Urticarial / Pruritus (cardinal symptom) / § Wheals
(swelling of upper dermis) / § Oral h1 histamine are the 1st line treatment
§ (loratadine)
angioedema / Swelling is the major manifestation
Painful or burning but not puritus / § Deep dermis
§ Face or part of extremity
ACD / pruritus / § Presents as eczematous, scaly edematous plaques with vesiculation distributed in areas of exposure
§ bilateral if the exposure is bilateral / § Avoid exposure to the offending substance
§ mild to moderate cases topical steroids of medium to strong potency for a limited course
§ In severe cases, a short course of systemic steroids
§
ICD / Pruritus can range from mild to extreme
Pain is a common symptom / Mild irritants produce erythema, chapped skin, dryness and fissuring after repeated exposures over time / * Identification and avoidance of the potential irritant is the mainstay of treatment
* Topical therapy with steroids to reduce inflammation and emollients to improve barrier repair are usually recommended
VITILIGO / depigmentation / To diagnose Vitiligo:
- Woods lamp
- Biopsy. / no definite treatment but it can be well controlled.
- Focal+ unilateral/segmental → Topical treatment.
- Vulgaris → Phototherapy
- Universal → De-pigment the small normal areas (bleach).
1- Sunscreen
2- Skin camouflage
3- Topical (limited treatment)
- Topical Tacrolimus
- (steroid) → The drug of choice
- Outdoor topical
- psoralen (Topical PUVA)
4- Phototherapy
5- Systemic treatment
6- Surgical
7- Depigmentation (bleaching agent)
Albinism / Lack of pigment / 1- Sun avoidance
2- Total sunblock
3- Regular clinical review
Chloasma / Mainly affect the face / 1- Sunscreen
2- Bleaching cream
3- Chemical peeling
4- Stop the predisposing factors
Organism / Disease / Investigation OR Note / Treatment
Malassezia furfur / SEBORRHOEIC ECZEMA / erythema, greasy yellowish scales / Keratolytic
Mild top. Steroid
antifungul
Leishmania / Leishmaniasis / · Skin biopsy
· Histopathology with Gimsa stain
· Leishman-Donovan bodies
· Culture
· PCR for DNA / 1- Resolve spontaneously
2- Antimony Pentostam
3- Cryothearpy.
4- Laser ablation.
5- Systmic antifugal.
sarcoptes scabiei / Scabies / · 1.pruritus mainly at night
· 2. Other member of the family also having severe pruritus
· 3. Pruritus and skin eruption is more severe in the flexors
· Document See the mite or eggs / 1- Permethrin cream
2- (1st line)
3- Lindane cream
4- Malathion lotion
5- 2.5% sulphur ointment
1- Head lice (Pediculosis Capitis)
2- Body lice (Pediculosis Corporis)
3- Pubic lice (Pediculosis Pubis) / PEDICULOSiS / The diagnosis can be conformed by seeing the lice eggs / 1- Best treatment is SHAVING for head and pubic lice. Alternatives: Permethrin creame rinse (1st line)
2- Malathion lotion
Human papilloma virus / WART
HERPES SIMPLEX / Human Herpes virus I and II / 1- Tzank smear
The Microscope will show ( Multinuculated Gaint cells )
2- Direct fluorescent antibody test
3- Viral culture
4- Blood serology
Poxvirus / Molluscum Contagiosum / ? / ?
Organism / Disease / Investigation-Note / Treatment
Staphylococcus aureus / Folliculitis / • beard area, axillae or buttocks
• Legs—Chronic folliculitis / • Superficial folliculitis
– folliculitis
• Deep folliculitis (next)
– Furuncle and carbuncle
Sycosis barbae
Both (Aureus+group Abeta hemolytic) / impetigo / • The diagnosis is usually made on clinical grounds.
• Gram stains or swabs / - Mild infection and localised lesions
- Topical antibiotics
- Widespread lesions or more severe infection
- Oral Flucloxacillin
Staphylococcus aureus / Furuncle / • May have Fever
• healing leave a scar / - drainage of pus and Systemic treatment with flucloxacillin
Organism / Disease / Investigation / Treatment
Staphylococcus
Aureus / Carbuncle / • / - Incision and drainage .
- Needs both topical and systemic antibiotics.
S. aureus / Sycosis barbae / • / Localized inflammation is treated topically Extensive disease is treated with oral antibiotics
group A streptococci / Cellulitis / • malaise, chills, and fever / • Elevation and rest
• systemic antibiotics oral or I.V
• Recurrence after antibiotic treatment happens
PARONYCHIA / • / - warm water compresses
- topical or systemic antistaphylococcal antibiotic
•
Staphylococcus aureus / STAPHYLOCOCCAL SCALDED SKIN
SYNDROME / • / - oral or intravenous flucloxacillin
- The patient’s skin lubricated with light lotions
Acne
· Acne vulgaris:
- mostly the face then chest and back
· Neonatal acne:
- 1st and 6th weeks – nose and cheeks
· Infantile Acne: 3-6 months
· Acne fulminans:
- 13-17 years
- Lab shows ESR
- Treated by isotretinion
- Associated sumptoms (fever-malaise-myalgia-arthritis- bone pain)
· Acne Conglobata:
- trunk more the face
- associated with XYY Syndrome
- resistance to treatment
- reat the underlying cause
· Treatment
- Topical Keratolytic
1. Retinoid (Retinoic acid 0.025, 0.05, 0.1%)
2. Adapalene (Differin 0.1%)
3. Salicylic acid à Also treat post inflamatory pigmentations
4. Benzoyl peroxide (peeling agent and antimicrobial)
5. Azelaic Acid (10, 15, 20 %)
- Topical Antibiotic: Used in mild to moderate cases
1. Topical clindamycin (Dalacin T)
2. Erythromycin
- Systemic therapy
1. Antibiotic
2. Tetracycline
3. Doxycycline à the best choice-safe- but it has teratogenicity
4. Minocycline (blue grey discoloration)
5. Erythromycin
6. Usually combination therapy is useful: give Abx + creams
- Systemic Retinoids
§ Isotretinoin caps (Roaccutane): 0.5 – 1 mg/kg -The most effective drug for acne-
§ Relapse is minimal with cumulative dose of 120 – 150 mg/kg.
