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The Management of Common Skin Conditions in General Practice
Management of Common Skin Conditions In General Practice including the “red rash made easy” © Arroll, Fishman & Oakley, Department of General Practice and Primary Health Care University of Auckland, Tamaki Campus Reviewed by Hon A/Prof Amanda Oakley - 2019 http://www.dermnetnz.org Management of Common Skin Conditions In General Practice Contents Page Derm Map 3 Classic location: infants & children 4 Classic location: adults 5 Dermatology terminology 6 Common red rashes 7 Other common skin conditions 12 Common viral infections 14 Common bacterial infections 16 Common fungal infections 17 Arthropods 19 Eczema/dermatitis 20 Benign skin lesions 23 Skin cancers 26 Emergency dermatology 28 Clinical diagnosis of melanoma 31 Principles of diagnosis and treatment 32 Principles of treatment of eczema 33 Treatment sequence for psoriasis 34 Topical corticosteroids 35 Combination topical steroid + antimicrobial 36 Safety with topical corticosteroids 36 Emollients 37 Antipruritics 38 For further information, refer to: http://www.dermnetnz.org And http://www.derm-master.com 2 © Arroll, Fishman & Oakley, Department of General Practice and Primary Health Care, University of Auckland, Tamaki Campus. Management of Common Skin Conditions In General Practice DERM MAP Start Is the patient sick ? Yes Rash could be an infection or a drug eruption? No Insect Bites – Crop of grouped papules with a central blister or scab. Is the patient in pain or the rash Yes Infection: cellulitis / erysipelas, impetigo, boil is swelling, oozing or crusting? / folliculitis, herpes simplex / zoster. Urticaria – Smooth skin surface with weals that evolve in minutes to hours. No Is the rash in a classic location? Yes See our classic location chart . -
What Is Acne? Acne Is a Disease of the Skin's Sebaceous Glands
What is Acne? Acne is a disease of the skin’s sebaceous glands. Sebaceous glands produce oils that carry dead skin cells to the surface of the skin through follicles. When a follicle becomes clogged, the gland becomes inflamed and infected, producing a pimple. Who Gets Acne? Acne is the most common skin disease. It is most prevalent in teenagers and young adults. However, some people in their forties and fifties still get acne. What Causes Acne? There are many factors that play a role in the development of acne. Some of these include hormones, heredity, oil based cosmetics, topical steroids, and oral medications (corticosteroids, lithium, iodides, some antiepileptics). Some endocrine disorders may also predispose patients to developing acne. Skin Care Tips: Clean skin gently using a mild cleanser at least twice a day and after exercising. Scrubbing the skin can aggravate acne, making it worse. Try not to touch your skin. Squeezing or picking pimples can cause scars. Males should shave gently and infrequently if possible. Soften your beard with soap and water before putting on shaving cream. Avoid the sun. Some acne treatments will cause skin to sunburn more easily. Choose oil free makeup that is “noncomedogenic” which means that it will not clog pores. Shampoo your hair daily especially if oily. Keep hair off your face. What Makes Acne Worse? The hormone changes in females that occur 2 to 7 days prior to period starting each month. Bike helmets, backpacks, or tight collars putting pressure on acne prone skin Pollution and high humidity Squeezing or picking at pimples Scrubs containing apricot seeds. -
What Is Acne and Why Do I Have Pimples?
