Transcript Dermatology

‘Slap, Scratch and Sniff’
Dermatology scenarios
Dr Sarah Hull
October 2011
Overview
Red Face
Rosacea
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Onset in 30s-40s
Cheeks –forehead- nose –chin
Symmetrical in most cases
Comedones absent
Papules often present
Telangiectasiae & erythema/flushing
Management
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Avoid aggravating factors
Metronidazole gel
Oral tetracyclines
Laser / beta blockers
Topical steroids exacerbate in long term
Roaccutane
Minocycline pigmentation
Rash around the mouth?
Perioral Dermatitis
• Greasy emollients
• Sunscreen
• Topical steroids
Perioral dermatitis
• Stop all topical therapies despite temporary
flare
• Oral tetracyclines
• Prevent recurrence
New onset eczema in later life?
Where to look next?
Autoeczematisation
• Acute generalised skin reaction
Trigger
(varicose) eczema
infective
Topical therapies
• Aqueous cream
Topical therapies
• Bath additives with antiseptic
Overview
Overview
Pruritus
Pruritus
• History
• Pre-existing dermatological history
• Drugs
• Social
• Exam
• Sparing of mid-back
• Rash/just excoriations
• Nails
Pruritus
• Mx
stop medication if appropriate
bloods (fbc lft u&e glu tft ferritin)
antihistamines
non-sedating +/- sedating
emollients / menthol
Overview
Overview
Management
• No leg ulcer is sterile – is a swab necessary?
• Antibiotics only used if pain / heat / erythema /
swelling
• Staph aureus & Strep pyogenes
• Gram –ve gut organisms ignored
• Pseudomonas
• Avoid topical antibiotics
Pseudomonas
What next ?
• Crucial to prevent re-ulceration by use of
support hosiery
• Proactive leg washes
• Tissue viability nurse
• Referral – if compliant patient
Reasons for failed healing
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Unrecognised arterial component / AAA
Co-existing medical problem eg. Anaemia
Malignancy
Non-compliance
Medication – steroids / methotrexate
Smoking
And finally...