If interpreting Data: Comment on the abnormal as well as the abnormal 3) If you are asked to describe lesion

Describe it fully:

o Shape: e.g.: round, regular or irregular, location and Distribution… o Colour:e.g : erythematous, brownish, pearly…

o Ulceration

o Crusting and colour of scales

o Lichnification, Bullae, bleeding points…etc. 4) Helpful Hints in Studying slides:

 Approaching slides on infectious disease: o What is the caustic organism

o How can you diagnose it?

e.g.-Micros-copy and culture of scrapings -Woods light examination. color change. -Special tests for some disorders.

o What is the distribution of the Rash.

o How is it prevented eg: hygiene, eradication of vector…etc. o What is your management or action?

 A good approach is to mention what you would actually do in your practice. eg. o Explaining the problem to the patient.

o Investigation (if you need further information such as culture).

o Advise : eg: hygiene, treating other members of the family if disease is contagious. o Preventing and treating complication.

o Prescription of medication, including generic name (best), dose, how to use, frequency and duration

o Referral

Dermatology & General Medicine

 Acute candidiasis of the oral cavity (thrush):

Description: Whitish layer that wipes off easily, leaving a bleeding surface. Characteristic feature on microscopy:

o Fungal hyphae usually in the mouths of debilitated patients e.g. anaemias. Precipitating factors:

o Diabetes mellitus o Hypothyroidism o Hypoparathyroidism

 Pitryasis Vesicolor:

Appearance:

o The eruption manifests itself either as pink or brownish patches on a pale background, or as hypopigmented patches on a dark background

o _{The organism produces azaieic acid which bleaches melanin.}

Causative Organism:

o The yeast malassezia furfur.

Differential diagnosis: Vetiligo

Treatment: Refer to handout.

o With topical agents e.g. benzoic acid compound ointment BPC (Whitfielf’s

ointment), selenium sulphide lotion, creams or lotions of the imidazole group. None offers a permanent cure.

 Scabies:

Description:

o Excoriations due to generalized pruritus. Pruritus starts about six weeks after the disease is acquired.

o Burrows in finger webs.

Transmission: By close physical contact with an infested person. Causative organism: Sarcoptes scabiei hominis, scraped out of a burrow. Treatment:

o By two application of an anti-scabetic lotion (benzyl benzoate or gammabenzene hexachloride) to the whole skin surface below the chin, on two occasions 24 hours apart for patient and close contacts. Pruritus can take up to two weeks to settle, during which time no further anti-scabetic treatment should be used.

o Children and pregnant woman  Benzyl benzoate o Wash the drug off after 24 hours

 Systemic Lupus Erythematosus (SLE):

Appearance: Butterfly (Malar) rash of face of young females. Other features of SLE: - Pleuritis, pericarditis,

- Nephritis, Anemia Diagnostic test:

o Antibodies to double stranded DNA, are found in over 80 per cent of patients.

 Cutaneous Leishmaniasis: Transmitted by: The sandfly

Causative organism: The protozoan leishmania tropica

Diagnosis: Smear demonstrates the organism with Wright’s or Giemsa stain.

 Pyogenic granuloma: Often a result of trauma. Differential diagnosis:

 Amelanotic melanoma: The lesion after removal should be sent for histological examination.

Treatment: - Silver nitrate application. - Curettage

- Diathermy under local anaesthetic  Kobner’s Phenomina: Seen in:  Lichen planus  Proriasis  Vetiligo  Warts  Moluscum contgiosum  Acanthosis nigricans:

Associated with: Malignancy of an internal organ:

o Occurs in almost 100 per cent of cases of the acquired type in non-obese adults.

o Commonly adenocarcinomas. o 85 per cent being intra-abdominal.

 Nail Changes in Psoriasis: 1) Pitting 2) Onycholysis 3) Discoloration 4) Thickening 5) Subungual Hyperkeratosis Differential Diagnosis: 1. Trauma 2. Eczema 3. Onychomycosis Treatment of psorisis:

 Dithranol, tar, corticosterods

 Emoliants

 Systemic PUVA, UVB

 Methotrexate, etretinate.  Basal cell carcinoma:

Associated with:

 Excessive sun exposure  X-ray treatment of the area

 Contact or medication with arsenic Treatment: By curettage, cryotherapy or excision

 Insulin induced fat hypertrophy (lipodystrophy): Dermatological side effects of insulin:

 Local reactions:

o Immediate or delayed erythema, keloid formation  General reactions:

o Erythema multiforme, urticaria, purpura.

 Palmar Erythema:

Causes: i) Cirrhosis (especially alcoholic) ii) Normal pregnancy

iii) Rheumatoid arthritis iv) Thyrotoxicosis

v) Dermatological disorders – eczema, psoriasis, pityriasis rubra pilaris. vi) Others include polycythaemia, diabetes mellitus, mitral valve disease, beri- beri.

 Henoch-Schonlein Purpura:

Complications: Bleeding from the gut and nephritis Causes:

 Usually none is found.

 In former years streptococcal infection was thought to be important.  It is now regarded as an immune complex disease but the antigen is

usually difficult to identify.

 Xanthelasmata: Causes:

 Essential familial hypercholesterolaemia  Primary biliary cirrhosis

 Diabetes mellitus

 Usually no underlying cause is found

Treatment: By cautery or trichloracetic acid or excision  Leprosy:

Characteristics:

 Hypo-or hyper-pigmented macule  Anaesthesia, neuritis

Causative organism: Mycobacterium leprae Diagnosis:

 Skin scraping and microscopy  Biopsy

 Lepromin test (Mitsuda test)  Stevens – Johnson Syndrome: Causes:

Infections: -Herpes simplex -Mycoplasma -Streptococcal -T.B.

Drugs: Barbitarates, penicillin, sulphonamides Neoplasia: e.g. Hodgkin’s disease

Connective tissue diseases  Malignant Melanoma: 

Differential Diagnosis:

 Seborrheic keratosis

 Moluscam Contagiosum: Tiny white (pearly), umbilicated papules Common in - Children

- Atopics

- Immune suppressed Caused by Pox virus.

Complications: secondary infections Treatment: Removal: - By curettage

- Expression of contents - Phenol or codeine.

Chicken Pox (Varicella):  Complications:

Secondary infection

Thrombocytopenic purpura Encephalitis

Varicella pneumonia (usually in adults and those with an impaired immune response).

Herpes Zoster:

 Commonly affects trunk then cranial nerves  Complications of herpes zoster ophthalmicus:

 Conjunctivitis, keratitis, iridocyclitis, optic neuritis (rarely).  Encephalitis.

 Secondary streptococcal/staphylococcal infection.  Haemorrhagic zoster (purpura fulminans).

 Dissemination (immunosuppressed patients).  Post-herpetic neuralgia.

 Treatment:

 Acyclovir, vidarabine, or idoxuridine will limit viral replication.  Systemic corticosteroids may reduce the incidence of post herpetic

neuralgia (contraindicated in the immuno-compromised host).  Local corticosteroids and atropine if anterior uveitis has developed.  (immunosuppressed patients).