§ Teratogenicity: Retinoid - induced embryopathy.
§ Pregnancy must be prevented during treatment and for at least 1 month after discontinuing the drug.
§ Mild Acne
1. topical antibiotic . Ex. Clindmaycin .
2. topical keratolytic
• Moderate acne
1. Topical benzoyl peroxide
2. Oral Tetracycline or erythromycin
3. If no response refers for systemic retinoic acid
• Severe acne
- Controlled in almost all cases by isotretinoin (females should take contraceptive pills)
Rosacea
Medications that induce flushing include:
1. all vasodilators,
2. calcium channel blockers
3. nicotinic acid
4. morphine, amyl and butyl nitrite
5. cholinergic drugs
6. bromocriptine
7. tamoxifen
8. cyproterone acetate
9. systemic steroids and cyclosporine.
Differential diagnosis include:
1. Seborrheic dermatitis
2. Steroid folliculitis/Perioral Dermatitis
3. Acne vulgaris
4. Erythromelanosis faciei and keratosis pilaris rubra
5. Lupus erythematosus
6. Lupus miliaris disseminatus faciei
· Treatment
1. Sunscreens
2. Avoidance of aggravating factors.
3. Topical medications include:
4. Metronidazole .
5. Sodium sulfacetamide and sulfur
6. Azelaic acid
7. Benzoyl peroxide
8. Tretinoin
9. Erythromycin and Clindamycin
• Oral medications include:
1. Tetracyclines: the most commonly prescribed oral medications for the treatment of rosacea.
2. Erythromycin (for children with granulomatous perioral dermatitis)
3. Isotretinoin
· Laser and light therapy: slides
· Treatment of Phymatous Rosacea
1. Early to moderate Phymatous changes could be treated with Isotretinoin.
2. Advanced phyma is treated with surgery or surgery followed by isotretinoin.
3. Electrosurgery
4. Laser CO2 ablation.
Eczema
· Acute
1. Weeping
2. Papules
3. vesicles & bullae
· Chronic
1. Dryness
2. Redness
3. Lichenification
4. scaling & fissuring
· SEBORRHOEIC ECZEMA
- infants
1. cradle cap
2. face
3. flexures
- Adults
1. Scalp - dandruff
2. Retro-auricular area
3. Face, blephritis, conjunctivitis
4. Trunk
· Treatment
1. no permanent cure
2. keratolytics
3. mild topical steroids
4. antifungals
· DISCOID ECZEMa: Limbs
· POMPHOLYX eczema: palms & soles characterized by vesicles & bullae
· PITYRIASIS ALBA:
- ill-defined erythematous scaly patches
- 3-16 years, atopic eczema
- face, neck, arms
· Treatment:
1. Emollients
2. Tar
3. 1% hydrocortisone
· STASIS ECZEMA:
- often obese
- lower legs
- edema, varicosities, purpura, ulceration, infection
Alopecia
· Alopecia Areata:
- Differential Diagnoses
1- Tinea capitis
2- trichotillomania
3- secondary syphilis
- Treatment:
1- observation
2- intralesional corticosteroids
3- skin sensitizers (anthraline+DPCP)
4- Topical steroids
5- Systemic Steroids
6- Cytotoxic Rx
7- Phototherapy
8- Minoxidil
9- Hair Transplant
- For localized patchy Alopecia Areata
1- Steroid both local (intralesional and topical)
2- systemic (in short course).
· Treatment of Androgenic Alopecia
1- Topical:Neoxidil 2%- 5% solution
2- Systemic: Fenastride or Spironolactone
3- Surgical treatment- Micrograft & minigraft from non-androgen dependent site (occiput).
Fungal infection
· Mycetoma Treatment
1- Surgery
2- Systemic antibiotics or antifungal drugs, depending on the organism isolated
· All others
1- Topical Antifungal
– Nystatin preparation (oral thrush)
– Imidazoles e.g. cotrimazole
2- Systemic Antifungal
– Itraconazole and fluconazole
– Allylamine e.g. Terbinafine
– Griseovulvin
· Investigation
1- Scraping clipping and Hair sampling
2- KOH/microscoy
3- Skin biopsy Histopathology with PAS stain
4- Culture
5- Wood's lamp
Cancer
· Basal Cell Carcinoma
- ages 40-79 year old
- head and neck
· Superficial Basal Cell Carcinoma
- trunk and extremities
· Clinical Features of SCC
1- slowly-growing
2- tender, scaly or crusted lumps.
3- SCCs are found on sun-exposed sites
4- particularly the face, lips, ears, hands, forearms and lower legs
· Melanoma
- All ages affected, median age 53
- Majority located in sun-exposed areas, but also occur in non-sun-exposed areas, such as the buttock