What is acne and why do I have pimples? The medical term for “pimples” is acne. Most people develop at least some acne, especially during their teenage years. Although many believe that acne comes from being dirty, this is not true; rather, acne is the result of changes that occur during puberty. Your skin is made of layers. To keep the skin from getting dry, the skin makes oil in little wells called “sebaceous glands” that are found in the deeper layers of the skin. “Whiteheads” or “blackheads” are clogged sebaceous glands. “Blackheads” are not caused by dirt blocking the pores, but rather by oxidation (a chemical reaction that occurs when the oil reacts with oxygen in the air). People with acne have glands that make more oil and are more easily plugged, causing the glands to swell. Hormones, bacteria (called P. acnes) and your family’s likelihood to have acne (genetic susceptibility) also play a role. SKIN HYGIENE Good skin care habits are important and support the medications your doctor prescribes for your acne. » Wash your face twice a day, once in the morning and once in the evening (which includes any showers you take). » Avoid over-washing/over-scrubbing your face as this will not improve the acne and may lead to dryness and irritation, which can interfere with your medications. » In general, milder soaps and cleansers are better for acne-prone skin. The soaps labeled “for sensitive skin” are milder than those labeled “deodorant soap” or “antibacterial soap.” » Many “acne washes” may contain salicylic acid. Salicylic acid (SA) fights oil and bacteria mildly but can be drying and can add to irritation. -
Sunburn, Suntan and the Risk of Cutaneous Malignant Melanoma the Western Canada Melanoma Study J.M
Br. J. Cancer (1985), 51, 543-549 Sunburn, suntan and the risk of cutaneous malignant melanoma The Western Canada Melanoma Study J.M. Elwood1, R.P. Gallagher2, J. Davison' & G.B. Hill3 1Department of Community Health, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK; 2Division of Epidemiology and Biometry, Cancer Control Agency of British Columbia, 2656 Heather Street, Vancouver BC, Canada V5Z 3J3; and 3Department of Epidemiology, Alberta Cancer Board, Edmonton, Alberta, Canada T6G OTT2. Summary A comparison of interview data on 595 patients with newly incident cutaneous melanoma, excluding lentigo maligna melanoma and acral lentiginous melanoma, with data from comparison subjects drawn from the general population, showed that melanoma risk increased in association with the frequency and severity of past episodes of sunburn, and also that melanoma risk was higher in subjects who usually had a relatively mild degree of suntan compared to those with moderate or deep suntan in both winter and summer. The associations with sunburn and with suntan were independent. Melanoma risk is also increased in association with a tendency to burn easily and tan poorly and with pigmentation characteristics of light hair and skin colour, and history freckles; the associations with sunburn and suntan are no longer significant when these other factors are taken into account. This shows that pigmentation characteristics, and the usual skin reaction to sun, are more closely associated with melanoma risk than are sunburn and suntan histories. -
"Abstract" "Comparison of Prevalence and Number of Lentigo, Freckle, Melanocytic Nevus and Other Neavus Lesions in Women with and Without Melasma"
"Abstract" "comparison of prevalence and number of lentigo, Freckle, melanocytic nevus and other neavus lesions in women with and without melasma" Introduction: Melasma is applied to a pattern of pigmentation seen mainly in women, and may be regarded as a physiological change in pregnancy. the hypermelanosis affects the upper lip, cheeks, forehead and chin and becomes more apparent following sun exposure. Developmental defects or naevoid lesions are circumcribed lesions of the skin and/or neighbouring mucosae, which are not neoplastic. objective: at this stady we studied prevalence and number of lentigo, freckle, melanocytic nevus and other Nevus in women with and without melisma. Methods and materials: in a case- control study 120 women who have melasma (case group) and 120 women who have not melasma (control group) were entered in study. They were matched for age. Subjects were examined by a dermatologist and a questioner was compeleted for every body. lesions diagnosis were done only by clinical sign and observation. collected data were analysed by soft ware of spss. Results: mean age was 29.97 ± 6.6 in case group and 29.7 ± 6.7 in control group. There were no significant difference. Prevalence of freckles was higher in control group [(24.3% versus 4.16%) P<0/001] 64.1% in case group and 16.6% of cintrol group had lentigo. there was significant difference between both group (p<0/001)mean number of lentigo in case group was 25.2 and in control group 8. (P=0.01) Prevalence of melanocytic naevus in control group was lower than case group (96.6% versus 98.3%).There was no significant difference. -
