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Derm - Inflammatory Skin Conditions - Coggle Diagram
Derm - Inflammatory Skin Conditions
Definition
Lesion
A singlea area of latered skin
May be solitary or multuple
Rash
Widespreasd eruption of lesions
How to Describe Rash
Distribution
Localised
Eg psoriais - elbows and kneese
Generalised
eg drug rash all over body
Colour
Erythematous
Psoriasis and eczema
Pupuric
Vasculitis
Hyperpigmented
Hypopigmented
Vitaligo - in auto immune conditions
DM
Pernicious anaemia
etc
Primary lesion
What is the rash made up of
Solid Raised
Papule
Nevus
Wart
Less than 1cm
Nodule
More than 1cm
Plaque
Bigger than 2 cm
Psoriasis
Fluid filled
Vesicle
Chicken pox
Shingles
Pustule
Acne
Solid Flat
Macule
Teleangiectasia macularis
Patch
Eczema
Not raised - different from plaque
Surgical / Other Lesions
Fissure
Linear small split in skin
Cutaneous crohn's
Erosion
Loss of epidermis
Beginning of vascular ulcer
Ulcer
Texture
Scaly
Smooth
Differential Diagnosis
Potential infectious causes
Potential non-ifnfectious causes
Potential functional causes
Potential medication / iatrogenic causes
Relevant Points in Hx
General questions relevent ot symptoms
Specific questions tailored to differental differential
?
Start
Itchy / painful?
What tx in past fortnight
Fhx
Med hx
Psoriasis
Description of Rash
Distribution
Localised
Scalp, behind ears, extensors, elbows, knees
Colour
Erythematous
Primary Lesions
Plaque
Texture
Scaly
Clinical features
Nails
Nails involvement increases probability of joint involvedment
Pitting
Onycholysis
Joints
40% deveop psoriatic arthritis
Always ask about joint involvement
Are your joints painful or stiff > 20 min in the morning?
EMS
How does the stiffness last ? > 20
Usually after 10 years after skin
Seronegative
5 types
Dactylytis - sausage finger
Management
Phototherapy
Systemic Therapy
MXT
Biologics
Anti TNF adalidumab
Anti Il-12 Secukinumab, lxekizumab, biemkizumab
Anti IL-23 Ustekinumab, Guselkumab, Risankizumab, Tildrakizumab
Screen for co-morbidities
Complications
More likely to have comorbidities
Significant psychological involvement
Eczema - Atopic Dermatitis
Describing Rash
Distribution
Localised
Antecubital fossa and popliteal fossa
Face of hands
Colour
Erythematous
Primary lesion
Patch
Scaly
Clinical Features
Intensely itchy - pt loose sleep
Ass asthma / allergic fhin9tis (hayfeevr), triad of atopu
Impaired skin barrier
Fails to hold water in skin
Allows irritants and allergens
Management
Repaire skin barrier
Soap avoidance and emollients
Reduce inflammation
Topical stds
Phototherapy
Sysemic tx
MXT
Azathioprine
Biologics
Anti IL-12 Dupilumab
JAK inhibitors Baricitinib, Upadacitininb
Tofadacitinib
Vascultitis
Rash
Distribution
Localised
Lower legs
Can spreasd
Colour
Purpuric
Primary lesion
Patch of
palpable purpura
Investigations
Organ involement
No organ involvement
Leukocytoclastic vasculitis
Bedsides
Urinalysis
Organ involement
Protein and blood
Bloods
FBC w/ WCC
Inflamatory markers - ESR, CRP
Electrolytes
Hepatic transaminase
GLucose
Serology
ANA
DsDNA
ANCA
C3, C4
Viral Titres
Hep b
Heb c
HIV
CMV
Parvovirus b19
etc
Rheumatoid factor
Electrophoresis
Immune complexes
Connective TIssue Disorders
SLE
Butterfly rash
Periungal erythema
Scleoderma
CREST syndrome
Calcinosis
Calcium deposits in the skin
Raynaud's phenomenon
Spasm of blood vessles in response to cold or stress
Esophageal dysfunction
acid reflux
Decreased motility
Sclerodactyly
Thicken and tightening of skin on fingers and hands
Lost the pulp of fingers at the top
Telangiectasia
Dilatino of capillaries causing red marks on surface of skin
Dermatomyositis
Gottrons papuleas
Shawl Sign
Check for my myopathy
Heliotope rash
Investigation
Check for Myopathy
Blood test
CK - differentiates from