Tag Archives: skin

Skin

“EBD”. CREAM: Apply one fingertip worth per each hand’s worth.

Infective:

Candida FUNGUS – folds and moist areas, like ahem down there. Itchy red macules/papules. Nystatin/azole  antifungal.

Impetigo – Staph aureus or strep pyogenes. Honey coloured, can be bullous. PO ABX.

Cellulitis – Group A strep or staph. Amoxicillin.

Scabies – fingers, nipples, genitalia.
Malathion, permetrin from neck down for 24 hours. Wash after 24 hours, new bedsheets.

Lichen planus – red shiny papules, white streaks. Topical steroids, antihistamines, pred.

HSP – Vasculitis in skin and kidneys. Can occur after URTI.
HSP = Purpura rash on legs and buttocks, joint pain, abdo pain. Also, haematuria + proteinuria –> nephrotic syndrome (leak protein, oedema, proteinuria, hypoalbuminaemia, also happens with Group A strep)
Supportive treatment. Cyclophosamide, azathioprine. Self-limiting, but chase kidneys for a year.

Drug reactions:

Erythema multiforme – target lesions on PALMS and soles, drug reaction.

Erythroderma – cover in vaseline
Bullous pemphigoid – vaseline + betnovate.
Toxic epidermal necrolysis – admit! Skin falls off.

Vasculitic rashes – drug reactions.

Dermatitis in the DIPS: Itchy red dry skin. FLEXURES.
Beware eczema herpeticum (Clustered blistered, punched-out ulcerated lesions, systemic signs); bacterial superinfection; chronic hand eczema.
Refer if unresponsive facial, contact allergic, 1-2 flares/month, reaction to emollients

a) Emollient QDS.
b) Mild steroids in flexures, else potent steroids BD.
c) Tacrolimus and pimeocrolimus

If exudative, permanganate and steroid.
Infective, fluclox/erthyro for two weeks.

Contact dermatitis: Allergic i.e. biological (delayed IV); Irritant i.e. chemistry; Phototoxic i.e. physical.

Psoriasis – too many keratinocytes –> plaques of psoriasis, then inflammation:
Psoriasis: EXTENSORS. Patellar, back of elbow, scalp, nails. Itchy red plaques in extensors with silvery scales.
– EtOH/B-blockers/NSAIDs/Lithium can cause psoriasis
– Nails, pitting, onycholysis. Koebner’s. Pinpoint bleeding on removal of plaque. Hands/feet can have pustules.

Treatment – messy:

a) Topical:
– Emollients.
– Tar
– Vit D: Calcipotriol.
– Topical steroids

– Dithranol cream – it burns, arrgh, and stains, arggh my silk sheets.
– Phototherapy – 2 months, three times a week.

b) Systemic:
– Acitretin retinoid
– MTX
– Cyclosporin
– Biologics

SCC & BCC & melanoma.

BCC: Commenest. Pearly nodules with raised red edge aka Rodent ulcer. Excise simply.

SCC: Red nbump, bleeder or crusty. Can go to nodes.
Act kays (red-brown scales) –> SCC. Bowens is SCC in situ. Sun or smoker.

MM:
A – asymmetry
B – border is irregular
C – colour – lesion of >1 colour
D – diameter > 7mm
E – enlarging/evolving
– See more at: http://almostadoctor.co.uk/content/systems/dermatology/skin-cancer#sthash.7BZOPGSE.dpuf

7mm.

Lentigo MM – Face, flat dark lesion.
Superficial spreading MM – Commonest – legs/back, raised plaque
Nodular MM – Anywhere, quick growers.
Acral/subungal – Palms, soles, fingernails.

4mm depth = 60% mets chance. Mets = 10 year% 5 yr survival. Breslow thickness = prognostic marker.