Introduction To Dermatology Dr D J Barker St Lukes Hospital, Bradford

Introduction To DermatologyIntroduction To Dermatology

Dr D J BarkerDr D J Barker

St Luke’s Hospital, BradfordSt Luke’s Hospital, Bradford

What Are the Functions of the Skin?What Are the Functions of the Skin? Temperature regulationTemperature regulation Water conservationWater conservation Protection (mechanical, UV, microbes)Protection (mechanical, UV, microbes) SensationSensation Synthesis & storageSynthesis & storage Psycho-sexualPsycho-sexual

Why Refer to a Dermatologist?Why Refer to a Dermatologist? Diagnostic difficultyDiagnostic difficulty Management adviceManagement advice Failure of agreed treatment protocolFailure of agreed treatment protocol Patient counselling or educationPatient counselling or education Increasing use of potent topical steroidsIncreasing use of potent topical steroids Special treatment e.g. PUVASpecial treatment e.g. PUVA Special investigation e.g. Patch TestsSpecial investigation e.g. Patch Tests

In-patient DermatologyIn-patient Dermatology

InfectionsInfections Urticaria & angioedemaUrticaria & angioedema Drug eruptionsDrug eruptions Connective tissue diseasesConnective tissue diseases Erythema nodosum & multiformeErythema nodosum & multiforme Cutaneous marker of systemic diseaseCutaneous marker of systemic disease Severe pre-existing skin diseaseSevere pre-existing skin disease

In-patient DermatologyIn-patient Dermatology


Infections - ErysipelasInfections - Erysipelas

Fever & RigorFever & Rigor Defined erythematous rashDefined erythematous rash Leg > face >elsewhereLeg > face >elsewhere Haemolytic streptococcusHaemolytic streptococcus Mild pre-existing skin diseaseMild pre-existing skin disease IV Benzyl penicillinIV Benzyl penicillin Lymphoedema and relapseLymphoedema and relapse

Infections – Herpes simplexInfections – Herpes simplex

Severe primary infectionSevere primary infection Kaposi’s varicelliform eruptionKaposi’s varicelliform eruption

Atopic eczemaAtopic eczema Cutaneous T-cell lymphomaCutaneous T-cell lymphoma Darier’s diseaseDarier’s disease

IV AciclovirIV Aciclovir Anti-staphylococcal antibioticAnti-staphylococcal antibiotic

Infections - Herpes ZosterInfections - Herpes Zoster

Varicella – Zoster virusVaricella – Zoster virus Pain confined to a single dermatomePain confined to a single dermatome Vesicles confined to single dermatomeVesicles confined to single dermatome Patients are infectiousPatients are infectious IV AciclovirIV Aciclovir

In-Patient DermatologyIn-Patient Dermatology


UrticariaUrticaria

May be associated with angioedemaMay be associated with angioedema Vasoactive amine release from mast Vasoactive amine release from mast

cellscells Acute attacks frightening, not Acute attacks frightening, not

dangerousdangerous Most attacks have no simple causeMost attacks have no simple cause AntihistaminesAntihistamines

AnaphylaxisAnaphylaxis

Urticaria – angioedemaUrticaria – angioedema Bronchospasm, Laryngeal obstructionBronchospasm, Laryngeal obstruction HypotensionHypotension Penicillin, peanuts, latex, insect stingsPenicillin, peanuts, latex, insect stings AdrenalineAdrenaline Hydrocortisone & antihistaminesHydrocortisone & antihistamines Oxygen & IV fluidsOxygen & IV fluids



Drug eruptions - 1Drug eruptions - 1

MorbilliformMorbilliform Toxic epidermal necrolysisToxic epidermal necrolysis Fixed drug eruptionFixed drug eruption Stevens-Johnson syndromeStevens-Johnson syndrome Lichenoid drug rashLichenoid drug rash AcneiformAcneiform

Drug eruptions - 2Drug eruptions - 2

Any drug, any rash, any timeAny drug, any rash, any time Likely: sulphonamides, penicillinsLikely: sulphonamides, penicillins Unlikely: digoxin, insulinUnlikely: digoxin, insulin Suspect recent agentsSuspect recent agents Stop inessential drugsStop inessential drugs A dermatologist may not solve your A dermatologist may not solve your

problemproblem



Connective tissue diseasesConnective tissue diseases

Lupus erythematosusLupus erythematosus DermatomyositisDermatomyositis Systemic sclerosisSystemic sclerosis PAN – Wegener’s granulomatosisPAN – Wegener’s granulomatosis



Erythema nodosumErythema nodosum

SarcoidosisSarcoidosis Post-streptococcalPost-streptococcal TBTB Inflammatory bowel diseaseInflammatory bowel disease LeprosyLeprosy Histoplasmosis, coccidiomycosisHistoplasmosis, coccidiomycosis

Erythema multiformeErythema multiforme

Oral, Ano-genital & CutaneousOral, Ano-genital & Cutaneous ‘‘Target lesions’ are acralTarget lesions’ are acral Often follows herpes simplexOften follows herpes simplex Lasts 10-14 daysLasts 10-14 days May be recurrentMay be recurrent



Cutaneous markersCutaneous markers NeoplasiaNeoplasia

Acanthosis nigricans, DermatomyositisAcanthosis nigricans, Dermatomyositis Secondaries & infiltratesSecondaries & infiltrates

Non-neoplasticNon-neoplastic Sarcoidosis and xanthomas, Sarcoidosis and xanthomas, Endocrine: e.g. necrobiosis, PTMEndocrine: e.g. necrobiosis, PTM

Inherited conditionsInherited conditions NeurofibromatosisNeurofibromatosis Tuberous sclerosisTuberous sclerosis



Severe pre-existing skin diseaseSevere pre-existing skin disease ErythrodermaErythroderma Extensive eczemaExtensive eczema Acute pustular psoriasisAcute pustular psoriasis Leg ulcers – venous eczemaLeg ulcers – venous eczema PhotosensitivityPhotosensitivity

Introduction To DermatologyIntroduction To Dermatology

Department of Dermatology (D2:F4)Department of Dermatology (D2:F4)

St Luke’s Hospital, BradfordSt Luke’s Hospital, Bradford

Derek Barker Andrew WrightDerek Barker Andrew Wright

Kate London Suzanne HatfieldKate London Suzanne Hatfield

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Introduction To Dermatology Dr D J Barker St Lukes Hospital, Bradford