Table S1. Checklist for Documentation of Google Trends Research
Table S1. Checklist for Documentation of Google Trends research. Modified from Nuti et al. Section/Topic Checklist item Search Variables Access Date 11 February 2021 Time Period From January 2004 to 31 December 2019. Query Category All query categories were used Region Worldwide Countries with Low Search Excluded Volume Search Input Non-adjusted „Abrasion”, „Blister”, „Cafe au lait spots”, „Cellulite”, „Comedo”, „Dandruff”, „Eczema”, „Erythema”, „Eschar”, „Freckle”, „Hair loss”, „Hair loss pattern”, „Hiperpigmentation”, „Hives”, „Itch”, „Liver spots”, „Melanocytic nevus”, „Melasma”, „Nevus”, „Nodule”, „Papilloma”, „Papule”, „Perspiration”, „Petechia”, „Pustule”, „Scar”, „Skin fissure”, „Skin rash”, „Skin tag”, „Skin ulcer”, „Stretch marks”, „Telangiectasia”, „Vesicle”, „Wart”, „Xeroderma” Adjusted Topics: "Scar" + „Abrasion” / „Blister” / „Cafe au lait spots” / „Cellulite” / „Comedo” / „Dandruff” / „Eczema” / „Erythema” / „Eschar” / „Freckle” / „Hair loss” / „Hair loss pattern” / „Hiperpigmentation” / „Hives” / „Itch” / „Liver spots” / „Melanocytic nevus” / „Melasma” / „Nevus” / „Nodule” / „Papilloma” / „Papule” / „Perspiration” / „Petechia” / „Pustule” / „Skin fissure” / „Skin rash” / „Skin tag” / „Skin ulcer” / „Stretch marks” / „Telangiectasia” / „Vesicle” / „Wart” / „Xeroderma” Rationale for Search Strategy For Search Input The searched topics are related to dermatologic complaints. Because Google Trends enables to compare only five inputs at once we compared relative search volume of all topics with topic „Scar” (adjusted data). Therefore, -
DCCC Skin Notes Gavin R Powell, MD • Ryan J Harris, MD • Seth a Permann, PA-C • Thea N Heaton, PA-C
May 2015 DCCC Skin Notes Gavin R Powell, MD • Ryan J Harris, MD • Seth A Permann, PA-C • Thea N Heaton, PA-C May Special Sun spots, blotches, liver spots, melasma: hyperpigmentation, or an in- crease of brown color in the skin, has 10% off IPL many names, but what can be done about ○○○○○○○○○○○○○ this common skin issue? 10% off Obagi, HydroQ and RetAdvanz Three of the most common causes of hyperpigmentation are an accumulation of sun exposure over time, hormone effects, or injury. There are multiple options for cosmetically treating these trouble areas. Your DCCC provider is able to diagnose the problem and work with you to find the best solution. Solar lentigo (sun spot, liver spot) is the most common benign, sun-induced lesion. A solar lentigo looks like a freckle and is more often seen in fair-skinned people. They appear most commonly on the face, arms, backs of the hands, chest, and shoulders as we age. The term “lentigo maligna”, refers to a lesion that may look similar to a solar lentigo, but is actually a superficial melanoma. If you notice a freckle that looks different than the others, including having a darker & irregular color or increased texture, these could be warning signs and should be evaluated by your dermatology provider. Yearly skin checks are recommended! For the most part, lentigines are a cosmetic concern which many people are interested in having re- moved. The procedures we offer at DCCC include: Excel V laser, Intense Pulsed Light (IPL), or cryo- therapy. -The Excel V laser is an excellent option for treating solar lentigines and may be used safely in people with all skin types. -
Cutaneous Manifestation of Β‑Thalassemic Patients Mohamed A
