PAEDIATRIC & ADULT DERMATOLOGY
Macule <1cm Non elevated/ Non-Palpable lesion of altered colour change
Patch >1cm Non elevated/ Non-Palpable lesion of altered colour change
Papule <1cm Elevated/Palpable lesion
Plaque >1cm Flat topped/Elevated/Palpable lesion
Nodule >1cm Solid/Elevated/Palpable lesion
Vesicle <1cm Fluid filled lesion
Bulla >1cm Fluid filled lesion
Symptoms RF Localised features Generalised features
• Where / distribution • Chronic Illnesses 1. Assymetry • Lymph Nodes
• Pruritis • Sexual History a. Flexural/Extensor • Neurologic Status
• Pain (which is worse?) • FHx of atopy b. Sun exposed/Clothing Covered • Body Temperature
• Inflammation = red, hot, Environmental c. Dermatomal vs Truncal • General Appearance
swollen, painful • Recent Travel 2. Border: Round/Oval/Annular/Reticular
• Discharge – pus, bleeding • Insect & Plant Exposure a. Ulcer ® erosion ® fissure Koebner phenomenon
• Blistering • Drug Exposure 3. Colour “lesions at site of injury”
• B Symptoms • Hobbies a. Erythematous, Scaly Ø Vitiligo
• • Ill contacts b. blanching Ø Psoriasis
• Pets c. Hypopigmented/Hyperpigmented Ø Warts
• Chemical Exposure 4. Diameter
Ø Lichen planus
5. Evolution
Ø Lichen sclerosis
6. Raised / vesicular vs pustular or flat
Ø Mollascum contagiosum
7. Smooth vs rough
RED FLAGS
Erythema Steven Johnson Syndrome vs
Non-blanching rash Cellulitis Urticaria (hives)
Multiforme toxic epidermal necrolysis
Def Itchy Red rash caused Bleeding under the skin Bacterial Infection of BOTH Rash caused by histamine SJS and TEN = spectrum of same
by Hypersensitivity Ø petechiae (< 3mm) = burst lower dermis + SC tissue. release from mast cells: pathology (disproportionate immune
reaction capillary Ø Acute - anaphylaxis response) = epidermal necrosis
Ø Purpura (3-10mm) = leaking BV (allergy), insect bites,
Viral infections DDx: Ø Immunocompromised meds, skin rubbing • Meds (ABx, allopurinol, anti-
Ø HSV (cold sore) Ø Meningococcal septicaemia Ø Recent travel -high risk (dermatographism), viral epileptics, NSAIDs)
Ø Mycoplasma Ø HSP – PAPAH areas (underwater infections • Infections (HSV, CMV, HIV,
Medications Ø ITP – post-viral swimming, travelling Ø Chronic - idiopathic, mycoplasma)
RF sunlight, exercise, hot or
Ø Ø Acute leukaemia bushes) • HLA genetic types
Ø HUS – oliguria, aneima, Ø Chronic illness cold weather, strong
diarrhoea emotions, autoimmune
Ø Recent trauma
Ø Mechanical – SVC distribution (e.g. SLE)
Target lesion (strong cough, vomit) – mostly Ø Painful unilateral red
DOES NOT affect MM around neck and eyes inlafmfed limb Blistering and shedding of top layer of
• Red small itchy patchy
but does cause sore Ø NAI DDx: erysipelas = only skin on lips and MM (e.g. eyes, lungs)
lumps
Sx mouth (stomatitis) Ø Viral illness – influenza, epidermis ® Leads to skin shedding days after
Arthralgia enterovirus • Assoc. w/ angioedema
SJS = <10% of body SA
and skin flusing
Headache TEN = > 10% of body SA
Flu-like symptoms
• 2nd infection = skin breaks causes
cellulitis and sepsis
COMP. Death Cellulitis and sepsis • Permanent skin damage +
scarring
• Vision loss – if eye involvement
Identify cause:
Ø Check BP – HSP, HUS
Ø FBC, EUC, LFT, CRP, ESR, Coag Acute urticaria
Supportive mx
(Leukaemia, infection)
Ø If clear cause • IM adrenaline (if
Ø Blood culture
If unclear cause anaphylaxis)
Ø UA
Ø CXR – Medical emergency
Ø LP
mycoplasma Chronic urticaria: Ø Steroids
Rx Mx: •
If severe • Antihistamines Ø IVIg
Ø Rx underlying cause
Ø Admit • PO steroids Ø immunosuppressants
Ø ABCDE – IV 1g ceftriaxone (HiB,
Ø IVF, analgesia • Anti-leukotrienes (e.g.
