DERMATOLOGY Flashcards
Vitiligo
Autoimmune which results in loss of melanocytes and depigmentation of skin. Affects 1% typically first presents 20-30 years old.
Peripheries more affected
Trauma may precipitate new lesions- koebners phenomenon.
Associated with type 1 DM, Addison’s disease, thyroid disorders.
Lichen planus
Thought to be immune mediated. Itchy papular rash most common on palms soles genitalia and flexor surfaces of arms. Also in mouth Koebnar phenomenon Oral involvement in 50% Thinning of nail plate Tx is topical steroids
Acne Rosacea
Typically affects nose cheeks and forehead
Flushing is often first symptom
Telangiectasia are common
Later develops into persistent erythema with papules and pustules
Rhiophyma
Blepharitis
Tx topical methronidazole, soolantra-ivermectin
Alopecia areata
Autoimmune
Pityriasis Versicolour
Superficial cutaneous skin infection caused by malassezia fur furfur.
Most commonly effects trunk
Patches may be hypopigmented, pink or brown
May be more noticeable after suntan
Mild pruritus
Topical antifungal/ ketoconazole shampoo for large areas.
Bullous Pemphigoid
Autoimmune- ab develop against hemidesmosomal proteins
More common in elderly Itchy tense blisters around flexures Blisters usually heal without scarring Mouth is often spared Referral to deem for biopsy- igG adnC3 Oral corticosteroids
Pyoderma gangrenosum
Typically on lower limbs Initally small red papule Later deep red necrotic ulcer with a violaceous border May be accompanied by fever, myalgia 50% idiopathic IBD RA SLE Primary binary cirrhosis Oral steroids to tx
Erythema ab igne
Caused by over exposure to IR.
CHARACTERISTICS; reticulate erythematous patches with hyperpig and telangiectasia.
Can develop into squamous skin
Hot water bottles and fires
Polymoprhic eruption in pregnancy
Pruitt can condition associated with last trimester
Lesion often first appear in abdo striae
Mgmt depend on severity; emollients mild potency steroids
Pemphigoid Gestationis
Pruritic blistering lesion
Often develop in peri umbilical region later spreading to the trunk back buttocks and arms
Usually presents in 2nd 3 rd trimester and is rarely seen in the first preg
Oral corticosteroids are usually required
Scabies
Spread by prolonged skin contact
Scariest mite lay eggs in stratum cornermen
Intense pruritus is associated with the delayed type Iv hypersensititvy to mites/eggs- occurs 30days after initial infection
Fts
Widespread pruritus
Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
In infants- face and scalp
Permethrin 5% first line
Pruritus persists up to 4-6 weeks post eradication
Psoriasis
2% prevalence
Red scaly patches on skin
Increased risk of arthritis and cardiovascular disease, metabolic syndrome venous thromboembolism
Subtypes- plaque- most common - extensor surfaces
Flexures- skin smooth
Guttate- triggered by strep infection, multiple red teardrop lesions appear on the body
Pustular - palms and soles
Other fts;
Nail pitting and onycholysis
Arthritis
Seborrhoeic dermatitis
Thought to be caused by proliferation of malassezia furfur. 2% of pop
Fts; eczematous lesions on the sebum rish areas- scalp periorbital auricular and nasolabial folds
Associated with HIV and Parkinson’s
Mgmt; zinc pyrithione , antifungal, topical steroids, difficult to tx.
Leukoplakia
Premalignant condition
Presents as hard white spots on mucous membrane of mouth
More common in smokers
Diagnosis of exclusion- candidiasis and lichen planus should be considered- especially if lesions rub off
Squamous carcinoma of skin
COMMON
Mets are rare
From; excessive exposure to sunlight
Actinic keratosis and bowens disease
Immunosuppressive
Long standing leg ulcers- Marjolins ulcer
Seborrhoeic keratosis
BENGIN EPIDERMAL SKIN LESIONS seen in older Doppler
Large variation of colour from flesh to light brown to black
Have stuck on appearance
Keratotomy plugs may be seen on the surface
Cherry haemangioma
Cherry haemangioma Campbell de Morgan spots- benign skin lesions which contain an abnormal proliferation of capillaries More common with increasing age. Erythematous papular lesions Typically 1-3 mm in size Non blanching Not found on mucous membrane
Spider naevi
Central red papule with surrounding capillaries
Lesion blanch upon pressure
Almost always found on the upper part of the body
10-15% of people will have one or more
Associated with liver disease
Preg
Cocp
Actinic keratoses
Actinic keratoses
Common premalignant skin lesion- due to chronic sun exposure
Small crusty, scaly lesions
May be pink red brown or same colour as skin
Typically on sun exposed areas multiple lesions may be present
Mgmt; prevention of further risk
FU cream 2-3 week course
Topical hydro after to settle inflammation
Topical imiquimod
Basal cell carcinoma
Most common skin cancer
Lesions known as rodent ulcers- slow growth and local invasion
Mets are rare
Sun exposed sites
Initally pearly flesh coloured appearance, rolled up edges, telangiectasia
May ulcerate
Fungal nail infection
Onychomycosis is a fungal infection of the nails.
