Primary Care: Common Skin Conditions In Gp

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atopic eczema

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nummular eczema

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asteatotic eczema

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hand eczema

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acne

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impetigo

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common warts

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genital warts

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shingles

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seborrheic keratoses

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pityriasis versicolor

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molluscum contagiosum

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erythema nodosum

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alopecia areata

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vitiligo

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ringworm

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chickenpox

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scabies

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seborrheic dermatitis

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periorificial dermatitis

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rosacea

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psoriasis

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actinic keratoses

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BCC

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asteatotic eczema
- who gets it and why?
- predisposing factors

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- common in elderly esp. on legs
- due to considerable scrubbing/bathing
- other predisposing factors - low humidity, diuretics

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pathogenesis of acne

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Four factors
- oily - increased sebum production (2 to androgens)
- keratin plugs
- p. acnes overgrowth
- inflammation

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general measures for dermatitis

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- soap free wash
- moisturiser
- avoid irritants like wool, synthetic or prickly clothing, sandpits
- wear cotton

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what are some topical steroids you can use for dermatitis?

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- weak e.g. hydrocortisone 1% (sigmacort)
- moderate e.g. betamethasone valerate 0.02% (celestone-M); triamcinalone (aristocort); methylprednisolone 0.1% (advantan)
- potent e.g. betamethasone dipropionate 0.05% (diprosone, eleuphrat), mometasone 0.1% (elocon)

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general measures for acne

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- don't squeeze
- avoid overwashing
- oil-free products
- avoid overexposure to sun
- low GI, balanced diet

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pharmacological options for acne

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- comedolytics - salicylic acid, retinoids
- antibacterials
- antiandrogens

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Tx for mild acne

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- adapalene (differin)
- tretinoin (retin-A)
- benzyl peroxide
- topic antibiotics e.g. clindamycin, erythromycin

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Tx for moderate acne

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- As per mild +
- oral antibiotics e.g. tetracyclines, erythromycin
- antiandrogens (e.g. oral contraceptives)

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Tx for severe acne

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- mostly oral isotretinoin
- oral antibiotics
- anti androgens

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what is impetigo

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highly contagious skin infection, esp amongst preschool kids
usually caused by staph or strep

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Tx for impetigo

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- consider swabbing
- general hygiene
- antiseptic cleansing and removal of crusts with antibacterial soap or chlorhexidine or povidone-iodine. Apply mupirocin (bactroban) TDS for 7 days
- if extensive - use oral antibiotics - diflucloxacillin 500mg
- stay home until healed

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Tx for common warts

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- either nothing or
- paring + keratolytics e.g. salicylic acid
- cryotherapy

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Tx for genital warts

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- cryotherapy
- imiquimod (aldara)
- podophyllotoxin

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pt comes in with genital warts, things to consider:

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- ?STI - screening for STI, pap smear, HPV immunisation
- SCC risk

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what is shingles?

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- react of varicella zoster virus
- usually dermatomal distribution

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symptoms of shingles

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painful (burning), paraesthesia

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in adults, risk of shingles

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post-herpetic neuralgia

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Management of shingles

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- manage pain - paracetamol; if very severe prednisone 50mg 7 days
- antiviral - valaciclovir, aciclovir, famcyclovir (PBS funding if used within 72 hours of rash)
- adult immunisation - Zostervax (live vaccine)
- warn of infectivity - children can get chickenpox if exposed

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what is pityriasis versicolor?

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chronic, often asymptomatic fungal infection
- 2 presentations
- in pale skin, appear as pale red round/oval patches with superficial scales
- in tanned skin, appear as hypopigmented areas

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what is molluscum contagiosum

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viral infection of the skin caused by pox virus - molluscum contagiosum virus

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what is erythema nodosum?

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inflammation of subcut fat, usu on shins

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what is vitiligo

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autoimmune pigmentation disorder; appear as white macules with no melanocytes

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what is seborrhoeic dermatitis

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chronic scaly eruptions affecting face, scalp and chest

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periorificial dermatitis

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itchy tender small papules around the mouth but border around lips spared often pale

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common cause of periorificial dermatitis

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topical steroids

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Tx for periorificial dermatitis

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- stop all cosmetics and topical steroids
- soap-free wash
- oral tetracyclines for 6-12 weeks

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what is rosacea

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red papules and pustules in central face
other features: telangiectasia, blepharitis/conjunctivitis

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what is psoriasis

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red scaly patches of skin; thought to be due to overactive immune system

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Tx for psoriasis

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- general skin care
- topical = steroids, calcipotriol, coal tar
- systemic - UVB therapy, other retinoids (e.g. acitretin), immunosuppresants

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what is actinic keratosis

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rough scaly spots on sun-damaged skin; precancerous

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ABCDE rule for melanoa

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Asymmetry
Border (irregular)
Colour
Diameter (>6mm)
Evolution (in size or shape)