Rashes and Skin Diseases Flashcards
Nail psoriasis
Pitting, onycholysis, yellowing, and ridging
Associated with inflammatory arthritis
Palmar/plantar psoriasis
Palms and/or soles
Keratoderma
Painful fissuring
Scalp psoriasis
Often the first or only site of psoriasis
- coal tar or ketaconazole shampoo
Flextural psoriasis
Affects body folds and genitals
Smooth, well-defined patches
Colonised by candida yeasts
Guttate Psoriasis
Post-streptococcal acute guttate psoriasis
Widespread small plaques
Often resolves after several months
Often later age onset
Treatment of Psoriasis?
General advice
- stop smoking
- avoiding excessive alcohol
- maintain optimal weight.
Topical therapy (mild)
- Emollients
- Coal tar preparations
- Dithranol
- Salicylic acid
- Vitamin D analogue (calcipotriol)
- Topical corticosteroids
- Combination calcipotriol/betamethasone dipropionate ointment/gel or foam
- A calcineurin inhibitor (tacrolimus, pimecrolimus)
Phototherapy (mod)
- ultraviolet (UV) radiation
- often in combination with topical or systemic agents. Types of phototherapy include:
Systemic therapy (mod-severe - refer)
- Methotrexate
- Ciclosporin
- Acitretin.
- ‘mabs’
What are the features of Psoriasis?
Psoriasis
chronic inflammatory skin condition characterised by clearly defined, red and scaly plaques.
- Symmetrically distributed
- well-defined edges.
- Scale is typically silvery white, except in skin folds where the plaques often appear shiny and they may have a moist peeling surface
- Common sites are scalp, elbows, and knees,
- Itch is mostly mild but may be severe in some patients
- can lead to ichenification (thickened leathery skin with increased markings) - Painful skin cracks or fissures may occur.
- May leave brown or pale marks that can be expected to fade over several months.
List some common features of Rosacea:
Frequent blushing or flushing
Peristant facial reddness
Telangiectasia (the first stage of erythematotelangiectatic rosacea)
Red papules and pustules on the nose, forehead, cheeks and chin often follow (inflammatory or papulopustular rosacea)
Dry and flaky facial skin
Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)
Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreens and other facial creams
Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and fibrous thickening – rhinophyma
- can also affect eyes, cause oedema, or granulomas
Treatment for Rosacea:
General measures
- reduce factors causing facial flushing (heat, spicy food, ETOH).
- Avoid oil-based facial creams
- Protect from the sun.
- Never apply a topical steroid rosacea
Oral antibiotics
- Tetracycline antibiotics (doxycycline and minocycline)
- 6–12 weeks
- cotrimoxazole or metronidazole for resistant cases.
Topical treatment
- Metronidazole cream or gel (long or short term, mono or dual)
- Azelaic acid cream or lotion
- Brimonidine gel
- Ivermectin cream
Isotretinoin
- When antibiotics are ineffective or poorly tolerated
Medications to reduce flushing
- clonidine
- and carvedilol
Vascular laser
Surgery for rhinophyma
List some common features of Rosacea:
Frequent blushing or flushing
Peristant facial reddness
Telangiectasia (the first stage of erythematotelangiectatic rosacea)
Red papules and pustules on the nose, forehead, cheeks and chin often follow (inflammatory or papulopustular rosacea)
Dry and flaky facial skin
Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)
Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreens and other facial creams
Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and fibrous thickening – rhinophyma
- can also affect eyes, cause oedema, or granulomas
Rosacea
Chronic rash involving the central face
Classically Red
Most often starts between the age of 30 and 60 years.
Common in those with fair skin, blue eyes and Celtic origins
May be transient, recurrent or persistent
Rosacea
Chronic rash involving the central face
Classically Red
Most often starts between the age of 30 and 60 years.
Common in those with fair skin, blue eyes and Celtic origins
May be transient, recurrent or persistent
Management of Impetigo
Wound Care
- moist soaks to remove crusts gently.
- Apply antiseptic 2–3 times daily
- Cover the affected areas.
Antibiotics
- Mupiricin ointemnt if localised and low risk
- Flucloxacillin (non-endemic)
- Benzyl penicillin IM stat (endemic) or bactrim (trim+sulfamethoxizole)
To prevent recurrence:
- apply antiseptic ointment to nostrils
- Wash daily with antibacterial soap or soak in a bleach bath
- Cut nails and keep hands clean
- Avoid close contact with others
- Children must stay away from school until crusts have dried out or for 24 hours after starting oral antibiotics
- Use separate towels and flannels
- Change and launder clothes and linen daily.
- Treat household contacts
Management of Impetigo
Wound Care
- moist soaks to remove crusts gently.
- Apply antiseptic 2–3 times daily
- Cover the affected areas.
Antibiotics
- Mupiricin ointemnt if localised and low risk
- Flucloxacillin (non-endemic)
- Benzyl penicillin IM stat (endemic) or bactrim (trim+sulfamethoxizole)
To prevent recurrence:
- apply antiseptic ointment to nostrils
- Wash daily with antibacterial soap or soak in a bleach bath
- Cut nails and keep hands clean
- Avoid close contact with others
- Children must stay away from school until crusts have dried out or for 24 hours after starting oral antibiotics
- Use separate towels and flannels
- Change and launder clothes and linen daily.
