CASE 3: SKIN ERUPTION

OBJECTIVE 1: DDX OF MULTIPLE RED ITCHY LESIONS

DISEASES
1. Insect bite
2. Irritant contact
dermatitis
3. Allergic contact
dermatitis
4. Folliculitis

SITES
Anywhere
Neck, face / point of contact
Contact sites
Scalp

5.
6.
7.
8.
9.

DISEASES
Pityriasis rosea
Dermatitis herpitiform
Viral exanthem
Diaper rash
Scabies

SITES
Chest, abdomen
Elbow, knees, back
Face spread downward
Groin
Hand & feet spread anywhere

OBJECTIVE 2: SKIN LESION PRECEEDED WITH SORE THROAT

DISEASES
IMPETIGO
Contagious superfi.
pyogenic skin inf.

CAUSATIVE ORGANISM : STREPTOCOCCAL

CLINICAL PICTURES
RF & COMPLICATION
NON-BULLOUS
Glomerulonephritis
Lesion : Vesicle on
erythematous base rupture
yellowish-brown crust dries &
fade without scar
Site: Face, scalp except palms
and sole
Course: Spont. In 2-3 weeks

ERYSIPELAS
Acute infection of
dermis

Prodrome: Fever, malaise

Lesion : Well demarcated,
tender, red, eodematous plaque.
+/- vesicle,bullae
[ERYTHEMA, PAIN, EDEMA,
WARMTH,CRUSTED]

Recurrent erysipelas
Glomerulonephritis
Subcuteneous abscess
Fatal septicemia

TREATMENT
1. Topical
Gentle removal by olive oil
Clean by antiseptic soap
Antibiotic: Neomycin,
bacitracin, sodium fusidate
2. Systemic
B-lactamase resistant
penicillin [1st gen cephalos]
Erythromycin [alternative]
3. Eliminate risk factors
1. Leg rest and elevated
2. Antipyretic
3. Penicillin [drug of choice]
4. Erythromycin [alternative]

Site: Limbs, face, abd wall

CELLULITIS
Inflammation of
subcutaneous tissue

INTERTRIGO
Sup. Inflammation of
skin folds

Couse : without ttt pigm +

desquamation. Lesion recur
+/- constitutional symptoms
Lymphangitis
Lymphadenopathy
Lesion : ill defined, indurated,
red, tender, swelling of skin

Lesion: Longitudinal painful

fissure at the angle of skin folds
[RED, PAINFUL, ERYTHEMA,
CRUSTED]

Focal suppuration,
hemorrhagic,necrosis,
gangrene
Periorbital & orbital
cellulitis intracranial
sepsis, thrombosis,
meningitis
DDX;
Simple intertrigo
Seborrheic intertrigo

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1.
2.
3.
4.

Leg rest and elevated

Antipyretic
Penicillin [drug of choice]
Erythromycin [alternative]

1. Eliminate risk factors

2. Topical antiseptic lotion
3. Topical & systemic
antibiotic

 Candida intertrigo

ANGULAR
CHEILITIS
Inflammation of skin &
labial muc. membrane

Sites: Behind ear, under breast,

axilla, groin, natal cleft, betw toes
Lesion: Triangular area of
erythema and edema at one/both
angle of the mouth
Recurrent exudate & crusting

DISEASES
IMPETIGO

FURUNCLES [BOILS]
Acure staph. Infection of
pilosebaceous apparatus &
dermal tissue around

CARBUNCLE
Staph. Infection of a group of
adjacent follicles, dermal
tissue and subcutaneous fat

1. Correct pred. factors

2. Steroid/antifungal/
Antibiotic ointment
3. Dental correction
(if increase size)

CAUSATIVE ORGANISM : STAPHYLOCOCCUS

CLINICAL PICTURES
TREATMENT
Bullous
1. Topical
Lesion; Flaccid bullae 2-3 days Rupture
Gentle removal by olive oil
Thin brownish crust
Clean by antiseptic soap
Peripheral extension + Central healing
Antibiotic: Neomycin, bacitracin,
Circinate lesion
sodium fusidate
2. Systemic
B-lactamase resistant penicillin
[1st gen cephalos]
Erythromycin [alternative]
3. Eliminate risk factors
Lesion: Tender, red, follicular nodule cone 1. General measures [improve
hygiene, regular bathing]
shaped projection surround by red areola
2. Systemic antibiotic : 1st gen
Centre --> yellow + pus discharge
cephalosporin
3. Topical antibiotic : Sodium
Sites: face, neck, arms, butt anogentital
fusidate/ mupirocin
4. Surgical incision and drainage
of pus
1. Antibiotic : 1st gen.
Fever, malaise
cephalosporin
Lesion: Painful, tender, red hard lump with
2. Surgical incision & drainage of
pus discharging from multiple follicular
pus
orifices
Sites: Back of neck, shoulder, hips, thighs

OBJECTIVE 3: FEVER WITH ERUPTION

1. VIRAL EXANTHEM
DISEASE
CAUSES & IP
MEASLES
Organism: Measles virus

CHICKEN POXS

IP: 9-11 days

Organism : Varicella-Zoster
virus

IP: 1-20 days

CLINICAL PICTURES
Prodrome : 2-5 days high fever,
conjunctivitis, coryza, cough
Lesion: Kopliks spot Rash
follows Discrete erythematous
macules & papules
Prodrome: Low grade fever,
malaise and pruritis
Lesion: Red macules Papules
Vesicles Pustules Crust

