Principle of treatment clinical Histopathology pathophysiology treatment Acne Impetigo Clinical manifestation • Non bullous type • Transient pustule quickly evolves horny-colored crust plaque at perioral ,nasal area • Streptococcus, Staphylococcus aureus • Bullous type • Yellow vesicle or flaccid bullae all trunk and extremities [neonatal] • Staphylococcus aureus → exfoliatin toxin • Nikolsky sign : negative
abscess Clinical • Tender, fluctuation, pustule Treatment : • incision and drainage • Antibiotic : penicillin group carbuncle Clinical • The involved area is red and indurated, and multiple pustules soon appear on the surface, draining externally around multiple hair follicles. The lesion soon develops a yellow–gray irregular crater at the center. • Nape of neck, back, thigh • Organism : S. aureus Treatment antibiotic and surgery คว้านออก อาจทํากราฟ เอาเนื้อส่วนอื่นมาคลุมไว้ SSSS Staphylococcal scalded skin syndrome Clinical manifestation • rash progresses from an exanthematous scarlatiniform to a blistering eruption • large flaccid bullae in flexural area then large sheets of the epidermal surface are typically shedding. • Spare mucosa • Seen evidence infection eg. Otitis media, nasopharyngeal infection, pyogenic skin infection, conjunctivitis • Seen 2 population : neonatal, person with renal insuffiency
Cellulitis Clinical and treatment • Erythema, pain, firm, tender indurated plaque • Margin are indistinct • Treatment : antibiotic → penicillin group Gas gangrene Clinical and treatment • When palpated → crepitation • Diagnosis is GAS GANGRENE • Organism : clostidium perfringen [ anaerobe ] • Treatment : • penicillin G + clindamycin • Early surgical Wart เกิดจากเชื้อ HPV ต้องมีแผล เชื้อถึงจะแทรกเข้าผิวหนังได้ Treatment • Shave biopsy • Electrocautery • Cryotherapy • Laser : co2 laser • Chemotherapy : podophyllin, topical/intralesion 5-fluorouracil • Caustic and acid agents : salicylic acid, lactic acid, trichloroacetic acid • Immunotherapy : imiquimod
Tinea versicolor Clinical manifestation • Skin color macule with scale at trunk • Hypopigment • Hyperpigment • Erythematous • KOH/methylene blue • Short fragment hyphae and budding yeast (spaghetti and meat ball) Treatment • Treatment • Antifungal shampoo ฟอกตัว • Antifungal oral and cream Dermato phyte Tinea on location • Tinea capitis • Tinea facii • Tinea coporis • Tinea manuum • Tinea cruris • Tinea pedis Clinical manifestation • Well demacted annular erythematous plaque with scale and central clearing [ active border ] • KOH • Septate hypahe Treatment • Antifungal cream • Antifungal oral
candidiasis Clinical manifestation • Pruritic, erythematous, marcerated patch with satellite lesion • KOH Treatment • Antifungal cream • Antifungal oral scabiasis Clinical manifestation • Erythematous papule at web space and burrow • Ink test help identified the burrow • Erythematous nodule can discrete all trunk and extremities but scrotum is very common location • Sarcoptesscabiei Treatment • 1% gamma benzene hexachloride • 5% Permethrin • Benzyl benzoate • 5-10% Sulfur ointment • Ivermectin oral • Advice 72 hr. packing and heat Pediculosis Clinical manifestation • Icthing at scalp Treatment • 1% gamma benzene hexachloride • 5% Permethrin Insect bite reaction Treatment • Topical steroid
Urticaria Clinical manifestation • Erythematous wheal and flare • Rash disappear within 24 hr. • Itchy rash • When disappear, skin remain normal skin color. Treatment • Antihistamine oral : • H1 blocker : CPM, atarax, ceterizine, loratadine, fexofenadine • H2 blocker : ranitidine • Mast cell stabilizer : cromoryn sodium • Steroid : prednisolone • Other immunosuppressive : cyclosporine, methotrexate, azathiopine eczema Clinical time • 3 stage : • Acute : vesicle • Subacute : crust and oozing • Chronic : lichenification Treatment • Topical steroid
Leprosy CARDINAL SIGNS • Specific skin lesions. • Paresthesia. • In skin lesion. • Area of nerve • Nerve enlargement. • Found organisms (AFB) for slitskin smear. Persistance nerve damage Bullous disease Pemphigus vulgaris • Younger patient • Mucosal involvement : common • Antibodies against desmogiein 3 • Blister are flaccid and rupture easy • Nikosky sign positive • Acantholytic in tzanck smear • Patho : intraepidermal separation Bullous pemphigoid • Older • Uncommon • Against hemidesmosomes • Tense and firm • Negative • No acatholytic • Subepidermal seperation Treatment • Oral steroid • Other immunosuppressive drug
Psoriasis Clinical manifestation • Erythematous plaque c silvery scale at extensor area • Nail : onycholysis, pitting nail, oil spot, subungual hyperkeratosis Auspitzsign แกะแล้วเลือดออก เกิดการแบ่งตัวของ keratinocyte ที่ผิดปกติ เร็วปกติไม่สมบูรณ์ Treatment • Topical steroid • Topical LCD and tar shampoo • Topical calciprotiol • Methotrexate oral • Neotigason oral • Immunosuppressive drug : cyclosporin • Biologic drug : ustekinumab Pityriasis rosea CLINICAL FINDINGS • History : In classic PR ; single truncal skin lesion followed several days to weeks later by the onset of numerous smaller lesions on the trunk → 1⁄4 severe pruritus • flu-like symptoms (5%) have been reported, including general malaise, headache, nausea, loss of appetite, fever, and arthralgias Cutaneous Lesions • well demarcated; 2 to 4 cm in diameter; oval or round; salmon colored, erythematous, or hyperpigmented • a fine collarette of scale just inside the periphery of the plaque • plaque is usually located on the trunk in areas covered by clothes • The interval between primary plaque and secondary eruption can range from 2 days to 2 months (typically occurs within 2 weeks) • secondary eruption reaches its maximum in 10 days Treatment • advice เกิดจากเชื้อไวรัส 100 วัน เดี๋ยวหายเอง
Lichen planus Characteristic 4P • Purple • Polygonal เป็นเหลี่ยมๆ ต่อกัน • Pruritus คันมาก • Papule เป็นตุ่มๆ • Associataed with HCV Treatment • Topical steroidทายากดภูมิั Discoid lupus erythematosus ผื่น ของโรคภูมิแพ้ตัวเอง Clinical • Violaceous or hyperpigment around atrophic scar Treatment • Topical steroid • Topical tacrolimus Leukocytoclasti c vasculitis เส้นเลือดฝอยอักเสบ มาในหน้าหนาว Clinical manifestation • Non blanchable erythematous macule or purpura at lower legs. • If clinical extend more than leg, should be work up internal organ. (most common organ is kidney) ถ้าผื่นเลยเกินขา = ไตอักเสบ ไตวาย Glomerulonephritis Treatment • Indomethacin • Colchicine • Dapsone • Steroid Erythema multiforme Clinical manifestation • 3 zone target lesion. Treatment • Steroid • If associated HSV add acyclovir
SJS & TENS แพ้ยารุนแรง Treatment • Stop drug • Steroid • IVIG Erythema nodosum Clinical manifestation • Erythematous subcutaneous nodules both legs Scleroderma Treatment • Calcium channel blocker • Antiplalet : aspirin • Antifribinolytic : colchicine, D penicillamine • Immunosuppressive drug