Skin Diseases

Skin Diseases & STD
Skin Diseases/ Skin Problems

CHRONIC SKIN DISEASES

Eczema/ Dermatitis
Psoriasis
Acne
Rosacea/ Acne Rosacea

INFECTIONS

Bacterial Boils
Fungal
Ring worm
Athlete’s Foot
Fungal Nail Infection
Viral
Chicken Pox
Herpes Zoster
Herpes Labialis
Warts
Molluscum contagiosum

ACUTE SKIN DISEASES

Urticaria/ Hives
Itching
Sunburn
Rashes

SKIN DISCOLORATION

Moles, Freckles
Vitiligo
Birthmarks

What is Eczema/ Dermatitis?

Its term for group of medical conditions that cause skin to become inflamed or irritated.
Most common type is Atopic eczema
Most of the people experience symptoms on and off throughout the life. The disease cannot be cured but can be controlled with proper treatment.

What are symptoms of Eczema?

Itching
Rash-commonly effects face, neck, back of knees and arms. Can spread to whole body.
Skin becomes dry, thickened and scaly
Pigmentation in dark skin type

What causes Eczema?

The exact cause of eczema is unknown. It is thought to be an overactive response of the body’s immune system to an irritant. It is this response that causes symptoms of eczema.
Commonly found in families with history of allergies or asthma.

How is Eczema treated?

Goal of treatment for eczema is to relieve and prevent itching.
Lotions and creams to keep skin moist, these should be applied when the skin is damp.
Cold compresses
Topical steroid creams
Oral steroids
Phototherapy

How can eczema flares be prevented?

Moisturize frequently
Avoid sudden changes in temperature
Avoid sweating
Reduce stress
Avoid wool
Avoid harsh soaps and detergents
Be aware of the foods that aggravate your problem

Quick facts about eczema
Eczema is not contagious
Eczema runs in families
Eczema is not an allergic reaction.

Triggers in Eczema
Trigger does not cause eczema, but can make it worse.
Wool
Soaps and cleansers
Makeup
Dust and sand
Irritants in environment
Cold, flu
Allergic reaction to mold, pollen
Stress
Hot showers
Not using lubricant after bath
Winter

What is Rosacea?
rosacea2
Rosacea or acne rosacea is a chronic skin disease characterised by redness and pimple-like skin lesions over face.
Rosacea effects central face- cheeks, nose and forehead.
It causes Blushing of face, spider-like blood vessels on the face and burning or stinging feeling.

Trigger factors for Acne Rosacea
Exposure to temperature extremes
Strenuous exercise
Sun exposure
Stress, anxiety
Cold wind
Moving to warm environment from cold one as heated shops and offices in winters
Food and drinks
Alcohol
Hot Tea and Coffee- Caffeine rich
Spicy food
Red wine, Beer, Yogurt- Histamine rich
rosacea1

Precautions for Rosacea
Avoid sun exposure
Use broad spectrum sunscreen
Avoid activity in hot weather
Avoid spicy foods, alcohol, and hot beverages
Reduce stress

Facts about Rosacea
Not contagious
Chronic skin disease
Rosacea cannot be cured, but it may be controlled with treatment.

When to see dermatologist of Rosacea/ Facial Redness?
Over-the-counter skin care products contain acids, alcohol and other irritants- that may worsen Rosacea.
If you feel persistent redness of your face, see your dermatologist for proper diagnosis and treatment.

Treatment of Rosacea
Targets to reduce facial redness, skin lesions and symptoms like itching and burning.

Avoid trigger factors
Use Sunscreen
Oral- Tetracycline antibiotics, Retinoids
Topical- creams containig Azelaic acid and Metronidazole
Chemical peel
Laser therapy
IPL ( Intense Pulsed Light) Photofacial/ Photorejuvenation
Reduces facial redness

WHAT IS FUNGAL INFECTION ?

• Tinea/ ringworm infection
• Candida Infection
• Pityriasis Versicolor

Tinea/ Ringworm Fungal Infection

• Restrict to dead keratinised tissue
• Stratum corneum of epidermis- Skin fungus
• Fully keratinised hair shaft- Hair fungus
• Nail plate/bed- Nail fungus

Tinea corporis

Tinea infection body

• Trunk and limbs
• Erythematous, scaly, circular lesions
• Sharply marginated with raised margin
• Central resolution is common
• Less inflammatory

Treatment for fungal infection
Mild- Topical Terbinafine applied twice daily, 2 weeks
Extensive- Oral Terbinafine 250mg OD 2-4weeks
Oral Itraconazole 200mg OD 2-3weeks

Tinea capitis

• Scalp fungal infection
• Predominantly children
• Adults with AIDS

Symptoms of scalp fungal infection

• Gray patch- scaling with patchy hair loss
scalp fungus infectiongrey patch
• Black dot- formation of black dots as the affected hair breaks at the surface of scalp
black dot scalp fungal infection
• Diffuse pustular- scattered pustules
diffuse pustular scalp fungus
• Kerion- most severe, painful inflammatory mass with loose hair
Kerion scalp fungus