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DIAGNOSIS
Diagnosis: Clinical,
serological

Diagnosis:
Clinical
Tzanck smear
Viral culture

ROSEOLA

Organism: Herpes virus 6

IP: 2-15 days

2. ERYTHEMA
MULTIFORM
MAJOR

Sites: Beggin on face, scalp and

trunk
Prodrome:High fever 3-5 days
and then rash disappear
Lesion: Discrete rose-pink
macules, papules
Site: Begin on face Trunk

Direct. Immunefluoresence
Serological test
Diagnosis: Clinical,
serological test

TREATMENT
Symptomatic treatment
Bed rest
Vaccine, immunization
Causes: Immmunological
Lesion: Target/ iris lesion on skin/
mechanism, HSV infections
MM [severe vesiculo-bullos erup]
Associated with systemic symp.
[fever,arthralgia]

OBJECTIVE 4: DDX OF ERUPTION AND CRUSTATION

ERUPTION
DISEASES
DRUG ERUPTION

CP
Common form:
1. Severe life-threatenig:
Angiodermal anaphylactic shock,
SJS, TEN, exofiative erythroderma

DIAGNOSIS
Clinical : Abrupt onset,
symmetrical

TREATMENT
1. Elimination of
offending drugs
2. Calamine lotion
3. Symptomatic ttt
4. Antihistamine

2. Exanthematous eruption:
Morbiliform rash Urticarial,
vascular/purpuric lesion lichenoid
rash,erythema multiform

PAPULAR
URTICARIA

3. Fixed drug eruption

4. Photosensitive rashes
5. Blistering rashes
6. Lupus-erythematous-like rash
7. Acneiform eruption
8. Alopecia
Causes: Hypersensitivity to insect
bite

Recurrent dissenated
itchy papular

Lesion: Itchy small red papules on

top of wheal Excoriated
Site: Limb & trunk

ACNE VULGARIS
VIRAL EXANTHEM
ERYTHEMA
MULTIFORM

DISEASES
PEMPHEGUS

1. General measures
[disinfect]
2. Local soothing lotion/
topical steroid
3. Oral antihistamine
4. Systemic steroid
[severe cases]

[refer above]

CRUSTATION
CP
DIAGNOSIS
Lesion: Flaccid bullae
1. Biopsy

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TREATMENT
1. Systemic steroid

Rupture Erosion Crusts

formed
Nikolsky sign

VULGARIS
Autoimmune dis.
antibodies form
intercellular bridge of
prickle layer
IMPETIGO

2. Immunofluorescence
3. High titre of serum
antibodies

2. Immunosuppressive
drugs

[refer above]

OBJECTIVE 5: CAUSES OF BULLOUS ERUPTION

CLINICAL
HISTORY
ETIOLOGY

BULLOUS & VESICULAR ERUPTION

Immunobullous : Pemphigus, pemphigoid
Autoantibodies-antigen reaction blister
ii) Epidermolysis bullosa [EB]
Genetical skin fragility disorder blister
PHYSICAL/CHEMICAL
INFECTION
Friction blister [EB] UV Bacterial: Bullous impetigo,
related : Sunburn,
cellulitis, staphylococcus
polymorphic light eruption
scalded skin syndrome
Bites/stings
Viral: Herpes zoster, herpes
simplex, hand foot mouth dis,
Burns
Other : Scabies, tinea
Malaria [heat rash]
i)

OTHERS
Eczema: Contact allergic
dermatitis
Papular urticaria
Pemphegoid gestationis
Mucous membrane
pemphigoid
Paraneoplastic pemphigus
SJS, TENS, epidermal
necrolysis
Leg edema [cellulitis]
Erythema multiform
Bullous SLE

OBJECTIVE 6: INDICATION OF INPATIENT IN DERMATOLOGY

OBJECTIVE 7: INDICATION OF HIGH DOSE OF STERIOD IN DERMATOLOGY
MEDICATION USED
AIM

INDICATION

CONTRAINDICATION
SIDE EFFECTS

Methylprednisolone, dexamethasone
1. Decrease long-term use of steroid
2. Anti-inflammatory effects
3. Faster recovery
4. Short term control of inflammation
1. Pemphigus vulgaris
2. Bullous dermatitis herpetiform
3. Severe psoriasis
4. Alopecia totalis / areata
5. Dermatomyositis

6. Severe SJS
7. Exfoliative dermatitis

Systemic infection [fungal sepsis, uncontrolled HTN]

Hypersensitive to steroid preparation
Mild HTN
Hyperglycemia, hypokalemia, infection common S/E
Cushingoid appearance 50% cases
Abnormal behavior [mood altered, psychosis, diorientation] - 10% cases

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 Sudden death, cardiac arrhythmias, cardiac arrest

OBJECTIVE 8: FATAL SKIN DISEASES

LECTURES WEEK 3
1. ACNE VULGARIS

2. BACTERIAL INFECTION

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