DERMATOLOGY
, of vulval Shingles
SCCI , so need
Risk
follow-up ↳ autoimmune
T-cell mediated
* vaccine offered to all 65
year olds
Lichen Sclerosus Most common in post-merropausal women
Lichen Planus
Inflammatory condition that usually affects Features = purple, pruritic, papular,
the genitalia and more common in elderly polygonal rash on flexor surfaces
Leads to atrophy of the epidermis with • itchy rash most common on palms,
white plaques forming soles, genitalia and flexor surfaces of
&
associated with urinary incontinence arms -
can't wipe off
Features >
- can lead to phimosis +
older males balanitis in
• 'white-lines' pattern on the surface
• white patches that may scar (Wickham's striae)
• itch is prominent pale atrophic -
skin
• Koebner phenomenon may be seen
• may result in pain during intercourse or ·
• Oral involvement common
urination vulval malignancy
• Longitudinal ridges in nails
↑ risk of
↑ risk
of malignancy
Management Management
• topical steroids and emollients • potent topical steroids = 1ST LINE
• If resistant, use topical tacrolimus - • benzydamine mouthwash or spray is
initiated by specialist recommended for oral lichen planus
DERMATOLOGY
Pyoderma gangrenosum
• Commonly associated with IBD RA + + AML +
myeloproliferative
orders
• Management = corticosteroids,
either topical or oral depending on
the size of the ulcer
Head lice
• Management = wet combing or
using dimethicone gel, repeated
after 7 days
• Do not require school exclusion
, Perioral dermatitis topical antibiotics
ECZEMA
or 10
Atopic Eczema
• Filaggrin gene variant strongly associated Venous Eczema
• Clinical Features = red inflamed skin on face initially, then abdomen, • Due to poor venous return, elderly
erythroderma • Precurosor to venous ulcers and lipodermatosclerosis
- Symptoms = itch, crust, scaling, bleeding, colour change
- Not well-demarcated, lichenification in chronic eczema Discoid Eczema (nummular eczema)
• Chronic, pruritic, inflammatory dermatitis - can be infection sign
/
• EASI Score & DLQI score
• Coin shaped lesions, extremely itchy
Management • Often difficult to treat - potent topical steroids
• Education & avoidance of triggers
Eczema Craquelé
• Topical treatment - steroids, macrolide immunomodulators (tacrolimus,
• Crazy paving appearance, common on shins
pimacrolimus) -riskSC
↳HN diabet, , renal as
,
dang
• Older people, retinoids, diuretics, hypothyroidism, malnutrition
• Phototherapy = NB-UVB, PUVA - extensive eczema
• DMARDS = methotrexate, azathioprine, ciclosporin - severe eczema yeast
Malassezia
↑
must test for
Seborrheic Dermatitis H
>
-
widespread
• JAK Inhibitors = baricitinib, upadacitinib, abrocitinib
came for molluscum
contagiosum
• Chronic/relapsing dermatitis affecting sebaceous gland-rich areas
• IL-13/4 = dupilumab, tralokinumab - advanced option
• Infantile and adult forms
• Features - eczematous lesions on
Ezema Herpeticum
- Scalp = dandruff
• Severe primary infection of the skin by HSV-1 or HSV-2 & Cocksackie Virus (uncommon)
- Periorbital
• Commonly seen in children
- Auricular and naso-labial folds
• Presents as rapidly progressive painful rash with systemic signs
- Otitis external and blepharitis may develop
• Monomorphic punched-out lesions usually seen
• Management
• Management = IV aciclovir
- Topical antifungals = ketoconazole (scalp treatment)
- Topical steroids
Contact Dermatitis
- Topical emollient - cradle cap in infants
• Allergic contact dermatitis = allergic reaction following allergen exposure
- Type 4 hypersensitivity -> nickel, acrylate, rubber, rosin, PPD (hair dye)
• Irritant contact dermatitis = repetitive exposure to ‘irritants’ Associated Genes
- Water, soaps, hand sanitiser, acids, alkalis, solvents • Filaggrin • IL-13
• Patch Testing = day 1 (apply patches), day 3 (1st reading), day 5 (2nd • IL-4 • CMA1
reading) • IL-4R • SPINK5
• Management = topical steroid