- Treat household contacts
Complications of Impetigo
Cellulitis
PSGN
RF/RHD
Staphlycoccal Scaled Skin Syndrome
Toxic Shock Syndrome
Folliculitis
infection, occlusion (blockage), irritation of the hair follicle
Swabs should be taken from the pustules for cystology and and culture in the laboratory to determine if folliculitis is due to an infection.
Bacterial folliculitis is commonly due to Staphylococcus aureus - may cause boils
Treat with Mupiricin
Boil
hair follicle–associated cutaneous abscesses that extend into the subcutaneous tissue
(deep folliculitis)
Carbuncles are boils with multiple heads (see below)
What is the treatment for tinea?
Topical Treatment
- midazoles or terbinafine
- Adequate margin around the lesion
- At least 1–2 weeks after the visible rash has cleared
- recurrence is common.
Oral
- hair-bearing site
- extensive,
- failed to clear with topical antifungals
Tinea (Ring Worm)
Atopic Dermatitis
Also called atopic eczema, the most common inflammatory skin disease worldwide, presents as generalised skin dryness and ‘the rash that itches’.
Name some “pharmacological measures” for controlling atopic dermatitis
Emollients
- Essential for all as long term
- Applied regularly and liberally even if skin looks and feels normal
- Generally, the greasier the better
- SLS-free.
- Wet wraps may be used over emollients to areas of red, hot, weepy dermatitis.
Antiseptics (for superimosed Staph infections)
- Bleach bath: Add half a cap of household bleach to a full bath
Prescription topical:
- Coal tar
- Topical steroids (weakest steroid used for the shortest time)
- Weekend treatment: When the dermatitis is under control, apply the steroid two days per week to any new or old areas of dermatitis, and then take a break for five days.
- A rebound flare may occur if too strong a steroid is used on the incorrect site for the incorrect reason.
- Other: Topical calcineurin inhibitors (Pimecrolimus - for face/genitals), Crisaborole ointment
Phototherapy
Systemic therapy
- Short Steroid Course - in severe cases
- Immunosuprssives and ‘mabs” (dermatologist)
Name some “general measures” for controlling atopic dermatitis
- Education - pt and carers
- Avoid skin irritants - may include fabrics, chemicals, humidity, and dryness.
- Food - The relationship between atopic dermatitis and food is complex - food allergies may exacerbate exacerbate atopic dermatitis, but avoidance may exacerbate
- Psychological support
Atopic Dermatitis
Also called atopic eczema, the most common inflammatory skin disease worldwide, presents as generalised skin dryness and ‘the rash that itches’.
Infantile Seborrhoeic Dermatitis
“cradle cap”
Mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk .
Infantile Seborrhoeic Dermatitis
Mainly affects the sebaceous, gland-rich regions of the scalp, face, and trunk .
What is the treatement of (adult) Seborrhoeic Dermatitis
Keratolytics
- salicylic acid, urea, propylene glycol
Topical antifungal
- ketoconazole, or ciclopirox shampoo and/or cream.
- zinc pyrithione or selenium sulphide
Mild topical corticosteroids
Topical calcineurin inhibitors (pimecrolimus cream, tacrolimus ointment - for face/genitals)
Seborrhoeic Dermatitis
- Winter flares, improving in summer following sun exposure
- Minimal itch most of the time
- Combination oily and dry mid-facial skin
- Ill-defined localised scaly patches or diffuse scale in the scalp
- Blepharitis: scaly red eyelid margins
- Salmon-pink, thin, scaly, and ill-defined plaques in skin folds on both sides of the face
- Petal or ring-shaped flaky patches on hair-line and on anterior chest
- Rash in armpits, under the breasts, in the groin folds, and genital creases
- Superficial folliculitis (inflamed hair follicles) on cheeks and upper trunk.
Scabies
Scabies rash is a hypersensitivity reaction that arises several weeks after the initial infestation. It has a varied appearance.
- Erythematous papules on the trunk and limbs, often follicular
- Diffuse or nummular dermatitis
- Urticated erythema
- Vesicles on palms and soles
- Acropustulosis (sterile pustules on palms and soles) in infants
- Papules or nodules in the armpits, groins, buttocks, scrotum and along the shaft of the penis
- Rare involvement of face and scalp.
Mild acne
<20 comedones
<15 inflammatory lesions
Or, total lesion count <30
Moderate Acne
20–100 comedones
15–50 inflammatory lesions
Or, total lesion count 30–125
Severe Acne
>5 pseudocysts
Total comedo count >100
Total inflammatory count >50
Or total lesion count >125
Inflammatory lesions
- small red bumps (papules)
- pustules
- large red bumps (nodules)
- fluctuant nodules (pseudocysts)
Inflammatory acne lesions are often painful.
Usually follows rupture of the wall of a closed comedo (white head). It may also arise from normal-appearing skin.
Define Comedo:
skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne. A single lesion is a comedo.
