9. PITYRIASIS ROSEA
• Acute disorder , self limiting , uncertain etiology
• On bathing suit areas of the body
• Eruption preceded by a large scaly annular
plaque - Herald patch
• Abrupt onset of symmetrical numerous oval
papules and macules with peripheral collarette
scales
• Back of trunk – Lesions along the lines of rib –
‘inverted fur tree’ appearance
12. STEVENS – JOHNSON SYNDROME
• Dermatological emergency
• Might progress to life threatening acute skin
failure
• Abrupt onset
• Fever , malaise , arthralgia
• Multiple bullae leading to painful erosions in
oral /genital/nasal mucosa ,lips
• Conjunctivitis and corneal ulcers
13. SJS
• Bullous /maculo papular eruptions – peeling
of skin.
• <10% SJS , >30% TEN , 10-30%-SJS-TEN
overlap
• Common causes- Drugs>95% - 10-20 days
after starting the drug
( phenytoin,sulphonamides,Carbamazepine)
Infections(HSV), Internal malignancy
14. Complications - MOF
• Fluid and electrolyte imbalance
• Hypoalbuminemia
• Renal failure
• Infections
• Hypothermia
• High output cardiac failure
• Mortality – 5% SJS, 30-40% TEN
15. Treatment
• IVIg
• Steroids- controversial
• Fluid and electrolyte correction
• Mucosal care
• High protein diet
• Care of infection
16.
17. STAPHYLOCOCCAL SCALDED SKIN
SYNDROME
• Mainly in children
• Staph.aureus gp II phage type 71
• Epidermolytic exotoxin
• Distant foci of Staph, URTI precedes
18. ssss
• Fever,Tender red skin, face( perioral), flexures-
generalise
• Shrinking & fall of erythematous skin - potato chip
desquamation
• Mucosae spared
• 2-3% mortality, Rx- Antistaph drugs.
19.
20. SCABIES
• Highly contagious disease
• Caused by Sarcoptes scabiei var hominis(itch
mite)
• Pruritis, worse at night
• Family history
• Papules , vesicles, pustules, excoriation, crusts
and burrows
• Interdigital spaces, wrists, axillae, abdomen,
breast, genitals- ‘circle of Hebra’
23. CUTANEOUS LARVA MIGRANS
• Creeping eruption
• Larval nematode that wanders in the s/c
tissue
• Exposure of skin to infective larvae of non
human hookworm or Strongyloides
• Unable to complete their life cycle , so
continues to migrate in skin
• Site of penetration - red itchy papule
24. CUTANEOUS LARVA MIGRANS
• Wander a few mm - cm/day
• Itchy skin colored tortuous tract
• Usually self limiting , larva dies in 4 weeks
• Treatment- Albendazole
Mebendazole
Ivermectin
25.
26. ALOPECIA AREATA
• Single or multiple, round /oval patches of
non cicatricial alopecia on scalp or elsewhere
• Asymptomatic, no s/o inflammation
• Smooth and shiny
• Whole scalp - alopecia totalis
• Whole body hair- alopecia universalis
• Nail changes- roughening and pitting
27. ALOPECIA AREATA
• Associations – Autoimmune diseases - vitiligo,
LE, thyroiditis, hemolytic anemia
• Spontaneous regrowth in most cases
• TREATMENT
Local irritants - salicylic acid, anthralin, phenol
Topical corticosteroids/IL/systemic
Topical minoxidil
28.
29. VARICELLA(Chicken Pox)
• Varicella zoster virus
• Droplet infection- epidemic
• Infectious period- 1-2 days before the rash to
1 week after eruption (until all vesicles
crusted)
• I.P- 2 weeks
• ± Prodrome – fever, malaise, myalgia
• Crops of vesicles – “dew drop on a rose petal”
30. VARICELLA
• Centripetal pattern
• 3-5 crops – crust in 1- 2 weeks
• First trimester of pregnancy- congenital
varicella syndrome
• Complication-
infection,septicemia,pneumonia,encephalitis,
myocarditis
31. Treatment
• In healthy symptomatic
• Oral acyclovir 800mg 5 times/day for 5-7 days
• Given within 24 – 48 hrs of exanthem-
Shorten duration
accelerates healing
decrease no of skin lesions
decrease scarring
• Usually life long immunity
32.
