7. Petechiae
red, non blanching
spots <5mm
Purpura
red, non blanching
spots >5mm
8. Plaque = Palpable
disc shaped lesion
Wheal = Area of
dermal oedema
9. Descriptive Terms
Annular : Ring shaped, hollow centre
Arcuate : Curved
Circinate : Circular
Confluent : Lesions that run together
Discoid : Circular without hollow centre
Eczematous : Inflammed and crusted
Keratotic: Thickened
Lichenified: Thickened and roughed with accentuated
skin markings
Zosteriform : Nerve distribution
10. History
How long
Had it before
Is it worsening / anything improving it
Distribution ie palms / plantar / face / mucosal membranes
How did it start / evolve
Itch
Social changes eg diet / work / cleaning
Meds & allergies
Cutaneous manifestations of systemic disorders eg sore joints & past medical
history
Family history
Travel
Contacts
Viral symptoms or fevers
20. VZV
Varicella / Chicken Pox – Respiratory droplets. Infectious for 2 days prior to
lesions. Ends when crusts
Rash head / trunk /
Simultaneous presence of rash at different stages. Macule / Papule / Vesicle /
Pustule / Crusts
A/w headache / malaise / anorexia / cough / coryza and sore throat / low grade
fever
Rx symptomatic. Antivirals in certain cases / Secondary infection risk
Shingles
Dermatomal distribution & enlarged draining node
Presents as pain, malaise, fever, rash in same distribution several days later
Dx Clinical but can do smears or titres or isolation of virus in blisters
Mx – antivirals / pain relief / IV antivirals if immunocompromised / IFN
Complications : Corneal ulcers / Gangrene of affected area / Phrenic Nerve palsy
/ Meningoencephalitis / Ramsay Hunt syndrome / Neuralgia / Disseminated
zoster
NB if AIDS – major CNS effects/
34. Slapped Cheek Syndrome
Fifth Disease “Erythema infectiosum”
Parvovirus B19
Respiratory droplets
Viral prodrome, slapped cheek, perioral pallor, later
extremities with palms and soles spared. Laced
appearance
Antipyretics and antihistamines
Generally benign. Rare aplastic crisis. In utero a/w
hydrops foetalis
35.
36. Hand, Foot + Mouth
Usually Coxsackie A or Enterovirus
Usually children, very infectious, incubation 3
days then fever malaise and rash / painful oral
lesions
Treatment supportive
37.
38. Kawasaki’s disease
Usually < 5 yo, early phase of prolonged fever,
irritability, and involvement of mucous
membranes (conjunctivitis and mouth). Hands
and feet red and swollen early, later may have
desquamating maculopapular rash
Association with cardiac abnormalities...
Treatment with IV Immunoglobulin
42. Scabies
Sarcoptes scabiei
Intense itch
Permethrin or Malathion
Applied at bedtime to whole body from chin
to soles.
Treat all close contacts even if
asymptomatic.
Wash all towels, clothes worn in last week
and bedlinen
Vacuum house and furniture!
Itch can persist for 6 weeks even after
successful treatment due to dead mites in skin.
48. Erythema Multiforme Major
Stevens Johnson Syndrome
Symmetric erythematous macules, head and neck and lower
body
Progresses to bullae, skin necrosis and denudation, at least
x2 mucosal surfaces involved
Widespread rash involving up to 10% BSA skin sloughing /
blistering.
Treatment:
Prompt drug withdrawal.
Admission / supportive care / general burns care.
50. Toxic Epidermal Necrolysis
Widespread rash like sunburn initially >30% TBSA with later
necrosis and sloughing. +ve Nikolsky sign
Large mucous membrane involvement.
Remove causative agent & manage as severe burns (ICU /
Burns unit)
Mostly thought to be drug related
Debates re plasmapheresis / IG / Steroids etc, nil proven
Complications: High mortality / NB Ophthalmology
involvement and regular eye irrigation
52. Pemphigus
Autoimmune
Blisters in mouth followed by on skin.
Diagnosis by biopsy – IgG in epidermis, disruption of connections
intercellular
3 Types:
Vulgaris – begins in mouth 50% cases
Foliaceous – may be drug induced
• Least severe.
• Often mistaken for eczema
Paraneoplastic.
• NHL most common
Mx: Barrier nursing / antibx / IV fluids / systemic steroids +/-
immunosuppressants (azathioprine / cyclophosphamide / methotrexate /
gold / dapsone /ciclosporin)
54. Pemphigoid
More common than pemphigus
Generally benign
Also Autoimmune
Affects older age group
Affects deeper layer in skin – tense flexural areas
Subepidermal / eosinophil rich with IgG and C3
deposited in basement membrane
Treatment same as Pemphigus – steroids +/-
immunosupressants
Variants
Gestational
Mucous membrane (Cicatricial)
56. Scalded Skin Syndrome
Syndrome of acute exfoliation of the skin typically following an
erythematous cellulitis. Severity varies from a few blisters to a
severe exfoliation affecting almost the entire body, but doesn’t
involve mucous membranes as in TENS
.
Staph aureus with epidermolytic exotoxins (A+B).
Nikolsky’s sign -separation of skin with gentle pressure.
Treatment.
Antibiotics, supportive care.
61. Red flags
Unwell patient
Other serious comorbidity, eg immunodeficiency
Large area of skin
Mucosal or ocular involvement
Specific conditions with serious complications
eg Kawasaki
62. If any doubts d/w senior colleague / dermatologist
Remember you can easily send them an image of
a rash ! (in hours)
A good reference website:
http://dermnetnz.org/doctors/