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Primary Care Dermatology

Primary Care Dermatology. Dr Mick McKernan . Description of skin lesions. Papule Macule Nodule Patch Vesicle Bulla Plaque. Papule . Small palpable circumscribed lesion <0.5cm. Macule. Flat, circumscribed non-palpable lesion. Pustule . Yellowish white pus-filled lesion. Nodule.

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Primary Care Dermatology

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  1. Primary Care Dermatology Dr Mick McKernan

  2. Description of skin lesions • Papule • Macule • Nodule • Patch • Vesicle • Bulla • Plaque

  3. Papule • Small palpable circumscribed lesion • <0.5cm

  4. Macule • Flat, circumscribed non-palpable lesion

  5. Pustule • Yellowish white pus-filled lesion

  6. Nodule • Large papule >0.5cm

  7. plaque • Large flat topped elevated palpable lesion

  8. patch • Large macule >2cm

  9. vesicle • Small fluid filled blister < 1/2cm

  10. Bulla • A large fluid filled blister > 1/2cm

  11. ECZEMA • =dermatitis • 10% of population at any one time • 40% of population at some time

  12. Features of eczema • Itchy • Erythematous • Dry • Flaky • Oedematous • Crusted • Vesicles • lichenified

  13. Types of eczema • Atopic • Discoid eczema • Hand eczema • Seborrhoeic eczema • Varicose eczema • Contact and irritant eczema • Lichen simplex

  14. Atopic eczema • Endogenous • Atopic i.e asthma, hay fever • 5% of population • 10-15% of all children affected at some time

  15. Atopic eczema • individual must have: • An itchy skin condition in the last 12 months+ three or more of: • Onset before 2 years of age • History of flexural involvement • or flexural eczema currently present • History of generally dry skin • History of other atopic disease or FH

  16. Exacerbating factors • Infection • Teething • Stress • Cat and dog fur • ? House dust mite • ? Food allergens

  17. Clinical features • Itchy erythematous patches • Flexures of knees and elbows • Neck • Face in infants • Exaggerated skin markings • Lichenification • Nail – pitted

  18. complications • Bacterial infection • Viral infections – warts, molluscum, eczema herpeticum ( refer stat). • Keratoconjunctivitis • Retarded growth

  19. Prognosis • Most grow out of it • 15% may come back – often very mildly • Chronic skin dryness common after

  20. Treatment • Avoid irritants especially soap • Frequent emollients • Topical steroids • Sedating antihistamines – oral hydroxyzine • Treat infections • Bandages • Second line agents

  21. Triple combination of therapy • Topical steroid bd as required • Emollient frequently • Bath oil and soap substitute

  22. Principles of treatments • Creams • Ointments • Amounts required • Potential side effects • Soap substitutes

  23. creams • Cosmetically more acceptable • Water based • Contain preservatives • Soap substitutes

  24. ointments • Oil based • Don’t contain preservative • Feel greasy • Good for hydrating

  25. Topical steroids • Mild –“hydrocortisone • Moderate –“eumovate” • Potent –“betnovate” • Very potent –“dermovate”

  26. Amounts required • Emollients – 500g per week for total body • FTU – steroids- the least potent that controls the symptoms. • Bath oils – 2-3 capfuls per bath

  27. FTU • Finger tip unit • Helps to give estimation of topical steroid amount used • To avoid over and under use of steroid

  28. FTU

  29. FTU • 2 FTU = nearly 1 gram • Enough for twice size of adult hand • A hand and fingers (front and back) = 1FTU • A foot (all over) + 2FTU • Front of chest and abdomen = 7FTU • Back and buttocks = 7FTU • Face and neck = 2.5 FTU • An entire arm and hand = 4 FTU • An entire leg and foot = 8 FTU

  30. Discoid eczema • Variant of eczema • Easily confused with psoriasis • Well demarcated scaly patches • Limbs • Often infective component (staph aureus)

  31. Hand eczema • Pompholoyx – itchy vesicles or blisters of palm and along fingers • Diffuse erythematous scaling and hyperkeratosis of palms • Scaling and peeling at finger tips

  32. Hand eczema • Not unusual in atopic • More common in non atopics • Cause often uncertain • Irritants • Chemicals • Occupational history • Consider patch testing – 10% positive

  33. Seborrhoeic eczema • Over growth of yeast (pityrosporum ovale, hyphal form malassezia furfur) • Strong cutaneous immune response • More common in Parkinson’s and HIV

  34. Clinical features • Infancy – cradle cap, widespread rash, child unbothered, little pruritus • Young adults – erythematous scaling eyebrows, nasolabial folds, forehead scalp • Elderly – more extensive

  35. Treatment • Suppressive • Mild steroid and antifungal combination • Ketoconazole or dentinox shampoo • Emollients • Soap substitutes

  36. Venous eczema • Gravitational = stasis eczema • Lower legs • Venous hypertension • Inflammation • Purpura • pigmentation

  37. Clinical features • Older women • Past history DVT • Haemosiderin deposition • often misdiagnosed as cellulitis. Cellulitis is nearly always unilateral, tender and has a well demarcated edge

  38. treatment • Emollients • Topical moderately potent steroids • Soap substitutes • Compression – check arterial supply first • Leg elevation

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