Open comedones are blackheads; black because of surface pigment (melanin), rather than dirt
Closed comedones are whiteheads; the follicle is completely blocked
Comedonal acne
A pattern of acne in which most lesions are comedones. Comedonal acne most often affects the forehead and chin.
*mixed comedonal
Comedonal acne
A pattern of acne in which most lesions are comedones. Comedonal acne most often affects the forehead and chin.
* closed comedonal
Define Papule:
Papules: plural of papule; elevated, solid, palpable lesions that are less than 1 cm in diameter.
Define Nodule
Nodules: plural of nodule; elevated, solid, palpable lesions > 1 cm in diameter.
Mild acne
<20 comedones
<15 inflammatory lesions
Or, total lesion count <30
Moderate Acne
20–100 comedones
15–50 inflammatory lesions
Or, total lesion count 30–125
Severe Acne
>5 pseudocysts
Total comedo count >100
Total inflammatory count >50
Or total lesion count >125
Inflammatory lesions
- small red bumps (papules)
- pustules
- large red bumps (nodules)
- fluctuant nodules (pseudocysts)
Inflammatory acne lesions are often painful.
Usually follows rupture of the wall of a closed comedo (white head). It may also arise from normal-appearing skin.
Define Comedo:
skin-coloured, small bumps (papules) frequently found on the forehead and chin of those with acne. A single lesion is a comedo.
Open comedones are blackheads; black because of surface pigment (melanin), rather than dirt
Closed comedones are whiteheads; the follicle is completely blocked
Comedonal acne
A pattern of acne in which most lesions are comedones. Comedonal acne most often affects the forehead and chin.
*mixed comedonal
Comedonal acne
A pattern of acne in which most lesions are comedones. Comedonal acne most often affects the forehead and chin.
* closed comedonal
Define Papule:
Papules: plural of papule; elevated, solid, palpable lesions that are less than 1 cm in diameter.
Define Nodule
Nodules: plural of nodule; elevated, solid, palpable lesions > 1 cm in diameter.
Recent URTI/cold
Pityriasis rosea
- often starts with single “herald patch”
- scaly flat patches or plaques
- gnerally on chest and back, +/- limbs
- slightly itchy
- lasts 6-12 weeks
Hx of atopy
Lichen Simplex Chronicus
Circumscribed, somewhat linear or oval in shape, and markedly thickened. It is intensely itchy. Other features may include:
- Exaggerated skin markings
- Dry or scaly surface
- Leathery induration
- Broken-off hairs
- Pigmentation
- Scratch marks.
1 week old baby
Miliaria aka
“prickly heat or sweat rash”
common
caused by blockage and/or inflammation of eccrine sweat ducts
affects up to 9% of neonates, with the mean age of 1 week. It can also occur in adults with fever.
Chicken pox
Erythema Marginatum
characteristic type of annular erythema that occurs in about 10% of first attacks of ARF in children; it is very rare in adults. The rash can be difficult to detect in dark-skinned people. When present, it is found on the trunk and upper arms and legs, but almost never on the face, palms or soles. The rash appears as pink or red macules (flat spots) or papules (small lumps), which spread outwards in a circular shape. As the lesions advance, the edges become raised and red, and the centre clears. The lesions are not itchy or painful, and sometimes go unnoticed by the patient. The lesions can fade and reappear within hours, reappearing in hot conditions. Erythema marginatum may persist intermittently for weeks to months, even after successful treatment of ARF.
Molluscum Contagiosum
mainly affects infants and young children under the age of 10 years. It is more prevalent in warm climates than cool ones, and in overcrowded environments
Meningcoccal
Rubella
Rash begins on the face that spreads to the neck, trunk and extremities.
Appear as pink or light red spots about 2–3 mm in size.
Lasts up to 5 days (average is 3 days).
May or may not be itchy.
As rash passes, affected skin may shed in flakes.
Usually not as widespread as in measles.
Parvo B19/Erythema Infectiosum
nonspecific viral symptoms such as mild fever and headache at first.
The rash, erythema infectiosum, appears a few days later with firm red cheeks, which feel burning hot.
lasts 2 to 4 days, and is followed by a pink rash on the limbs and sometimes the trunk.
This develops a lace-like or network pattern
Measles
Flat red spots ranging from 0.1–1.0cm in diameter appear on the 4th or 5th day following the start of symptoms.
This non-itchy rash begins on the face and behind the ears. Within 24–36 hours it spreads over the entire trunk and extremities (palms and soles rarely involved).
The spots may join together, especially in areas of the face.
The onset of the rash usually coincides with a high fever of at least 40C.
The rash begins to fade 3–4 days after it first appears. It fades first to a purplish hue and then to brown/coppery coloured lesions with fine scales.
Varicella/Chicken pox
Usually begins as itchy red papules progressing to vesicles on the stomach, back and face, and then spreading to other parts of the body. Blisters can also arise inside the mouth
The spread pattern can vary from child to child. There may be only a scattering of vesicles, or the entire body may be covered with up to 500 vesicles. The vesicles tend to be very itchy and uncomfortable.
presence of different stages of lesions simultaneously.