[Downloaded free from http://www.mmj.eg.net on Thursday, January 14, 2021, IP: 156.204.184.20] Original article 267 Cutaneous manifestation of β‑thalassemic patients Mohamed A. Gaber, Marwa Galal Departement of Dermatology and Venereology, Objective Menoufia University, Menoufia, Egypt The aim was to study the prevalence of common dermatological problems in patients with Correspondence to Marwa Galal, MBBCh, β‑thalassemia major to help rapid treatment and prevent complications. Shiben Elkom, Menoufia, Background Egypt β‑Thalassemia major affects multiple organs and is associated with considerable morbidity Tel: +20 100 276 8385; Postal code: 32511; and mortality. In β‑thalassemia, a wide spectrum of skin diseases was identified, which were e‑mail: [email protected] caused by both the hemoglobin disorder and the complications of treatment. Patients and methods Received 07 August 2018 Revised 10 September 2018 This cross‑sectional study included 105 Egyptian patients (50 female individuals and 55 male Accepted 23 September 2018 individuals) with transfusion‑dependent β‑thalassemia major in the period spanning from June Published 25 March 2020 2017 to February 2018. The study was performed on child and adult patients of β‑thalassemia Menoufia Medical Journal 2020, 33:267–271 who presented to the hematology clinic, Menoufia University hospital. Skin examination of each patient was carried out, and any skin disease present was recorded. Results The main skin disorders that were noticed in decreasing order of frequency were pruritus (34.4%), xerosis (24.8%), urticaria (21.1%), freckles (17.1%), tinea infections (11.6%), pitriasis alba reported in 10.5%, scars (10.5%), hypersensitivity to deferoxamine pump (9.5%), herpes simplex (9.5%), acne vulgaris (8.6%), miliaria (6.7%), contact dermatitis (4.8%). -
USMPAKL00310919(1) AKLIEF Patient Brochure
You may pay as little as $0*† LIGHTEN YOUR LOAD Patients† May pay as little as: Avoid wearing a backpack or sports equipment with $0 commercially unrestricted | $75 uninsured patients a chin strap or anything that rubs against your skin, Visit GaldermaCC.com/patients which can cause acne to fl are. to download your savings card now. * Certain limitations may apply. Visit Galdermacc.com/patients for program details. GUARD AGAINST THE SUN † Galderma CareConnect is only available for commercially insured or uninsured patients. You may have heard spending time in the sun can Patients who are enrolled in a government-run or government-sponsored healthcare plan with a pharmacy benefi t are not eligible to use the Galderma CareConnect Patient help clear up skin but, in fact, sunlight may darken Savings Card. the appearance of acne and cause it to last longer. DON'T LET IMPORTANT SAFETY INFORMATION Be sure to ask your dermatology YOUR ACNE BE ® provider if you have any questions INDICATION: AKLIEF (trifarotene) Cream, 0.005% is a retinoid indicated for the topical treatment of acne THE FOCUS. about AKLIEF Cream. vulgaris in patients 9 years of age and older. ADVERSE EVENTS: The most common adverse reactions (incidence ≥ 1%) in patients treated with AKLIEF Cream were application site irritation, application site pruritus (itching), and sunburn. WARNINGS/PRECAUTIONS: Patients using AKLIEF Cream may experience erythema, scaling, dryness, and stinging/burning. Use a moisturizer from the initiation of treatment, and, if appropriate, depending upon the severity of these adverse reactions, reduce the frequency of application of AKLIEF Cream, suspend or discontinue use. -
CSI Dermatology
Meagen M. McCusker, MD [email protected] Integrated Dermatology, Enfield, CT AbbVie - Speaker Case-based scenarios, using look-alike photos, comparing the dermatologic manifestations of systemic disease to dermatologic disease. Select the clinical photo that best matches the clinical vignette. Review the skin findings that help differentiate the two cases. Review etiology/pathogenesis when understood and discuss treatments. Case 1: Scaly Serpiginous Eruption This patient was evaluated for a progressively worsening pruritic rash associated with dyspnea on exertion and 5-kg weight loss. Despite its dramatic appearance, the patient reported no itch. KOH examination is negative (But, who’s good at those anyway?) A. B. Case 1: Scaly Serpiginous Eruption This patient was evaluated for a progressively worsening pruritic rash associated with dyspnea on exertion and 5-kg weight loss. Despite its dramatic appearance, the patient reported no itch. KOH examination is negative (But, who’s good at those anyway?) A. Correct. B. Tinea Corporis Erythema Gyratum Repens Erythema Gyratum Repens Tinea corporis Rare paraneoplastic T. rubrum > T. mentagrophytes phenomenon