, of vulval Shingles
SCCI , so need
Risk
follow-up ↳ autoimmune
T-cell mediated
* vaccine offered to all 65
year olds
Lichen Sclerosus Most common in post-merropausal women
Lichen Planus
Inflammatory condition that usually affects Features = purple, pruritic, papular,
the genitalia and more common in elderly polygonal rash on flexor surfaces
Leads to atrophy of the epidermis with • itchy rash most common on palms,
white plaques forming soles, genitalia and flexor surfaces of
&
associated with urinary incontinence arms -
can't wipe off
Features >
- can lead to phimosis +
older males balanitis in
• 'white-lines' pattern on the surface
• white patches that may scar (Wickham's striae)
• itch is prominent pale atrophic -
skin
• Koebner phenomenon may be seen
• may result in pain during intercourse or ·
• Oral involvement common
urination vulval malignancy
• Longitudinal ridges in nails
↑ risk of
↑ risk
of malignancy
Management Management
• topical steroids and emollients • potent topical steroids = 1ST LINE
• If resistant, use topical tacrolimus - • benzydamine mouthwash or spray is
initiated by specialist recommended for oral lichen planus
DERMATOLOGY
Pyoderma gangrenosum
• Commonly associated with IBD RA + + AML +
myeloproliferative
orders
• Management = corticosteroids,
either topical or oral depending on
the size of the ulcer
Head lice
• Management = wet combing or
using dimethicone gel, repeated
after 7 days
• Do not require school exclusion
, Perioral dermatitis topical antibiotics
ECZEMA
or 10
Atopic Eczema
• Filaggrin gene variant strongly associated Venous Eczema
• Clinical Features = red inflamed skin on face initially, then abdomen, • Due to poor venous return, elderly
erythroderma • Precurosor to venous ulcers and lipodermatosclerosis
- Symptoms = itch, crust, scaling, bleeding, colour change
- Not well-demarcated, lichenification in chronic eczema Discoid Eczema (nummular eczema)
• Chronic, pruritic, inflammatory dermatitis - can be infection sign
/
• EASI Score & DLQI score
• Coin shaped lesions, extremely itchy
Management • Often difficult to treat - potent topical steroids
• Education & avoidance of triggers
Eczema Craquelé
• Topical treatment - steroids, macrolide immunomodulators (tacrolimus,
• Crazy paving appearance, common on shins
pimacrolimus) -riskSC
↳HN diabet, , renal as
,
dang
• Older people, retinoids, diuretics, hypothyroidism, malnutrition
• Phototherapy = NB-UVB, PUVA - extensive eczema
• DMARDS = methotrexate, azathioprine, ciclosporin - severe eczema yeast
Malassezia
↑
must test for
Seborrheic Dermatitis H
>
-
widespread
• JAK Inhibitors = baricitinib, upadacitinib, abrocitinib
came for molluscum
contagiosum
• Chronic/relapsing dermatitis affecting sebaceous gland-rich areas
• IL-13/4 = dupilumab, tralokinumab - advanced option
• Infantile and adult forms
• Features - eczematous lesions on
Ezema Herpeticum
- Scalp = dandruff
• Severe primary infection of the skin by HSV-1 or HSV-2 & Cocksackie Virus (uncommon)
- Periorbital
• Commonly seen in children
- Auricular and naso-labial folds
• Presents as rapidly progressive painful rash with systemic signs
- Otitis external and blepharitis may develop
• Monomorphic punched-out lesions usually seen
• Management
• Management = IV aciclovir
- Topical antifungals = ketoconazole (scalp treatment)
- Topical steroids
Contact Dermatitis
- Topical emollient - cradle cap in infants
• Allergic contact dermatitis = allergic reaction following allergen exposure
- Type 4 hypersensitivity -> nickel, acrylate, rubber, rosin, PPD (hair dye)
• Irritant contact dermatitis = repetitive exposure to ‘irritants’ Associated Genes
- Water, soaps, hand sanitiser, acids, alkalis, solvents • Filaggrin • IL-13
• Patch Testing = day 1 (apply patches), day 3 (1st reading), day 5 (2nd • IL-4 • CMA1
reading) • IL-4R • SPINK5
• Management = topical steroid
