The derms Flashcards
Acne Roseaca
Rosacea is a chronic inflammatory skin condition predominantly affecting the central face and most often starts between the age of 30–60 years.
Rosacea is common and is characterised by persistent facial redness. It typically has a relapsing and remitting course, with symptoms controlled by lifestyle measures, general skin care, medications, and procedural intervention
rash affecting labial folds
Telangiectasia
Facial skin other than in the nasal alar region
Eyelid margin telangiectasia
Inflammatory papules and pustules (papulopustular)
Phymatous changes
Thickening of the skin due to hyperplasia/fibrosis of the sebaceous glands of the face
Most common area affected is the nose (termed rhinophyma)
sunlight may exacerbate symptoms/
assox with blepharitis
Common triggers include spicy food, hot/cold temperatures (hot baths), exercise, sun exposure, cosmetic products, medications (those that cause vasodilation), alcohol, fruits and vegetables, dairy, marinated meat products
Avoid the triggers identified.
Mild- topical Ivermectin (Limited number of papules and pustules, no plaques))
severe- oral doxycycline + topical ivermectin
can consider isoretinoids, laser therapy, topical a agonist brimonidine
Poplhyx eczema/dihydrotic
Pompholyx is a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema.
Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures.
Features
small blisters on the palms and soles
pruritic
often intensely itchy
sometimes burning sensation
once blisters burst skin may become dry and crack
Management
cool compresses
emollients
topical steroids
Pityriasis rosacea
Pityriasis rosea describes an acute, self-limiting rash which tends to affect young adults. The aetiology is not fully understood but is thought that herpes hominis virus 7 (HHV-7) may play a role.
Features
in the majority of patients there is no prodrome, but a minority may give a history of a recent viral infection
herald patch (usually on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance
Management
self-limiting - usually disappears after 6-12 weeks
Erythema marginatum
target lesions
causes –Rheumatic Fever
Erythema multiforme
Features
target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild
Causes
viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy
erythema nodosum
Overview
inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring
Causes
infection
streptococci
tuberculosis
brucellosis
systemic disease
sarcoidosis
inflammatory bowel disease
Behcet’s
malignancy/lymphoma
drugs
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy
Coeliac assox derm
Dermatitis Herpetiformis -IgA mediated
Features
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
Diagnosis
skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
Management
gluten-free diet
dapsone
IBD skin relations
Erythema Nodosum
Pyoderma gangrenosum
Pyoderma gangrenosum
Pyoderma gangrenosum is a rare, non-infectious, inflammatory disorder. It is an uncommon cause of very painful skin ulceration. It may affect any part of the skin, but the lower legs are the most common site.
diopathic in 50%
inflammatory bowel disease in 10-15%
ulcerative colitis
Crohn’s
rheumatological
rheumatoid arthritis
SLE
haematological
myeloproliferative disorders
lymphoma
myeloid leukaemias
monoclonal gammopathy (IgA)
location
typically on the lower limb
soften at the site of a minor injury as in this patient’s case and this is known as pathergy
initially features:
usually starts quite suddenly
small pustule, red bump or blood-blister
Diagnosis
often made by the characteristic appearance, associations with other diseases, the presence of pathergy, histology results and when other diseases have been ruled out
Management
the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
