LOUERE GRACE J. PAYPA

DERMATOLOGY

1.	 Skin  lesions
1.1	Cues for Acute vs.  Chronic

Acute   -  begins abruptly with marked intensity or sharpness
-	duration is short period of time
-	intensity is severe
-	quality sharp

Chronic   -   develops  slowly
-	duration is a long period of time, often for the remainder of the life of  the individual

1.2	Cues for exanthem vs. non-exanthem

Exanthem  -  skin eruption or rash

Non- exanthem  -  non- eruptive

1.3	Clinical cues for:

Disease
	      History	PE	Paraclinical diagnostic procedure	Treatment	
ATOPIC DERMATITIS	>Age: infant and 12 y.o.

>Allegic rhinitis Exacerbating factors:

>Skin -dehydration by freq. Bathing and hand washing

>Emotional –
Stress

>Hormonal –pregnancy

>Infections- Staph
	>Untreated involved sites persist for months to years

>Skin Lesions: poorly defined erythematous patches, papules and plaques with or without scale. Edema with widespread involvement skin appears “ puff” and edematous. Erosions: Moist, crusted. Excoriation: occur as a result of scratching. Pustules. Crusts
Distribution of lesions: predilection for the flexures, front and sides of the neck, eyelids, forehead, face, waists, and dorsa of the feet and hands	Bacterial Culture: colonization with S. Aureus

	Wet dressing and topical Corticosteroids; topical antibiotics.	
SCABIES	Epidemiology:
>contact with mite-infested sheets
History:

>immunocompromised  - HIV
Duration:

>weeks to months unless treated.  Crusted scabies may be present.
Skin symptoms:
Pruritus  -  intense, widespread, usually sparing head and neck. 
Rash: Rages from no rash to generalized erythroderma.	Skin lesions:
>Lesions occuring at the sites of mite infestation, cutaneous manifestation of hypersensitivity to mite, lesions seconadary to  chronic rubbing and scratching.
Cutaneous as manifestation of hypersensitivity to mite:
>Pruritus

>Small urticarial edematous papules mainly on ant. Trunk, thighs, buttock and forearms.
>Urticaria

>Eczematous dermatitis

Lesions secondary to chronic rubbing and scratching:

>Excoriation, lichen simplex Chronicus, prarigo nodules

>Atopic dermatitis

>Post inflammatory hyperpigmenta-tion

>Gen. Eczematous dermatitis

>Erythroderma
	Finding the mite: A chop of mineral oil is placed over a burrow is scrapped off with a no.15 scalpel blade and placed on a microscope slide.

	Scabicides- Permethrine is effective and safe.	
PSORIASIS	Heredity:
>1 parent = 8% offspring both parents = 41%
Trigger Factors:

>Physical trauma- rubbing, scratching

>Infections-strep.

>Stress-

>Drug – Systemic corticostenoids
Duration of lesions: Usually indolent lesions are present for months

Skin SX:
>Pruritus-Scalp
Constitutional symptoms:

>Acute illness- weakness, chills, fever

	Skin Lesions:
Type- papules, plaques, sharply marginated with marked silvery white scale, pustules, erythroderma 
Color – salmon pink
Shape- round, oval, polycyclic, annular, linear
Arragement- Zosteriform, arcifrom, serpiginous, scattered discrete lesions, enythroderma
Distribution- Extent- single lesion or lessions localized to one area, regional involvement, gen. or universal.
Pattern- bilateral
disseminated small lesions without prediction of site	Dermatopatho-logy
	Topical fluorinated corticosteroids ( bethamethasone 
Valerate, flucinolone, acetonide ) in ointment base applied after removing the scales by soaking in water. The ointment is applied to the wet skin, covered with plastic wrap, and left overnight.	

CONTACT DERMATITIS	>Occupation

>Duration: Acute - days 
weeks
Chronic- months 
Years

>Skin Sx: pruritus

>Constitutional Sx: Acute illness	Skin lesions:
Acute- well demarcated plaques of erythema and edema on which are superimposed closely spaced, nonumbilical vesicles, punctate erosions exuding serum, and crusts.
Subacute- plaques of mild erythema showing small, dry scales or superficial desquamation, sometimes assoc. with small, red pointed or rounded, firm papules
Chronic- plaques of lichenification with satellite, small, firm, rounded or flat- topped papules, excoriations, and pigmentation or mild erythema.
Distribution: Extent- isolate, localized pattern- random or exposed areas.	Patch test	>Wet dressing using gauze scaled in Burow’s solution changed every 2 – 3 hrs.

>Typical class I corticostioroids..	

DISEASE	HISTORY	PE	PARA CLINICAL DIAGNOSTIC PROCEDURE	TREATMENT	
LEPROSY	Geography:
>More prevalent in hot and humid climates
Sex:
>Males> females
Age:
>Incidence rate peaks at 10-20 yrs: prevalence peaks at 30-50 yrs.
Risk factors:
>Residence in an endemic area
>Having a blood relative
>Poverty
Onset:
>Insidious and painless, first affects the peripheral nervous system with persistent or recument paresthesias and numbness
System review:
>Neural involvement leads to muscle weakness, muscle atrophy, severe neuritic pain, contractures
of hands and feet.	Tuberculoid Leprosy:
Type of lesion- well defined hypopigmented anesthetic macules with raised edges and varying in size 
Color of lesion- erythematous or purple border and hypopigmented center
Border of lesion- shaping defined raised Shape- annular
Distribution- any site including the face 
Nerve-involvement- thickened nerve on the edge of the lesion.

Lepromatous leprosy:
Type of lesion- small erythematous or hypopigmented macules that are anesthetic; later papules, plaques, nodules and diffuse thickening of the skin with loss of hair ( eyebrows, eyelashes) 
Color- normal skin color or erythematous or slightly hypopigmentedDistribution- bilateral symmetric involving earlobes, face, arms and buttocks or less frequently the trunk and lower ext. mucous, plaques, tissues 
	Slit- Skin Smears

	Anti Lepromatous Therapy:
Multidrug Regimen:

Paucibacillary disease (TT & BT) 
>Monthly , suspervised Rifampin/600mg 
>Daily, unsupervised Dapsone, 100mg 
Duration 6 months, all treatment then stop
>Follow –up after  stopping treatment- Minimum of 2 yrs. With clinical examinations at least 9 – 12 months

Multibacillary Disease(LL, BL & BB)
>Monthly, surpervised medication- Rifampin, 600 mg Clofazamine, 50 mg
>Duration – A minimum of 2 yrs, but whenever possible until  slit-skin smears are negative
>Follow-up after stopping treatment- A minimum of 5 yrs. With clinical and bacteriologic exam at least 12 months