typically > M. canis associated with lung Risk factors cancer>esophageal and breast Close contact, previous cancers. infection, Less commonly associated with occupational/recreational connective tissue disorders such exposure, contaminated as Lupus or Rheumatoid furniture or clothing, Arthritis gymnasium, locker rooms “Figurate erythema” migrates up 1-3 week incubation → to 1 cm a day centrifugal spread from point of Resolves with treatment of the invasion with central clearing malignancy This patient was diagnosed with squamous cell carcinoma of the lung. Case 2: Purpuric Eruption on the Legs & Buttocks A 12-year old boy presents with a recent history of upper respiratory tract infection, fever and malaise. -
DRUG-INDUCED PHOTOSENSITIVITY (Part 1 of 4)
DRUG-INDUCED PHOTOSENSITIVITY (Part 1 of 4) DEFINITION AND CLASSIFICATION Drug-induced photosensitivity: cutaneous adverse events due to exposure to a drug and either ultraviolet (UV) or visible radiation. Reactions can be classified as either photoallergic or phototoxic drug eruptions, though distinguishing between the two reactions can be difficult and usually does not affect management. The following criteria must be met to be considered as a photosensitive drug eruption: • Occurs only in the context of radiation • Drug or one of its metabolites must be present in the skin at the time of exposure to radiation • Drug and/or its metabolites must be able to absorb either visible or UV radiation Photoallergic drug eruption Phototoxic drug eruption Description Immune-mediated mechanism of action. Response is not dose-related. More frequent and result from direct cellular damage. May be dose- Occurs after repeated exposure to the drug dependent. Reaction can be seen with initial exposure to the drug Incidence Low High Pathophysiology Type IV hypersensitivity reaction Direct tissue injury Onset >24hrs <24hrs Clinical appearance Eczematous Exaggerated sunburn reaction with erythema, itching, and burning Localization May spread outside exposed areas Only exposed areas Pigmentary changes Unusual Frequent Histology Epidermal spongiosis, exocytosis of lymphocytes and a perivascular Necrotic keratinocytes, predominantly lymphocytic and neutrophilic inflammatory infiltrate dermal infiltrate DIAGNOSIS Most cases of drug-induced photosensitivity can be diagnosed based on physical examination, detailed clinical history, and knowledge of drug classes typically implicated in photosensitive reactions. Specialized testing is not necessary to make the diagnosis for most patients. However, in cases where there is no prior literature to support a photosensitive reaction to a given drug, or where the diagnosis itself is in question, implementing phototesting, photopatch testing, or rechallenge testing can be useful. -
Dermatology from the Outside in Rob Danoff, DO, MS, FACOFP, FAAFP
Dermatology from the Outside In Rob Danoff, DO, MS, FACOFP, FAAFP + A Pictorial Review of Primary Care Dermatology ACOFP Intensive Review Update 8-22-15 Rob Danoff, DO, MS, FACOFP, FAAFP + In the Beginning Proof that babies are delivered by storks + What’s the diagnosis? 1 + Erythema Toxicum Neonatorum “E-Tox” Benign transient self-limiting eruption in the newborn seen in 40% of healthy full-term infants Follicular aggregation of eosinophils and neutrophils Resemble flea bites (yellow/beige papule on an erythematous base) Presents within first four days of life, peak at 48 hours Most cases resolve within five to fourteen days No treatment necessary + What is the diagnosis? + Distribution Crawling Children in diapers – typicaly seen on elbows and knees Older children and adults – typically present in folds of skin opposite to the elbow and kneecap, but spares armpits Other areas commonly involved include the cheeks, neck, wrists, and ankles. 2 + Atopic Dermatitis / Eczema Treatment: Avoid triggers—cold, wet, irritants, emotional stress Aggressive hydration with cream based or petrolatum based moisturizer to restore skin barrier Less irritating soap Infants--Low potency corticosteroid ointments for maintenance Older children and adults—medium potency corticosteroid ointments, sparing the face Stronger corticosteroids ointments should be used for flares or refractory plaques short term only to avoid thinning of skin Calcineurin inhibitors (tacrolimus or picrolimus) –useful on face or eyelids Short course oral Prednisone only