nodosum
- 153. SKIN CANCERS
- 154. Skin cancers • Common in white skin individuals • Rare in Asians • Eg; Basal cell carcinoma, Squamous cell carcinoma, Melanoma, etc Risk factors high sun exposure white skin family history immunosupression chronic ulcers and scarring arsenic ingestion
- 155. Basal cell carcinoma
- 157. Basal cell carcinoma
- 160. Malignant melanoma
- 161. Management complete excision radiotherapy look for metastases ( local and distal spreading )
- 162. BLISTERING DISEASES
- 163. Causes of blisters • Frictional • Cold and Thermal injury • Bullous Impetigo • Diabetes • Insect bites • Drug reaction • Herpes Simplex infection • Chicken Pox, Herpes Zoster • Epidermolysis Bullosa • Autoimmune Eg; Pemphigus, Pemphigoid
- 164. • There are many causes for blisters • We must find the cause and treat • Some conditions such as auto immune blistering disorders need special treatment and regular follow up
- 165. Pemphigus Vulgaris
- 166. Pemphigus Vulgaris • Flaccid blisters • Easily ruptured and left with erosions • Mouth, genital area and eyes can be involved • Can be life threatening • Common in Asians Treatment • Depends on the severity of the disease • Mainstay of treatment is steroids • IV dexamethasone and cyclophosphamide pulse therapy • Antibiotics for the secondary infection • Sometimes IV Immunoglobulins and plasmapharesis
- 167. Bullous Pemphigoid • Tense blisters • Oral lesions are very rare • Common in old age • Incidence is high in west • Less severe than Pemphigus Treatment • Prednisolone • Azathioprine • Dapsone • Tetracycline • Topical steroids
- 172. Epidermolysis Bullosa • Blisters appear on frictional sites • These are mechanical blisters • Exacerbates with sweating, hot and humid climates Treatment • Prevention of repeated trauma • Loose clothes • Keep the skin dry and clean • Minimal handling
- 173. Linear IgA disease ( chronic bullous dermatosis of childhood )
- 174. Linear IgA disease ( chronic bullous dermatosis of childhood )
- 176. Linear IgA disease ( chronic bullous dermatosis of childhood ) • Tense blisters • Mainly peri-orificial ( around mouth and genitalia ) • Oral mucosa can be involved Treatment • Dapsone • prednisolone
- 178. • Various systemic diseases including Diabetes Mellitus have skin manifestations • Therefore skin features are important to detect underlying illnesses
- 179. Carbuncle on the nape of a diabetic man. This is a staphylococcal infection of several contiguous hair follicles. Carbuncle
- 180. Diabetic Bulla
- 181. Older lesions of necrobiosis lipoidica are often pigmented as well as obviously atrophic, but often lose the more inflamed appearance of more recent lesions. Necrobiosis Lipoidica
- 182. Melasma
- 183. Pityriasis rosea
- 184. Pyogenic granuloma
- 185. Dermatitis artefacta by proxy
- 186. Urticaria
- 187. Miliaria
- 188. Miliaria
- 189. Vitiligo
- 190. Lichen planus
- 191. Granuloma annulare