Facial Rashes

PLECommon, photosensitivity eruptionAdult females 20- 40 yrs, 10% women holidaying in the med!Rash takes many forms but tends to be the same for an individualcrops of 2-5 mm pink or red raised spots occurring on the arms. Also chest and lower legs, but the face is usually spared. Burning/itchMay be blistered/dry or e.multiforme likeMay be confined to earshttp://www.dermnetnz.org/reactions/pmle.html1Settles with sun avoidance, but recursCan deteriorate if not allowed to settle extensivehardening as the summer progresses and more sun can be tolerated some very sensitive individuals even develop PMLE in the winterimmune reaction to a compound in the skin which is altered by exposure to ultraviolet radiationshort wavelength UVB but also longer wavelength UVAOccurs through glass, sunblockers may be ineffective

PreventionCover all affected areas Choose UPF 40+ clothingBroad Spectrum Sun Protection Factor 30+ semi-opaque sunscreen Stay in the shade

TreatmentShort course of oral steroids e.g. to cover a summer holiday. Polypodium leucotomos extract (PLE)(Heliocare) Beta carotene. Hydroxychloroquine UVA or PUVA

PLE

http://www.dermnetnz.org/reactions/pmle.html4

Juvenile Spring Eruption

Juvenile Spring EruptionLocalised from of PLESun induced, exposed areas esp skin of ears Occurs 8-24 hrs after exposure lasting some 2 wksAffects young males in spring (!)Itchy red lumps forming blisters and crustsResolves after several weeksSteroids/emollients

Solar elastosisMelasma

http://dermnetnz.org/colour/melasma.html 9Blotchy pigmentation due to overproduction of melaninPregnancy will resolve with timeDrugsOCPSun

Sun blockersStop offending drugsAzalaic acid may prevent new pigmentSalicylic acid creamsAwait resolution

Erosive Pustular DermatosisRare disorder, but do see it!Unknown aetiologyClinical diagnosisSterile crusting erosions and pustulesSeen in atrophic skin sec to actinic or other damage incl cryotherapyYellow/brown crusts, erosions, pustules, purulent leakage and lakes of pus.Oedema, erythema, lymphadenopathy absent

http://emedicine.medscape.com/article/1404360-overview 13

Erosive Pustular Dermatosishttp://emedicine.medscape.com/article/1404360-overview14

TreatmentRemove crust with oilTreat with potent/ultrapotent topical steroid ie dermovateReview at 3 wksInvestigations - nil

What lesions are demonstrated?What is the condition?Quizz: Max 20Closed comedonesAcne

1 what lesions are demonstrated?2 name the conditionPustulesAcne

1 what lesion is demonstrated?2 can it occur alone?Open comedoneYesGiant/senile comedone

1 - Would you refer this patient?2 - What treatment would be considered?YesRoaccutane

1 What is the diagnosis?2 What are the two diagnostic clues?Perioral dermatitisPerioral Vermillion area spared

1 Give three diagnostic features2 and the diagnosisNasolabial sparingErythemaTelangiectasiaePustulesPapules

Rosacea

1 Give a name to the complication affecting his nose?2 Name two ocular manifestationsRhinophyma

BlepharitisKeratitis

1 - Diagnosis please?2 What microorganism is implicated?

Seborrhoeic eczemaPityrosporum ovale

1 List two classical features of this process2 Give the diagnosisScarringAlopecia

CDLE

1 Name the process?2 Give two precipitants?MelasmaPregnancyDrugs

Diagnosis?Lick eczema

?Delayed hypersensitivity reaction to oil

?PLE acquired during a recent beach holiday in Libya

Or a bad case of photoshop!http://youtu.be/JlmEc8rd_Nw Thankyou!paracetamoxyfrusbendroneomycinBacterial infections of skinImpetigo, cellulitis/erysipelasFolliculitisFuruncle, carbuncle, abscessCutaneous LeishmaniasisLeprosyTB (Lupus vulgaris)AnthraxCellulitis

Staphylococcal Folliculitis

Erysipelas

P

Impetigosuperficial skin infection of the epidermis characterized by translucent (honey) crusts caused by S. aureus and strep. pyogenes (GABHS) FlucloxacillinBactroban topical

http://www.dermnetnz.org/bacterial/impetigo.html 39

ImpetigoTwo variations of impetigoBullous impetigo is more often caused by S. aureus Ecthyma has a ulcerated punched-out base

http://www.dermnetnz.org/bacterial/impetigo.html42

EcythmaEcthyma begins as a vesicle or pustule overlying an inflamed area of skin that deepens into a dermal ulceration with overlying crust.

The crust of ecthyma lesions is gray-yellow and is thicker and harder than the crust of impetigo. A shallow, punched-out ulceration is apparent when adherent crust is removed. The deep dermal ulcer has a raised and indurated surrounding margin.

Ecthyma lesions can remain fixed in size (sometimes resolving without treatment) or can progressively enlarge to 0.5-3 cm in diameter.

Ecthyma heals slowly and commonly produces a scar.

Regional lymphadenopathy is common, even with solitary lesions

http://emedicine.medscape.com/article/1052279-overview http://www.dermnetnz.org/bacterial/ecthyma.html 44

Cutaneous Leishmaniasis

http://www.dermnetnz.org/arthropods/leishmaniasis.html46

TB (Lupus vulgaris)

http://dermnetnz.org/bacterial/tuberculosis.html 48ViralHSV1HerpesVaricella/ZosterMolluscum contagiosumExanthems

EczemaAtopic EczemaContact DermatitisSeborrheic Eczema