May be causes by dematophytes- T. Rubrum accounts for 90%
Yeasts- candida
Non derma mounds
Up slightly nails are a common reason for presentation
Thickened rough opaque nails
Nail clippings
Scrapings of the affected nail
Tx is successful in 50-80% of people Diagnosis should be confirmed by micro before tx Oral terbinafine 6 weeks to 3 months for fingernail 3-6 months toenails
Dermatitis heretiforms
Autoimmune blistering of skin associated with coeliac disease
Caused by deposition of IgA in dermis
Itchy vesicular skin lesions of extensor surfaces
Tx by gluten free diet
Dapsone
Guttate psoriasis
More common in children and adolescents
May be prescipitated by a strep infection 2-4 weeks prior
Tear drop papules on the trunk and limbs
Most cases resolve spontaneously within 2-3 months
Ubv phototherapy
Rarely seen on soles
Differential diagnosis for shin lesions
Erythema nodosum
Pretibial myxoedema
PYODERMA GANGRENOSUM
Necrobiosis lipoidica
Erythema nodosum
Symmetrical erythematous tender nodules which heal w/o scarring
Most common causes are strep infections, sarcoidosis, IBD and drugs- penicillin, sulphonamides and oral pill
Pretibial myxoedema
Symmetrical erythematous lesions seen in Graves’ disease
Shiny orange peel skin
Pyoderma gangrenosum
Initially small red papule
Later deep red necrotic ulcers with a violaceous border
Idiopathic in 50% may also be seen in IBD, connective tissue disorders nad myeloprolif disorders
Necrobiosis lipoidica
Shiny painless areas of yellow/ red skin typically on the shin of diabetics
Often associated with telangiectasia
Erythema nodosum
Infammation of sub q fat
Typically causes tender erythematous nodular lesions
Usually occurs over shins- ,at be else here
Usually resolves In6 weeks
Heals without scarring
Causes; Infection- strep, to, brucellosis Systemic- sarcoidosis, IBD, behcets Malignancy Drugs- penicillin sulphonamides and cocp Pregnancy
LICHEN SCLEROSUS
Inflammatory condition which usually affects the genitialia and is more common in elderly females
Itch is prominent
Topical steroids and emollients to tx
Increased risk of vulval cancer
Alopecia areata
Autoimmune causing localised demarcated patches of hair loss. Edge of hair loss exclamation hairs
Hair will regrow in 50% in 1 year. 80-90% eventually.
Impetigo
Superficial bacterial infection caused by strep pyogens or staph aureus.
Features; golden crusted skin lesions typically found around the mouth. Very contagious
Mgmt; limited localised disease
Topical fusiliers acid is first line
Extensive disease oral flucloxacillin
Skin manifestations of SLE
Discoid lupus
Photosensitive butterfly rash
Alopecia
Livedo reticularis
HSV
Two strains 1 and 2.
Primary infection may present with severe gingivostomatitis, cold sores, painful genital ulceration.
Oral acid lover, chlorhexidine mouthwash
C section recommended if you get an attack of herpes after 28 weeks
Eczema in children
15-20% if kids
Typically presents before 6 months but clears in 50% by 5 years, 75% by 10.
In infants face and trunk often effected,
Younger children’s extensor surfaces
Older flexor surfaces
Acanthosis nigricans
I
Occurs mainly in axillary, groin and back of neck and appears as a thickened brown velvety patches of skin.
Skin tags often found in area.
Obesity associated an is the most common type and is often linked to insulin resistance.
Also associated with Cushing syndrome, pcos and drugs like nicotinic acid and systemic corticosteroids, pill.
Rare cases can be a sign of malignancy- stomach cancer.
