Common Dermatological Conditions in Adults in Ghana Margaret Lartey FWACP
Outline Introduction Two Common disorders Discussion
Case 1 34 yr old female C/o pruritus of 2 months duration First episode Seen GP Prescribed ceterizine for 2 weeks Completed tablets but still itching Referred dermatologist
Pruritus Epidemiology Very common Pathophysiology Complex, interplay of peripheral and central receptors and many chemical agents Pattern of itching Localised or generalised but ear canals, eyelids, nostrils perianal and genital areas more susceptible to pruritus
Aetiology Dermatological causes Eczema Lichen planus Scabies Pediculosis Insect bites Cutaneous Larva Migrans Urticaria Drug eruptions Dermatitis herpetiformis Bullous pemphigoid Prurigo + localized ones like pruritus vulvae or ani
Non dermatological causes Drugs-opiates and derivatives, chloroquine Haem-primary polycythaemia, IDA Hepatic-extra hepatic obstruction, cholestasis of pregnancy, drugs, PBC Renal disease-ckd Malignancy-lymphomas, leukaemia Endocrine-hyper/hypothyroidism psychological
History Basic Minimum Duration Site With or without rash Aggravating/releasing factors
Physical examination Examination in well lit room Good exposure General exam if indicated Systemic examination Normal skin-dermographism
Laboratory investigations Battery of Investigations?? Focused investigations??
Treatment Modalities Not all pruritus responds to antihistamines which are very useful in urticatia and histamine mediated pruritus Topical/Systemic steriods have limited value and should be used when indicated. Topical antihistamines Lotions containing phenol, menthol or camphor may be effective Amitriptyline, doxepin Naloxone Cholestyramine
Urticaria Definition-Transient, itchy, (red) swellings of the skin and mucous membranes secondary to the release of histamine and other vasoactive agents from granules within mast cells Histology-vasodilatation, dermal odema with mild perivascular infiltrates Clinical Features-itchy, varying colour and sizes of wheals not lasting more than few hours, occurring in crops and worse in areas of pressure.
Causes Anything under the sun!!!
Types Acute<2months, chronic>2 months Physical Urticarias Pressure Solar, cold, heat Aquagenic Cholinergic-very tiny wheals sometimes difficult to see in response to exercise, emotion sweating and hot food. Common in young people
Diagnosis If wheals are not present can be demonstrated by the presence of dermographism
Laboratory investigations Most often non rewarding and DEFINITELY NOT STOOL MICROSCOPY (Routine Examination)
Management Prophylactic Antihistamines Must be taken regularly and NOT prn or when the rash appears Doses can be stepped up After urticaria has cleared COMPLETELY tail off antihistamines watching carefully for recurrence.
Acne Vulgaris Epidemiology common inflammatory skin disorder commonly occurring during adolescence. It is a disorder of the pilo-sebaceous gland (oil glands in the skin). It can range from very mild to very severe forms common in adolescents and teenagers due the following reasons: There are higher levels of sex hormones at puberty than in younger children. These hormones stimulate oil glands in the skin to enlarge.
Pathophysiology Androgenic stimulation of sebacceous glands Impaction and distension of the follicles with tightly packed horny cells Proliferation of propionibacterium acnes which metabolize sebum to FFA, also staph epidermidis Disruption or rupture of follicle into dermis releasing FFA and other irritants resulting in inflammation
Can occur in anybody, neonates to adults Scarring disease- atrophic, hypertrophic and keloids Primary and secondary forms Can be exacerbated by steroids (both topical and systemic)
AGGRAVATING FACTORS Genetic factors Hormonal factors (higher levels of androgenic hormones) Diseases of the ovaries (Polycystic ovaries) Pregnancy Psychological stress and depression Certain medications e.g. steriods-creams and tablets Cosmetics application especially certain moisturizers, foundation and pomades (watch out for lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol and oleic acid) -
Acne myths Diet- nuts, chocolate If you did not have acne as an adolescent you cannot have acne as an adult Acne and pimples are different diseases Acne does not require treatment Washing your face often and with cleansers will get rid of acne
Physical examination Lesions commonly of face, upper chest(anterior and posterior) and upper arms Closed and open comedomes, papules, pustules, nodules, cysts, scars, hyper and hypo pigmentary changes
Laboratory diagnosis If history suggestive of secondary acne
Principles of Treatment Treatment depends on severity Multi drug treatment Patient education and buy in Treatment is long term Plan for complications-scars and pigmentary changes
Treatment Options Long term antibiotics-topical and systemic Salycilic acid and azelaic acids-topical Hormonal Therapy- oestrogen therapy and anti androgens ((OCP) and high dose oestrogen Benzoyl peroxide Retinoids- topical Steriods- intralesional and acne fulminans Systemic retinoids- ISOTRETINION
Acknowledgements Fiesta Organisers Dr. S B Ofori for some of photographs
Thank you