Common Dermatological Problems

Question 1

Atopic Eczema: (15% of population)
What is it usually associated with? What’s it called?

What is it?

How is it presented in Infants?

How is it presented in Toddlers?

How is it presented in Adults? What is it a major factor for?

Answer 1

• Allergic Rhinitis (hayfever) and Asthma = Atopic Tendency
• Inflammatory process due to internal and external factors; Defect of skin barrier function causes skin to be more susceptible to irritation by irritants, weather, temp etc.
• • Widespread, Dry, Red, Scaly skin, which can be weeping
  • Often affects cheeks first, but nappy area isn’t affected due to moisture
• • More Localised (Flexural), Thickened, Leathery (Lichenified) lesions
  • Affects elbows, knees, eyelids, ear creases, neck, scalp.
• • Persistent Localised eczema, with recurrent 2nd staphylococcal infection
  • Major factor for Irritant Contact Dermatitis

Question 2

What occurs in the Acute stage of atopic eczema?

What occurs in the Chronic stage of atopic eczema?

Answer 2

• Spongiosis (Epidermal Oedema), Formation of Intraepidermal vesicles
• Loss of vesicles, Epidermal thickening
  o Spiny layer thickening = Acanthosis
  o Cornified layer thickening = Hyperkeratosis

Question 3

What are the treatment options for atopic eczema?

What are the complications of atopic eczema?

Answer 3

• • Avoid triggers and BREAK the itch-scratch-itch cycle; to break cycle, give: Emollients (Moisturisers) - Lotions, Creams, Ointments

• Topical steroids, Antihistamines, Oral antibiotics

• Bacterial/Viral co-infection, Post-inflammatory Hyperpigmentation, Scarring, Psychosocial impact

Question 4

Psoriasis:
What is it?

What cellular changes occur?

What are the treatment options?

Answer 4

• • Chronic inflammatory disorder; Focal, Well-demarcated, Inflamed, Oedematous plaques covered with silvery-white scales
  • Symmetrical distribution of various shapes/sizes of lesions, with nail changes like Onycholysis (nail splits from nail bed)
• Disordered maturation of Keratinocytes with reduced Epidermal transit time from 30 to 6 days = Hyperproliferation and Epidermal thickening
• • Topical; Emollients, Coal tar, Salicylic acid, Topical steroids, Calcipotriol (Vit D)

• Systemic drugs, Biologics

Question 5

Skin Malignancies:

1. Basal Cell Carcinoma:
   What is it?

What cellular changes occur?

Where is it commonly found?

How is it treated?

Answer 5

• Slow growing skin malignancy; Shiny, Translucent nodule with
  rolled edges, Telangiectasia (capillary dilation), Central depression/ulceration
• Basal tumour cells, Palisading of cells at the Periphery
• Head, Neck
• Routine referral, Surgical excision

Question 6

2. Squamous Cell Carcinoma:
   What is it due to?

What cellular changes occur?

Where is it commonly found?

How is it treated?

Answer 6

• Long-term sun exposure = ↑Incidence with age
• Invasion of squamous cells into Dermis; Lips and ears have a higher rate of metastasis to the lymph nodes
• Sun exposed sites; Back of hands, Forearms, Ears, Forehead, Lower lip
• Refer immediately before 2 weeks for Surgical excision

Question 7

3. Malignant Melanoma:
   What are the types?

Where is it commonly found?

What are the ABCDE signs to see on examination?

Answer 7

• Nodular, Superficial spreading, Lentigo Maligna, Acral Lentiginous
• Torso of males, Legs of females

Asymmetry - one side of lesion different to the other
Border irregularity - notched, uneven, blurred
Colour variation - different to other moles or different colours within it
Diameter >6mm - with persistent growth
Extra features - itching, bleeding, evolving