Keloid scarsmpet
Tumour like lesions that arise from the connectivee tissue of a scar and extend beyond the dimensions of the original wound.
More common in those with dark skin.
Young adults
Sternum most common, shoulder, neck face
Less likely if incisionsa re made along relaxed skin tension lines.
Early tx intra lesion also steroids
Excision is sometimes required.
Keratoacanthoma
Benign epithelial tumour.
More frequent in middle age and no not become more common in increasing age
Looks like a volcano or crater
Initally smooth dome shaped papule
Rapidly grows to become a crater filled with keratin
Spontaneous sregression within 3 months is common, often results in scar. Removed often because difficult clinal you to exclude squamous cell. Removal may prevent scarring.
Acne vulgaris mgmt
Usually in adolescence
Face neck upper trunk
Comedones inflammation and pustules
Mild- open and closed condones with or without inflamm lesions
Mod- wind spread non inflamm- papules and pustules
Severe- extensive inflamm lesions
No role in diet modifications
Fungal nail infections
Onychomycosis- fungal infection
May be caused by dermatophytes- trichophyton rubrum 90%
Yeasts Candida
Non dermatophye mounds
Oral terbinafine
Lichen planus
Skin disorder immune mediated
Itchy , papular rash most common on palms soles genitilia and flexor surfaces of arms
Rash often polygonal in shape white lace pattern on the surface.
Koebner phenomenon
Oral involvement in 50%
Nails; thinning of the plate and lontiduinal ridging
Causes gold, quinine thiazides
Tx topical steroids
6 p’s planus; pruritic, purple papular and polygonal - flexor
Vasulitides
Large vessel
Temporal arteritis
Takaysau ateritis
Medical vessel
Polyarthritis nodosa
Kawasaki disease
Small vessel
ANCA
Henoch schonlein
Venous ulceration
Seen above medial malleolus
ABPI- Normal 0.9-1.2
Below 0.9 arterial disease
Above 1.3 arterial disease
Mgmt
Compression bandage
Oral pentoiftyline- vasodilator
Dermatomyositis
Inflamm disorder causing symmetrical proximal muscle weakness and characteristic skin lesions May be idiopathic or associated with connective tissue disorders or underlying malignany- gastric and ovarian tumors ANA Skin fts Photosensitive Macular rash over back and shoulder Heliotrope rash in periorbital region Gottrons papules- extensor of fingers Nail fold capillary dilatation
Other fts Proximal muscle weakness +- tenderness Raynauds Respiratory muscle weakness Interstitial lung disease Dyspagia Dysphona
Actinic keratoses
Common premalignat skin lesion- consequence of sun exposure Fts; small, crusty, scaly lesions May be skin brown or same colour as skin Typically on sun exposed areas Multiple lesions may be present
Mgmt
5fu
Avoid sun
Lentigo maligna
Type of melanoma in situ.
Typically progresses slowly
Asymmetrical as opposed to symmetrical seen in solar lentigo.
Drug induced lupus
Usually resolves after stopping drug
Fts arthralgia, myalgia, malar rash, pleurisy
Ana positive in 100% dsDNA neg
Most common causes;
Procainamide- anti arrhythmic
Hydralazine- smooth muscle relaxant- HTN tx.
Less common
Isoniazid
Minocyclin
Phenytoin
Eczema herpeticum
Primary infection of the skin by herpes simplex 1 or 2. More commonly seen in children with atopic eczema.
Admission for IV aciclovir.
