Dermatology for the General

Physician

Mohammed S Shareef

Consultant Dermatologist

York Hospital

General principles

Basic morphology

Associated features

Distribution

Colour/pigmentation

Associated laboratory findings

Common presentations

Dermatoses with systemic

symptoms/emergencies

Rashes

Lesions

Symptoms like pruritus

Infections

Dermatoses associated with underlying

systemic disorders

Bacterial infections

Staphylococcal scalded skin syndrome

Necrotizing fasciitis

Meningococcemia

Cellulitis

Staphylococcal scalded skin syndrome

Staphylococcal Scalded Skin

Syndrome

Staph Toxin mediated

Clinical presentation ◦ Prodrome of fever, malaise, sore throat

Predominantly children <6 years

◦ Adults with immunosuppression

DD: Drug rash

IV antibiotics and skin care

Necrotizing fasciitis

- Shock and organ

failure

- Urgent surgical

opinion

Meningococcemia

Cellulitis

Leg Cellulitis

Unilateral

Short history

Pain, swelling, fever/chills

Background of venous insufficiency

Bloods deranged

Viral infections

Varicella

◦ Chicken pox

◦ Shingles

Eczema herpeticum

Chicken pox/Zoster

Management

Viral and bacterial swabs

Oral/IV aciclovir

Oral antibiotics

Emollient and antiseptic

Topical steroid

Pain management

Eczema herpeticum

Drug reactions

Fixed drug eruption

Exanthem/Morbilliform rash

Urticarial rash

Phototoxicity

Vasculitis

Erythema multiforme/targetoid

DRESS

SJS/TEN

Fixed drug eruption

Exanthem/Morbilliform rash

Urticarial rash

Phototoxicity

Photosensitizers

Antibiotics

NSAIDs

Diuretics

Anti-malarials

Retinoids

Amiodarone

Vasculitis

Drug-induced vasculitis

Anti-TNF

Hydralazine

Sulphasalazine

Minocycline

Anti-epileptics

Erythema multiforme/targetoid

DRESS

Drug reaction with eosinophilia and

systemic symptoms (Hypersensitivity)

2-6 weeks

Anticonvulsants and sulphonamides

Fever, lymphadenopathy

Eosinophilia

Steven Johnson/Toxic Epidermal

necrolysis

Drug induced mucocutaneous reaction

Genetic susceptibility

1-3 weeks

Antoconvulsants, NSAIDs, Allopurinol,

Suphonamides

SJS: BSA<10%

SJS/TEN : 10-30%

TEN: >30%

SJS/TEN

Clinical presentation

◦ Prodrome: fever, chills, malaise

◦ Stinging eyes, difficulty swallowing and urinating

Dermatologic findings

◦ Skin tenderness

◦ Dusky erythema

◦ Epidermal detachment and desquamation

◦ Mucosal involvement

SJS/TEN

Management

Withdraw offending medication

Supportive care

Skin care

ICU/HDU

Non-adherent dressings

Pain management

Steroids/IVIG

Erythroderma

>90% BSA

Unwell, shivery

Eczema

Psoriasis

Drug rash

Cutaneous lymphoma

Idiopathic

Erythroderma

Management

Workup to exclude infection

Thorough history

Heat management

◦ Blanket / warm room

Rehydration

Emollients

Antihistamines

Skin biopsy

Pruritus

Multifactorial

Anaemia

Dernaged liver/renal function

Hypothyroidism

Underlying malignancy

Eczema

Urea based emollient, soap substitute,

antihistamine, phototherapy

Scaly rash on extensors

Hyperkeratosis and pustules

Dystrophic nails

Greenish dystrophic nails

Ulcerated lesions

Inflammatory plaques

Swelling, rash and ulceration

Striae and atrophy

Bald patches

Violaceous papules and plaques

Firm indurated plaque

Cysts, nodules and scars

Annular non-itchy plaques

Scaly rough lesions

Shiny telangiectatic lesion

Peri-orbital yellow/orange lesions

Nodular indurated lesion

Pigmented lesion

Pigmented lesion

Questions