Dermatology by Dr Cintia Flashcards
Precancerous skin lesions
Melanoma INVESTIGATION BEST
Surveillance:
- First 2 years: e/3m
- Next 2 years: e/6m
- After: e/1y
- 1st Deg Rel: Skin check
e/1y
For the patient with a history of melanoma:
- First 2 years: Examination every 3 months (e/3m)
- Next 2 years: Examination every 6 months (e/6m)
- After 4 years: Examination every year (e/1y)
For first-degree relatives (due to increased risk):
- Skin check: Examination every year (e/1y)
These surveillance intervals help in early detection of recurrence or new melanomas, optimizing patient outcomes through timely intervention.
Melanoma TREATMENT
Excision margin:
- In situ: 0.5cm
- <1mm: 1cm
- 1-4mm: 1-2cm
>4mm: 2cm
If eye: Refer to plastic surgery
NODULAR MELANOMA
ACRAL LENTIGINOUS MELANOMA
LENTIGO MELANOMA
DESMOPLASTIC MELANOMA
Squamous Cell
Carcinoma TREATMENT
Surgery with 3-5mm margin
BOWEN DISEASE BEST INVESTIGATION
Shave or Punch Biopsy
BOWEN DISEASE TREATMENT
Fluorouracil, Imiquimod
KERATOACANTHOMA
Basal Cell Carcinoma BEST INVESTIGATION
Biopsy
Basal Cell Carcinoma TREATMENT
Mohs Surgery with 3-4mm excision
Gas gangrene (Clostridial myonecrosis)
Gas gangrene, also known as Clostridial myonecrosis, is a severe and potentially life-threatening bacterial infection that affects muscle tissue. It is most commonly caused by bacteria from the Clostridium family, particularly Clostridium perfringens.
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Cause:
- Clostridium Bacteria: These bacteria are anaerobic, meaning they thrive in environments with little or no oxygen. They are often found in soil, dust, and the intestines of humans and animals.
- Infection Trigger: Gas gangrene typically occurs after a traumatic injury or surgery, where the bacteria can enter a wound. Once inside the body, they multiply rapidly and produce toxins that destroy tissue.
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Symptoms:
- Severe Pain: The pain at the site of infection is often out of proportion to the injury.
- Swelling and Discoloration: The affected area becomes swollen, pale, and may turn a purplish or black color as the tissue dies.
- Gas Production: The bacteria produce gas as they multiply, which can cause a crackling sensation under the skin when touched (crepitus).
- Foul-Smelling Discharge: The wound may ooze a thin, foul-smelling fluid.
- Rapid Progression: The infection spreads quickly, leading to shock, organ failure, and, if untreated, death.
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Diagnosis:
- Clinical Examination: The appearance of the wound, the presence of gas in tissues (seen on imaging like X-rays), and the rapid progression of symptoms are key indicators.
- Laboratory Tests: Blood tests, cultures, and analysis of the wound tissue can confirm the presence of Clostridium bacteria.
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Treatment:
- Emergency Surgery (Debridement): Immediate removal of dead tissue (debridement) is critical to stop the spread of the infection.
- Antibiotics: High-dose intravenous antibiotics, typically penicillin and clindamycin, are administered to fight the bacteria.
- Hyperbaric Oxygen Therapy: This treatment involves breathing pure oxygen in a pressurized room. It increases oxygen in the blood, which helps kill the anaerobic bacteria.
- Amputation: In severe cases, if the infection has spread extensively, amputation of the affected limb may be necessary to save the patient’s life.
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Prognosis:
- High Mortality Rate: Gas gangrene has a high mortality rate, especially if not treated promptly. Quick medical intervention is essential for survival.
Gas gangrene (Clostridial myonecrosis) is a rapidly progressing and deadly infection caused by Clostridium bacteria, often following a wound or injury. It is characterized by severe pain, swelling, gas production in tissues, and rapid tissue death. Immediate surgical removal of dead tissue, aggressive antibiotic therapy, and sometimes hyperbaric oxygen therapy are crucial for treatment. Without prompt intervention, the infection can lead to death.
Shingles
Molluscus contagiosum TREATMENT
No tx needed.
Resolvesin 3-6m
No school exclusion necessary
Avoid sharing towels/baths
Impetigo TREATMENT
- Topical mupirocin 2% OR
- cefalexin if widespread or large areas.
Staphylococcal scalded skin syndrome
Dermatophyte infections
Tinea CLINICAL FEATURES
Ringworm
Tinea TREATMENT
- Oral Griseofulvin/Terbinafine
Scabies CLINICAL FEATURES
Common in nursing homes
Scabies TREATMENT
1.Permethrin.
Lice
Cutaneous larva migran
PAPULAR URTICARIA
CERCARIAL DERMATITIS Erythrasma
Dermatitis CLINICAL FEATURES
Itchy, rash
Dermatitis TREATMENT
- Topical steroids & Moisturiser
Dermatitis Herpetiformes CLINICAL FEATURES
Assoc w/ Celiac Dx in elbows, knees, lumbosacral area
Dermatitis Herpetiformes BEST INVESTIGATION
Skin biopsy
Dermatitis Herpetiformes TREATMENT
- Dapsone.
- Gluten free diet
Atopic Dermatitis CLINICAL FEATURES
Kids in face, cubital, popliteal
Atopic Dermatitis TREATMENT
- Topical Steroids & Moisturiser
- Severe: Immunosuppressants - Infected: Swab then mupirocin/Dicloxacillin
Contact Dermatitis
Seborrheic Dermatitis CLINICAL FEATURES
Dandruff
Seborrheic Dermatitis
- Dandruff Shampoo
- Ketoconazole
Stasis Dermatitis
Discoid Dermatitis
ASTEATOTIC DERMATITIS
GENITAL DERMATITIS