Rheumatic fever
Develops 2-6 weeks after strep pyogenes infection Fts Erythema marginatum Chorea Polysrthritis Carditis Subcut nodules
Minor
Raised crp esr
Pyrexia
Prolonged PR
Liver disease fts
History of alcohol excess
Stigamata - spider naevi, bruising, palmar erythema, gynecomastia
Evidence of decompensation; as cites, jaundice, encephalopathy
Iron def anaemia
Pallor Koilonychia Strophic glossitis Post cricoid webs Angular stomatitis
Polycythemia
Pruritus after warm bath
Ruddy complexion
Gout
PUD
CKD
Lethargy and pallor
Oedema and weight gain
Hypertension
Lymphoma
Night sweats LN Splenomegaly Hepatomegaly Fatigue
Stephen Johnson syndrome
Severe form of erythema multoforme- mucosal involment and systemic symptoms
Fts;
Rash has target lesions - may develop into vesicles or bulla
Mucosal involement
Systemic symptoms- fever arthralgia
Causes; Idiopathic Bacteria- mycoplasma, strep Virus- herpes simplex Drugs- penicillin, sulphonamides, lamotrigine, carbamexepine allopurinol NSAIDS, pill Sarcoidosis Malignancy
Breslin thickness
Single most important factor in determining prognosis of patients with malignant melanoma
<1mm 5 year survival 95-100
>4 50%
Bowens disease
Untraepidermal squamous cell carcinoma
More common in elderly females
3% chance of developing into invasive skin cancer
Red scaly patches
Often occur in lower limbs
Isotretinoin side effects
Teratogenic Dry skin eyes lips Low mood Elevated TAG Hair thinning Nose bleeds Benign intracranial hypertension - no tetracyclines too Photosensitivity
Chrondrodermatitis nodularis helicis
Benign condition
Development of painful nodule on ear
Persistent pressure on ear
More common in men
Mgmt
Ear protectors for sleeping
Steroid/ collagen injections
Pityriasis rosea
Acute self limiting rash
Affects young adults
Viral mediated
Herald patch on trunk
Erythematous oval scaly patches which follow a characteristic distribution / fir tree
Self limiting usually disappears after 4-12weeks
Hereditary haemorrhagic telangiectasia
Olser Weber- Rendu syndrome
Autosomal dominant condition
Multiple telangiectasia over the skin and mucus membranes
20% of cases occur spontaneously without prior family history,
Epitaphs
Tell Angie tases
Family hx
Psoriasis- exacerbating factors
Trauma
Alcohol
Drugs- beta blockers, lithium, antimalarials, NSAID ace
Withdrawal of systemic steroids
After burns- children
Stress ulcers- duodenum
Rhabdomyolysis
Electrical high voltage burns .
ATN may occur
Aggressive iV fluids
Circumfrenential burns
Constrict the limb and cause compartment syndrome- eshcarotomy and decompression
Burns
Immediate first aid- ABC
Remove person from source
Irrigate within 20mins with cool water
Cover with cling film- layer don’t wrap
Lung and browder- most accurate method
Types of burns
Superficial epidermal- red and painful
Superficial partial thickness- pale pink , blistered
Deep partial thickness- white but may be patches of non- blanching erythema, reduced sensation
Full thickness- white, black, no blisters, no pain
Referral to secondary care
All deep dermal and full thickness burns
Superficial dermal burns more than 3% tbsa adult or 2% children
Superficial dermal burns involving face, hands, feet, genitalia and flexors or circumferential burns of limbs torso
Electrical or chemical
Suspicion of non accidental injury
Pathophysiology of severe burns
After burn- local response with progressive tissue loss and release of inflammatory cytokines
Systemically there are cvs effects from fluid loss and sequestration of fluid into the third space
Catabolic response
Immunosupression
Sepsis
Mgmt of severe burns
IV fluids for children >10% Tisa, adults 15%.
Parkland formula- volume of fluid= tbsa of burn x weight x 4. Half fluid in first 8hrs since burn.
Catheter insertion
Analgesia
Referral for complex burns, hand, face, perineum large Tisa
Hyperhidrosis
Excessive production of sweat
Mgmt; Topical aluminum chloride- s/e skin irritation Iontophoreiss- palmar and axillary Botox- axillary Endoscopic transthoaracic sympathectomy
Lipomata
Benign tumor of adipocytes Occur in Middle aged adults Smooth, mobile, painless Subtypes; angiolipoma, angiolipoleiomyoma Malignant transformation is rare
Worried if >5cm Increasing size Pain Deep anatomical location
Seborrhoeic dermatitis
First line tx is ketoconazole
Erythema multiforme
Hypersensitivity reaction most commonly triggers by infections
Minor and major forms
SJS is not a severe form- now a separate condition
Fts Target lesions Initially seen on back of hands/ feet before spreading to torso Upper limbs most commonly affected Pruriris mild and less common
Causes Erythmea multi force
Viruses; hsv- most common Idiopathic Bacteria- strep, mycoplasma Penicillin, sulphonamides, carbamazepine, allopurinol, cocp, NSAID CTD Sarcoidosis Malignancy
Athletes foot
Tinea pedis
Scaling flaking and itching between toes
Topical imidazole, or terbinafine
Pyoderma Gangrenosum features
Seen usually on lower limbs
Initially small red papule
Later deep red nectrotic ulcer with violaceous border
May be accompanied by systemic symptoms
Causes of pyoderma gangrenosum
Idiopathic IBD RA SLE Myeloproliferative disorders Lymphoma Myeloid leukemia IgA PBC
Tx for pyoderma gangrenosum
Oral steroids
Erythema nodosum
Inflammation over subq fat Tender erythematous nodular lesions Usually over shins- may be elsewhere Usually resolves in 6 weeks Heal without scarring
Causes of erythema nodosum
Infection- tb, step, brucellosis Systemic disease- sarcoidosis, IBD, bechets Malignancy Penicillin sulphonamids, cocp Pregnancy
Vitiligo
Autoimmine- loss of melanocytes and depigmentation of the skin
20-30. 1% of population
Fts- well demarcated patches of depigmented skin
Peripheries most affected
Koebner phenomenon
Conditions associated with vitiligo
Type 1DM Addison’s Autoimmune thyroid Pernicious anemia Alopecia areata
Mgmt vitiligo
Sun block
Make up
Early- topical corticosteroids
Strawberry nevi
Type of congenital haemangionma occuring in 1/20
Grow rapidly until 6-9 months then regress over a period of years
Usually don’t require treatment
Usually face scalp and back
Skin prick test
Drops of diluted antigen are placed on skin, skin pricked with needle.