33. HERPES ZOSTER
• Varicella- VZV-sensory nerve endings- ganglia-
latent-reactivation-back along sensory
afferent to skin
• Less contagious than varicella
• Recurrence rare
• Prodrome- paraesthesia/hyperaesthesia 2-4
days prior
• Unilateral group of erythematous maculo
papules- vesicles-pustules-crusting 7- 10 days
34. HERPES ZOSTER
• 1 or more contiguous dermatome
• Thoracic most common
• Disseminated in immunocompromised
• Complications – scarring, ocular
• PHN – recurrent or persisting pain > than 2
months after zoster
• PHN - 30% in > 40 years
• Treatment- same as varicella
35.
36. HERPES LABIALIS
• Most common HSV -1 infection
• Recurrent
• Stress, sunlight ,fever , trauma- ppt factors
• On lips- usually on the outer border
• Prodromal - tingling, itching, burning pain
• Grouped vesicles- ulcer, crust
• Heal in 7-10 days
• Infectious -1st 2 days of eruption
37. HERPES LABIALIS
Primary
• Acyclovir 400mg tid x 5-7days
200mg 5times x 5-7 days
• Val 1g BD x 5-7 days
Recurrent - Within 1 day of eruption - ↓severity
Acyclovir 400mg tid x 5days
200mg 5 times x 5days
Valacyclovir 1g OD x 5 days
38.
39. HERPES GENITALIS
• HSV -2 infection
• One of the most common STDS
• I.P 3 -12 days
• Recurrent episodes
• Heals in 7-10 days
• Virus remains latent in sacral nerve root ganglia
• Triggers - stress,trauma,menstruation,infection
40. HERPES GENITALIS
• Over time-rate of recurrence lesser
Severity decreases
• Painful grouped,vesicles on genitalia
erosions,edema,dysuria,purulent discharge
• R/c episodes- less severe, heals more quickly
• Rx- acyclovir,valacyclovir,local care
41.
42. HAND, FOOT & MOUTH DISEASE
• Coxsackie virus type A 16, A5 ,A10 ,
Enterovirus 71
• Commonly in children
• Occur in epidemics
• Respiratory droplet spread
• IP 5-7days , lasts for 8-10 days
43. HFMD
• Fever , painful stomatitis , malaise
• Small vesicles , thin walled , pearly grey with
red areola , oval/linear - MC on hands,feet
• Buttocks, knees, generalized
• Relapses – rare - c/c intermittent course
• Complications – dehydration, aseptic
meningitis , encephalitis
44.
45. TINEA VERSICOLOR
• Superficial fungal infection caused by Malassesia furfur
• Usually asymptomatic , more of cosmetic importance
• Hypopigmented or hyperpigmented macules with
branny scales
• Upper trunk- common
• Rx
Topical
ketoconozole,clotrimazole,miconazole,oxyconazole
Systemic
Fluconazole 400mg stat
Ketoconazole 200mg 1 OD x 5days
49. Treatment
• DOC- Griseofulvin 10-12mg/kg/day 4-6 weeks
Fluconazole 150mg once weekly 4-6 weeks
Terbinafine 250mg/day 4-6 weeks
• Oral ab – secondary infection
• Oral CS - to reduce incidence of scarring if severe
infection
• Removal of matted crusts followed by
shampooing
• Close contacts & pets
50.
51. IMPETIGO
• Primary pyoderma
• Superficial contagious skin infection
• 2 types
Bullous
Crusted (non bullous ,impetigo contagiosa)
• Non Bullous – Gp B hemolytic streptococcus
• Preschool and primary school children
• Vesicles or pustules coalesce, thick crust and
erythema
• Complication - AGN
59. SEBORRHEIC KERATOSIS
• Benign skin tumour
• Brownish black , well defined plaque
• Stuck on appearance , warty surface
• Face, scalp, chest, back
• Asymptomatic
• Middle aged and elderly
• Sudden onset of numerous lesions with pruritus - In
malignancy( adeno ca stomach & colon) – LESER
TRELAT SIGN
• Otherwise only cosmetic concern
• Rx - Electrocautery,cryosurgery,laser, shave excision
60.
61. TINEA INCOGNITO
• Steroid modified tinea
• Topical steroid- due to mistaken diagnosis
• Systemic steroid - given for some other
pathology
• Inflammatory response suppressed
• More susceptible to dermatophytic infection
• ↓Margin, ↓scaling, ↓inflammation- bruise
like , brownish discolouration
62. TINEA INCOGNITO
• With chronic use- atrophy , telangiectasia , striae
• Initially satisfied - control of itching and
inflammation
• On stopping- relapses
• Cycles repeated
• Fungal scraping - very few fungal elements
• Stop steroids
• Systemic & topical antifungals