Scalp Fungal infection cure

Griseofulvin 10-20mg/kg/day with meals, 6-8weeks

Terbinafine
• weight > 40 kg 250mg OD
• 20-40kg 125mg OD
• 10-20 kg 62.5mg OD

Selenium sulphide or Ketaconazole shampoo to prevent spread

Kerion

• Removal of crusts- wet compresses
• Coexistent bacterial infection must be treated
• Oral steroid can be used early in treatment course

Tinea barbae

tinea fungal infection on beard
• Fungal infection of beard and moustache
• Highly inflammatory pustular folliculitis, exudation and crusting
• Dry, reddish, scaly lesions enclosing lustreless hair stumps

Treatment of skin fungus

Terbinafine, Itraconazole 4-6 weeks plus topical

Tinea faciei

tinea fungal infection on face
• Skin fungal infections on Face
• Terbinafine, Itraconazole 4-6 weeks plus topical

Tinea pedis/ Foot fungus

Skin Fungal infections of foot

Symptoms of foot fungus

• Intertriginous dermatitis- peeling, maceration and fissuring affecting lateral toe clefts
• Scaling hyperkeratotic variety- Dry type infection
teniapedis dry
• Vesicular, pustular

Tinea manuum

tinea fungal infection on hand
• Fungal infections on hand
• Hyperkeratosis of palms and fingers
• Unilateral

Tinea cruris

fungal infection of groin
Skin fungal infection of Groin

Steroid-modified tinea/ Tinea incognito

Tinea incognito
• Oral or topical steroid
• Clinical picture altered
• Raised margin diminished
• Scaling lost
• Nodules
• Bruise-like brown discoloration

Treatment for tinea infection

• Use a weaker steroid early in course
• warn patient of rebound

Fungal nail infection/ Onychomycosis

nail fungus
Nail fungus symptoms

• Streak or patch of discoloration, white or yellow at the free edge of nail plate, often near lateral nail fold
• Dorsal surface of nail plate is eroded, well-circumscribed powdery white patches, away from free edge

Treatment of nail fungus

Fingernail fungus

• Terbinafine 250mg/day, 6 weeks
• Terbinafine 250mg BD for 7days/month, 2-3 months
• Itraconazole 400mg/day for 7 days/month, 2-3 months

Toenail fungus

• Terbinafine 250mg/day, 12weeks
• Terbinafine 250mg BD for 7days/month,3-4 months
• Itraconazole 400mg/day for 7 days/month, 3-4 months

Topical treatment for nail fungus

• Amorolfine 5% nail lacquer once a week applied after abrading the nail
• Ciclopyroxolamine 8% nail lacquer applied daily

Avulsion of nail or removal of infected areas

What is Candidiasis ?

Candida Intertrigo

candida infection
• Infectious/non-infectious inflammatory condition of two closely opposed skin surfaces
• Under arms, groin, infra mammary, inter-digital

Risk factors for candidia yeast infection

• warm, humid environment
• Obesity
• Tight clothing

Candida infection symptoms

• Soreness and itching
• Erythema, moist exudation
• Spreads with fringed, irregular edge and tiny erosions
• Papular or pustular satellite lesions are classical

Candida treatment

• Topical creams- clotrimazole, miconazole 2 weeks
• Oral- Fluconazole, Itraconazole
• Potassium permanganate soaks

Candidal balanitis

Risk Factors

• Uncircumcised men
• Abundant vaginal candida carriage or frank vulvovaginitis in sexual partner
• Corticosteroid use
• Immunocompromised
• Poorly controlled daibetes

Clinical features

candida infection of penis
• Tiny papules or pustules develop on glans a few hours after intercourse
• Rupture leaving a peeling edge

Treatment

• Topical creams Clotrimazole, miconazole 10-14 days
• Oral Fluconazole, single dose
• Sexual partner should be treated appropriately

Candidal Paronychia

Clinical features

candia paronychia
• Nail fold red and swollen
• Loss of cuticle
• Thick white pus may discharge
• Nail dystrophy

Treatment candida infection of nail fold

• Adequate drying of hands
• Hands should be kept warm, poor peripheral circulation should be improved
• Imidazole lotions
• Oral Fluconazole, Itraconazole

What is tinea versicolor?

tinea versicolor
• caused by lipophilic yeast Malassezia, normal flora of skin
• Warm climate
• Family history
• Rare in children, more common in late teens and early twenties

Tinea versicolor symptoms

Pityriasis versicolor
• Patient usually complains of patchy change of skin color, white patches
• Asymptomatic
• Red, brown, hypopigmented macules or patches
• Fine, branny scaling
• Upper trunk, upper arms, neck and abdomen

Tinea versicolor treatment

Topical
• Ketoconazole 2% shampoo
• Terbinafine, Miconazole, Clotrimazole, Econazole topical 1-2 times daily, 2-4 weeks

Oral
Ketoconazole
• Single dose 400mg
• 400mg once a week for 2 weeks
• 200mg/day 5-7 days
Itraconazole- recalcitrant cases
• 200mg/day for 5-7 days
Fluconazole
• 150mg once a week for 4 weeks

Repigmentaion of white patches may take several months
Sunlight accelerates repigmentation of white patches

Preventing recurrences of tinea versicolor

• 2% Ketoconazole shampoo once weekly
• Oral Ketoconazole 400mg once monthly for 6-8 months