Large number of allergens can be tested in one session.
A wheal develops if someone has an allergy.
Can be interpreted after 15mins.
Useful for food allergens and pollen
RAST test
Determines amount of IgE that reacts specifically with suspected or known allergens.
Results given 0-no allergy to 6- strongly positive
Useful for food allergens, inhaled allergens/ wasps bee venom
Skin patch testing
Useful for contact dermatitis
30-4- allergens placed on back.
Patches removed after 48hrs and interpreted
Contact dermatitis
Irritant contact dermatitis- non allergic rxn due to weak acids or alkalis. Often seen in hands. Erythema is typical, crusting vesicles are rare.
Allergic contact dermatitis
Type IV hypersensitivy rxn
Uncommon
Presents as acute weeping eczema which predominantly affects the margins of the hairline rather than hairy scalp itself. Topical to with a potent steroid.
Skin disorders associated with SLE
Photosensitive butterfly rash
Discoid lupus
Slope is
Livedo reticularis - net like rash
Impetigo px
Mild- topical fusidic acid
Severe- oral flucloxacillin
Pressure ulcers risk factors
Malnourishment
Incontinence
Lack of mobility
Pain
Px of pressure ulcers
Waterlow score used to screen patients at risk of pressure ulcer
Mgmt; Hydrocolloid dressing hydrogels Referral to tissue viability nurse Surgical debridement may be necassary No routine to swab as it will be colonized with bacteria anyway
Hirsutism causes
PCOS Congenital adrenal hyperplasia Androgen therapy Obesity - oestrogen converted to androgens Adrenal tumor Drugs- phenyton Androgen secreting ovarian tumor
Assessment of hirsutism
Ferriman gallway scoring system >15- mod/ severe hirsutisum
Mgmt of hirsutism
Advise weight loss
Cosmetic techniques
COCP- co-pyprinidol(dianette) yasmin
PYROGENIC GRANULOMA
Often appear at sites of trauma
Overgrowth of blood vessels
Red nodules
May mimic amelanotic melanoma
Erythema no do sum
Symmetrical erythematoius tender nodules which heal without scarring Most common causes are strep infections Sarcoidosis IBD Drugs- pill penicillin and sulphonamides
Pyoderma gangrenosum
Initially small red papule Later deep red necrotic ulcer with a viola exodus border Idiopathic in 50% IBD Ctd
Pretibial myxoedema
Symmetrical erythematious lesions in Graves’ disease
Shiny orange peel skin
Dermoid cysts
Embryological remnants and may be lined by hair and squamous epithelium
Often located in the midline
Complete excision required
Desmoid tumors
Commonly develop in ligaments and tendons
Mgmt similar to soft tissue sarcomas
Kapsoi Sarcoma
Tumour of vascular and lymphatic endothelium
Purple cutaneous nodules
Associated with immune suppression
Classical form affect elderly males and is slow for growing
More aggressive if immunosupressed
Dermatitis herpetiformis
Chronic itchy clusters of blisters
Linked to underlying gluten enteropathy
Dermatofibroma
Benign lesion
Firm elevated nodules
Usually hx of trauma
Lesion consists of histiocytes blood vessels and fibrotic changes
Pyogenic granuloma
Overgrowth of blood vessels
Red nodules
Usually follow trauma
May mimic amelanotic melanoma
Polymorphic eruption of pregnancy
Pruritic condition associated with last trimester
Lesions often first appear in abdominal striae
Mgmt depends on severity emollients, mild potency topical steroids and oral steroids
Not associated with blistering
Pemphigoid gestation is
Pruritic blistering lesions
Oftendevelop in peri umbilical region later spreading to the trunk back buttocks and arms
Usually presents 2nd and 3rd trimester and is rarely seen in first pregnancy
Oral steroids are usually required
Milia
Small benign keratin filled cysts that typically appear around the face,
Many appear at any age but are more common in newborns
Resolve spontaneously
Liver disease
Hx of alcohol excess
Stigmata of lchronic liver disease; spider naevi, bruising, palmar erythema, gynaecomastia
Evidence of decompensation; ascites, jaundice, encephalopathy, iron def anaemia
Other signs
Koilonychia, strophic glossitits, post cricoid webs.
