Dr Janakan Natkunarajah (Dr Jana)
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1 Dr Janakan Natkunarajah (Dr Jana)
2
3 Diagnosis
4 Furuncle (Boil) Deep follicular abscess Anti-staph antibiotics Systemic & topical
5 Carbuncle Deep abscess formed in a group of follicles Incise and Drain
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7 Recurrent Abscesses Think PVL
8 Recurrent Skin Abscesses Panton-Valentine Leukocidin (PVL) associated Staph. Aureus Toxin -> kill White blood cells and cause tissue damage Seen in UK since 1950s Genes encoding for PVL found in <2% of Staph Aureus
9 Recurrent Painful Abscesses Swab skin, nose, axillae, perineum Request for PVL testing -> sent to reference Lab
10 PVL Treatment PVL -MSSA Flucloxacillin 500mg QDS or clindamycin 450mg QDS PVL MRSA Rifampicin 300mg BD & doxycycline 100mg BD Rifampicin 300mg BD & fusidic acid 500mg TDS Rifampicin 300mg BD & Trimethoprim 200mg BD
11 PVL Decolonisation Decolonisation until acute infection resolves Contacts undergo decolonisation at same time 5 days Bactroban nasal TDS and Hibiscrub or Triclosan 2% wash
12 Inform Health protection agency Infection in care home/residential home Suspicion of spread in nurseries, schools, universities, gyms Cluster/outbreak suspected Invasive disease suspected
13
14 Diagnosis
15 Hot Tub Folliculitis
16 Bacterial infection of hair follicle after exposure to contaminated water (whirl pools, hot tubs) Pseudomonas aeruginosa 48 hours after exposure Resolve in 7-14 days
17 Hot tub Folliculitis Erythematous follicular papules and pustules Intertriginous areas Self limiting infection clears 2-10 days Severe: ciprofloxacin 500mg bd for 7 days
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19 Diagnosis
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21 Tinea Incognito Less scaly More pustular More extensive Less raised margin More irritable
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30 Diagnosis
31 Onset any age No Sex/Race preponderance 30% Positive Family history
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34 Disease severity at presentation is the strongest predictor of long term outcome
35 Ophiasis pattern
36 beard area affected in 30%
37 10% nail involvement:- pitting/ longitudinal ridging
38 14-25% progress to A. totalis/a. Universalis
39 Associations Vitiligo Autoimmune thyroid disease Lupus Erythematosus
40 Treatment No treatment % spontaneous remission in AA of short duration (<1yr) Superpotent Topical Steroids Intralesional Steroids (every 4-6wks) Oral Prednisolone (6 weeks tapering course) Contact Immunotherapy: Diphencyprone Phototherapy
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42 Diagnosis
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44 Diagnosis
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47 Scabies Parasitic Infection of the skin Intensely itchy Sarcoptes scabiei var hominis
48 Pregnant female lay 2-3 eggs per day Larvae emerge after 48-72hrs Tragic life : Male mite mates with female and then dies! Cycle: days Mites live for around 30 days
49 Skin Contact
50 Incubation: 4-6 wks Itching worse at night
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57 12 30 mites adults: immunocompetent adults
58 Treatment: 2 treatments one week apart Baby/Elderly/ Immunosuppressed- include Face/neck
59 Treat all family members/sexual partners!
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61 Post Scabetic Itch Last up to 4-6 weeks
62 Crusted Scabies Immunosuppression - Cancer - HIV - Immunosuppressive drugs - Elderly - Itching is unexpectedly mild! - Up to a million mites on the skin - Oral Ivermectin 200ug/kg (named patient basis) and topical permethrin 5% cream
63
64 Diagnosis
65 Risk factors Trauma Occlusion Water immersion Tinea pedis Immunosuppression
66 90% - dermatophyte- T. rubrum 7% - Yeasts- mainly candida 2-3% Non-dermatophyte moulds- fusarium,
67 Distal and Lateral Distal and lateral nail plate spreads proximally
68 White Superficial 10% of onychomycosis T. interdigitale
69 Proximal Least common Think immunosuppression HIV, DM, PVD
70 Candidal Frequent hand immersion
71 Onychomycosis Terbinafine 250mg OD for 3-6 months Itraconazole 200mg OD for 3 months Toe nail Itraconazole 200mg BD for 7 days 21 day break repeat- 21 day break - repeat
72 Chronic
73 Diagnosis
74 Paronychia Swelling of nail fold Loss of cuticle Pus under inflamed areas Nail can be ridged
75 Diagnosis
76 Treatment Acute antibiotics +/- surgical Chronic antibacterial/antifungal cream +/- orals Steroid cream Avoid predisposing factors ie biting
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78 Diagnosis
79 Salicylic Acid
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82 Diagnosis
83 Pompholyx Eczema Vesicles or bullae Personal or family history of eczema in 50% Potent superpotent topical steroids
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88 Diagnosis
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93 Psoriasis Body sites eg scalp /nail Co-morbidities arthritis & cardiovascular factors Family planning Previous Treatments Topical vs phototherapy vs systemic vs Biologic
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95 Papular urticaria Reaction to insect bites Breakfast Lunch Dinner Pattern
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102 Diagnosis
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104 Why buy a Dermatoscope? Diagnostic accuracy for melanoma is 15.6 times higher compared to the naked eye Sensitivity (% of melanomas correctly diagnosed) was higher for dermoscopy (90%) than eye examination only (71%) 42% reduction in patients referred for a biopsy Benign/malignant ratio Pre dermoscopy 18/1; Post dermoscopy 4/1
105 A Asymmetry B- Borders C- Colour D- Diameter >6 mm
106 Asymmetry- colour or structure Atypical network pattern Blue White structures
107 Benign or Malignant?
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109 Asymmetry
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114 Network Pattern
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119 Blue White Structure
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123 Risk Factors Fair skin, red hair, and blue eyes Intermittent sun exposure Sunburns Tanning beds Freckles and melanocytic nevi Family history of melanoma
124 Prognostic Factors Breslow Mitoses: dermal mitoses per mm 2 Ulceration
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134 Diagnosis
135 BCC is the most frequent skin cancer (80%) BCC is 4x more frequent than SCC Metastases are rare (<1% of cases) Local destruction of tissue
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141 Pigmented BCC Similar to nodular but with black discoloration Melanin deposits Pigmented races Face, trunk, and scalp
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147 Diagnosis
148 Superficial BCC Erythematous scaly plaque Slow growth Asymptomatic Trunk, extremities, face
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152 Diagnosis
153 Morphoeic BCC Resembles scar Asymptomatic and slow growing Ill-defined margins Marked subclinical extension
154 Moh s micrographic surgery
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156 Diagnosis
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159 SCC of the lip. A brown, keratotic, crumbly, ulcerated surface with an infiltrating edge. They can present with pain and may be associated with regional lymphadenopathy
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166 Diagnosis
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168 Diagnosis
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170 Diagnosis
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172 Diagnosis
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174 Diagnosis
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Clinical characteristics
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