[C2C]
Major & Minor Illnesses in Primary Care
Skin and superficial pathology:
Disease: Image: Notes:
Chickenpo Self-limiting.
x (VZV) Minor but can be an emergency when immunocompromised,
preg, chemo, neonates, oral steroids.
Children back to school only when ALL lesions have crusted
over.
Shingles 1/5 who have had chickenpox go on to develop shingles.
(HZV) Burning pain (possible before rash appears).
Minor but can be an emergency e.g. ophthalmic shingles sight
loss; immunocompromised; elderly. Ophthalmic HZV = 10 – 25%
of shingles.
Herpes zoster oticus is viral infn of inner, middle, external ear.
When aw facial paralysis = Ramsey Hunt syndrome.
Post-herpetic neuralgia is the most common complication of
shingles. Causes burning pain that lasts long after the rash.
Molluscum Small lumps which are pearly-white/slightly pink.
contagios Each lump is round, firm, 1-5mm. Tiny dimple develops on top
um of each lump – if squeezed, a white cheesy fluid comes out.
Virus can be passed on skin-skin.
Mostly occurs in 1 – 4 yrs.
Typically, each molluscum lasts 6 – 12 wks, crusts over, goes.
But, they come and go. Takes 12 – 18 mo before last of mollusca
go.
Atopic Primarily seen in children, affecting 5 – 15% of UK children by 7
eczema yrs.
Common Sx – itchy, dry, red skin; may be broken or cracked. In
infants, on face + scalp + limbs. In adults/children, on hands or
around jts on limb (flexor surfaces).
Emollients are mainstay Rx – BD maintenance & up to QD flare-
ups.
Meningoc Glass test demonstrates a non-blanching rash that is
occal meningococcal septicaemia until proven otherwise.
septicaem Give IM benzylpenicillin &IV ceftriaxone in hospital.
ia
Cold sore Usually heal within 7 – 10 days.
(HSV1) Sometimes the virus can be activated by triggers outbreak of
cold sores.
Impetigo More common in those with skin conditions e.g. dermatitis.
Caused by Staph, Strep.
Any age; usually children.
Self-limiting; resolves by 2 – 3 wks.
Rx – fusidic acid or mupirocin or oral ABX (if extensive or pt
unwell).
Can go back to school once all lesions crusted over or ABX >
48 hrs.
Acne 80% of 11 – 30 yrs will be affected.
Inflamm of sebaceous glands – typified by comedone which is
open (blackhead) or closed (whitehead).
MILD topical retinoid or benzoyl peroxide. Consider OCP.
MOD as for mild + topical ABX if at risk of scarring or oral ABX
(tetracycline, oxytetracycline, doxycycline, lymecycline).
Erythromycin if 1st lines can’t be used.
SEVERE oral retinoid (roaccutane 4-6/12) ↓ size + activity of
sebaceous glands.
Boil Red, hot, tender inflammatory nodule with walled-off purulent
(furuncle) material, arising from a hair follicles.
Carbuncle is caused by infn of a group of adjoining hair follicles.
Rx flucloxacillin, clarithromycin, erythromycin.
Head lice Affects only humans.
(Pediculus Tiny grey-brown, wingless insects suck blood from scalp.
capitis) After 7-10 d, baby lice hatch & empty eggshells remain place =
Major & Minor Illnesses in Primary Care
Skin and superficial pathology:
Disease: Image: Notes:
Chickenpo Self-limiting.
x (VZV) Minor but can be an emergency when immunocompromised,
preg, chemo, neonates, oral steroids.
Children back to school only when ALL lesions have crusted
over.
Shingles 1/5 who have had chickenpox go on to develop shingles.
(HZV) Burning pain (possible before rash appears).
Minor but can be an emergency e.g. ophthalmic shingles sight
loss; immunocompromised; elderly. Ophthalmic HZV = 10 – 25%
of shingles.
Herpes zoster oticus is viral infn of inner, middle, external ear.
When aw facial paralysis = Ramsey Hunt syndrome.
Post-herpetic neuralgia is the most common complication of
shingles. Causes burning pain that lasts long after the rash.
Molluscum Small lumps which are pearly-white/slightly pink.
contagios Each lump is round, firm, 1-5mm. Tiny dimple develops on top
um of each lump – if squeezed, a white cheesy fluid comes out.
Virus can be passed on skin-skin.
Mostly occurs in 1 – 4 yrs.
Typically, each molluscum lasts 6 – 12 wks, crusts over, goes.
But, they come and go. Takes 12 – 18 mo before last of mollusca
go.
Atopic Primarily seen in children, affecting 5 – 15% of UK children by 7
eczema yrs.
Common Sx – itchy, dry, red skin; may be broken or cracked. In
infants, on face + scalp + limbs. In adults/children, on hands or
around jts on limb (flexor surfaces).
Emollients are mainstay Rx – BD maintenance & up to QD flare-
ups.
Meningoc Glass test demonstrates a non-blanching rash that is
occal meningococcal septicaemia until proven otherwise.
septicaem Give IM benzylpenicillin &IV ceftriaxone in hospital.
ia
Cold sore Usually heal within 7 – 10 days.
(HSV1) Sometimes the virus can be activated by triggers outbreak of
cold sores.
Impetigo More common in those with skin conditions e.g. dermatitis.
Caused by Staph, Strep.
Any age; usually children.
Self-limiting; resolves by 2 – 3 wks.
Rx – fusidic acid or mupirocin or oral ABX (if extensive or pt
unwell).
Can go back to school once all lesions crusted over or ABX >
48 hrs.
Acne 80% of 11 – 30 yrs will be affected.
Inflamm of sebaceous glands – typified by comedone which is
open (blackhead) or closed (whitehead).
MILD topical retinoid or benzoyl peroxide. Consider OCP.
MOD as for mild + topical ABX if at risk of scarring or oral ABX
(tetracycline, oxytetracycline, doxycycline, lymecycline).
Erythromycin if 1st lines can’t be used.
SEVERE oral retinoid (roaccutane 4-6/12) ↓ size + activity of
sebaceous glands.
Boil Red, hot, tender inflammatory nodule with walled-off purulent
(furuncle) material, arising from a hair follicles.
Carbuncle is caused by infn of a group of adjoining hair follicles.
Rx flucloxacillin, clarithromycin, erythromycin.
Head lice Affects only humans.
(Pediculus Tiny grey-brown, wingless insects suck blood from scalp.
capitis) After 7-10 d, baby lice hatch & empty eggshells remain place =