Polycythaemia
Pruritus after warm bath
Ruddy complexion
Gout
Peptic ulcer disease
Chronic kidney disease
Lethargy
Pallor
Oedema and weight gain
Hypertension
Lymphoma
Night sweats Lymphadenopathy Splenomegaly Hepatomegaly Fatigue
Impetigo
Superficial bacterial skin infection usually caused by staph aureus or strep pyogenes.
Ft’s golden crusted skin lesions usually found around the mouth
Very contagious
Mgmt impetigo
Limited localised disease- topical fusidic acid is first line
Extensive disease- oral flucloxacillin
Erythromycin if allergic
Molluscum contagiosum
Common skin infection caused by MCV.
Transmission occurs directly by close personal contact or indirectly via contaminated surfaces.
Usually seen 1-4 years
Molluscum contagiosum fts,
Pinkish or perky white papules with a central umbilication which are up to 5mm in diameter.
Lesions appear in clusters, in kids usually seen on trunk
Soles palms are spared.
Self care advice molluscum contagiosum
Self limiting
Spontaneous resolution occurs in 18months
Lesions are contagious but exclusion from school not needed
Cryotherapy
Keratoacanthoma
Benign epithelial tumour.
More frequent in middle age and do not become more common in old age.
Said to look like a volcano or crater- initally a smooth dome shaped papule.
Rapidly grows to become a crater centrally filled with keratin
Spontaneous regression within 3 months is common- may have scar.
Should be excised because need to rule out SCC. Removal may prevent scarring.
Sarcoidosis
Multisystem disorder of unknown aetiology characterised by non caseating granulomas.
More common in young adults and Africans
Features of sarcoidosis
Acute; erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia.
Insidious; dyspnoea, non productive cough, malaise, weight loss
Skin; lupus pernicious
Hyerpcal- macrophages inside the granulomas cause an increase in conversion of vit D to active form.
Lofgren’s syndrome
Acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia. Excellent prognosis
Heefordt’s syndrome
There is parotid enlargement, fever and uveitis secondary to sarcoidosis
Syndromes associated with sarcoidosis
Lofgren’s syndrome
Heerfordt’s syndrome
Sarcoidosis presentation and treatment
Often asymptomatic but can present acutely with arthritis- often sudden onset
Ace levels are normally high.
Treatment involves steroids and surveillance of hilar LN using CXR.
Toxic epidermal necrolysis
Potentially life threatening skin disorder - most commonly seen secondary to drug reaction.
Skin develops a scalded appearance over an extensive area.
Features of TEN
Systemically unwell
Positive Nikolsky’s sign; the epidermis separates with mild lateral pressure
Drugs known to induce TEN
Phenytoin Sulphonamides Allopurinol Penicillin Carbamazepine NSAIDs
Mgmt of TENS
IV immunoglobulin
Immunosuppressive
Plasmapheresis
Acne Vulgaris
Common skin disorder usually appears in adolescents
Effects the face neck and upper trunk
Due to obstruction of pilosevaceous follicle with keratin plugs which results in comedomes, inflammation and pustules
Effects 80-90% of teenagers
10-15 % F over 25
5% males
Granuloma annulare
Papular lesions that are often slightly hyperpigmented and depressed centrally
Occur on the dorsal surfaces of hands and feet and extensor of arms and legs