gram -ve)
Ø +/- ABx or montelukast)
Benzyl – Neisseria, pneumo,
antivirals
GBS, listeria
Ø Notify health department if HIB
and meningitis
LIVEDO RETIUCLARIS MOTTLED NET-LIKE DUE TO SWOLLEN BV assoc. to COLD exposure
ERYTHEMA AB IGNE RETICULAR HYPERPIGMENTATION DUE TO LONG-TERM HEAT exposure
, PSORIASIS + DDx
Pathogenesis [not curable] Risk factors Clinical features General Rx
• Chronic autoimmune skin condition (2-3%) • Streptococcal infection • May present with onycholysis, Conservative
• hyperproliferation of keratinocytes and precipitate guttate psoriasis koilonychia, ridging (50%) • Reduce sun exposure
inflammation due T-cell immune (Esp. in children) • Dry flaky scaly Well-demarcated red • Avoid smoking, alcohol
dysregulation (release of inflammatory • Trauma – localises psoriasis plaque with silvery scale ® affects • Reduce stress
cytokines ® IL1B, TNFa and IL17A) (Koebner phenomenon) extensor surfaces (e.g. elbows and Medical
• Bimodal distribution (15-25yo and 50-60 • Excess alcohol consumption knees) + scalp, lower back
• Topical steroids
yo) • Medication (BB, • Mild itching
• Topical vit D analogues
• 1 in 3 psoriasis patients suffer from hydroxychloroquine, NSAIDs, • Auspitz sign = small bleeding points (calcipotriol)
psoriatic arthritis prednisone withdrawal) after psoraitc plaque removed
• Topical tacrolimus (calcineurin)
• Strong familial & genetic disposition • MetSyn
– only in adults
(30%) – 1st deg relatives • Stress (emotional + physical) *Psoriasis Area and Severity Index (PASI) =
• Phototherapy or narrow band
assess psoriasis based on redness, thickening
UVB – for extensive guttate
and scaling
psoarisis
Scalp psoriasis Guttate Pustular Psoriasis Chronic plaque psoriasis Inverse (flexural) Erythordermic psoriasis
(classical) (droplet-like psoriasis) psoriasis
• Diffuse or well- • Acute onset of widespread • Rare = pustules under • Most common (90% in • Found under folds • Rare dermatological
circumscribed small plaques (often on red skin psoriasis patients) (armpits, groins, emergency (Acute +
plaques trunk) • Confined to palms and • Thick well-defined red breasts) chronic)
• 2-3 wks after streptococcal soles ® scaling red scaly plaques ® • Sharp-edged patches • Red inflamed psoriasis
throat infection ® mostly • Triggered by extensors + lower back (no scaling) areas whole body
young adults withdrawal of systemic • Auzpitz sign (bleeding) • Systemic illness causing
steroids when plaque removed temp. dysregulation,
electrolyte disturbance,
cardiac failure
Steroid lotions 1) Phototherapy Treatment resistant Treatment resistant Oral meds to control
2) Topical CS symptoms
3) ENT referral +
tonsillectomy
Differential Dx:
Tinea (Ringworm) Pityriasis rosea Intertrigo Seborrheic dermatitis
“cradle’s cap”
Def Fungal infection of the skin (dermatophytosis) • Generalised Self limiting rash • Irritant dermatitis Inflammatory condition affecting
Ø Well-demarcated itchy red scaly annular (with 3/12) (confused with sebaceous glands ® usu. found in
patch or plaque • NOT contagious flexural psoraisis) scalp, eyebrows and nasolabial folds
DDx: pityriasis versicolor
• XS sweat • Post-viral URTI • Not showering • 10% if infants (3 wks - 12 mths)
• Occlusive clothing • Not removing
RF • Chronic illness clothing
• Poor hygiene
• Tinea capitis = scalp + hair loss • Herald small scaly oval red • Inflammed red skin • Greasy rash
• Tinea pedis “athlete’s foot” = foot (between rash/patch on trunk – with fissuring and • self-limiting and usu. resolved
toes) • Xmas tree distribution Along peeling by 4 mths old
• Tinea cruris = groin langer’s lines (skin creases) • Moist areas of body •
Sx • Tinea corporis = body • Low grade Fever
• Onychomycosis = fungal nail infection • Malaise, Fatigue
(thickened, discoloured and deformed nails) • Headache
• Arthralgia, sore throat
• Scrap scales ® M/C/S • Self-limiting Psudo cream Conservative
Conservative • Continue normal ADLs (not • Gentle emollient = mineral oil
Ø Loose breathable natural clothing contagious) Medical
Ø Keep area clean, dry • If itchy ® emollients, topical, • Scalp = Ketoconazole shampoo
Ø Use separate towel, new socks sedating antihistamines (left on for 5 minutes before
Ø Avoid scratching and spreading to other areas (chlorphenamine) washing off)
Medical • Face & body - Anti-fungal
• Topical antifungals (minimise steroid combos) topical up to 4 weeks +/- topical
® risk of cataract hydrocortisone 1% for inflamed
o LAMISIL = Athlete’s foot areas and itch
o Pevaryl – back If unresponsive
• Hydrozole (only if itchy BUT avoid 1st ) ® • Refer to dermatologist
steroid may mask an underlying fungal
infection ® tinea incognito
Rx • Amorolfine nail lacquer for nail infections for
6-12 months
• PO terbinafine (if resistant -monitor LFTs)
