Dermatology in Primary Care

1. Dermatologyin Primary Care

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3. Contact Dermatitis • Poison Ivy, oak and sumac are common causes of skin irritation • Irritating substance is the same for each plant – do you know what it is?

4. Answer • An oily resin called: • Urushiol (u-ROO she-ol)

5. Poison Ivy Plant

6. Poison Oak Plant

7. Poison Sumac Plant

8. Diagnosis • Redness • Itching • Swelling • Blisters • Vesicular lesions – many times in a linear pattern

9. ??? • How long does it take the reaction to develop after exposure? • How long can the reaction last?

10. True or False • Spreading blister fluid from scratching doesn’t spread the rash.

11. Treatment • Self-care methods: • Calamine lotion • Hydrocortisone cream 1% • Benadryl 25-50mg q 6 hours prn • Domboro’s or Bluboro’s solution for weeping lesions

12. Widespread Rash • Oral Prednisone tapering dose over 2-3 weeks

13. Complications • Scratching the rash with dirty fingernails may cause a secondary bacterial infection.

14. Prevention • “Leaves of three, let them be” • Identify poison ivy, oak and sumac • Take precautions outdoors • Remove poison ivy • Clean anything that may be contaminated • Wash skin with mild soap and water

15. Time to Laugh

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17. Tinea Versicolor

18. Tinea Versicolor • Common fungal infection of the skin • Fungus interferes with the normal pigmentation of the skin resulting in small, discolored patches

19. Symptoms • Small scaly patches of discolored skin • Patches grow slowly • Patches become more noticeable after sun exposure • Possible mild itching

20. Symptoms • Most common in warm, humid climates usually affecting: • Back, Chest, Neck, Upper Arms • Patches can be various colors: • White, Pink, Tan, Dark Brown

21. Causes • Healthy skin may normally have the fungus growing in the hair follicles • Occurs when the fungus becomes overgrown. Factors that trigger growth: • Hot, humid weather • Excessive sweating • Oily skin • Hormonal changes • Immunosuppression

22. Diagnosis • Examination of skin • If there is doubt can take skin scraping and view under microscope

23. Treatment • OTC antifungal lotion, cream, or ointment for mild cases • If severe or doesn’t respond to OTC: • Topical: Selsun 2.5% lotion, Loprox cream, or Nizoral cream or shampoo • Oral: Nizoral, Sporanox, or Diflucan

24. Prevention • Avoid oil or oily products to skin • Avoid wearing tight clothing • Can prescribe a topical or oral treatment taken once or twice a month for chronic cases.

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26. Hives • AKA – Urticaria • Raised, itchy welts (wheals) of various sizes that appear and disappear on skin • One in five people experience • Usually harmless • Can be acute or chronic

27. Causes • Causes by inflammation in the skin • Triggered when mast cells release histamine into the bloodstream and skin • Allergic reaction to: • Food • Medications • Other allergens • Physical factors • Dermatographism

28. Diagnosis • Examination of the skin reveals raised, pink to red, warm wheals. • Can be located anywhere on the body. • Classic complaint from patient: “They come and go in different places”.

29. Risk Factors • Prior history of hives/angioedema • Other allergic reactions • Lupus, lymphoma or thyroid disease • Family history of hives

30. Acute vs. Chronic • Usually hives are self-limited and can be treated at home • If hives continue for several days or become worse medical evaluation is warranted • Considered chronic if persist 6 weeks or longer

31. Chronic Hives • If develop chronic hives further evaluation is warranted • Referral for allergy testing • Blood tests – CBC, ESR, TSH, RF, ANA, Hepatitis panel

32. Treatment • OTC – Benadryl, Chlor-Trimeton, Tavist, Alavert, Claritin, Zyrtec • RX – Clarinex, Allegra, Atarax, Vistaril

33. Prevention • Avoid known triggers • Keep a food diary

34. Time to Laugh

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38. Folliculitis/Furuncle • Infection of the hair follicles • Most infections are superficial • Can clear on it’s own in a few days

39. Diagnosis • Folliculitis • Clusters of small red bumps that develop around hair follicles • Pus-filled blisters that break open and crust over • Itchiness or tenderness

40. Diagnosis • Furuncle/Boil: • A large swollen bump or mass • Pus-filled blisters that break open and crust over • Usually painful • Possible scars once the infection clears

41. ??? • What organisms cause folliculitis?

42. Types of Folliculitis • Pseudomonas (hot tub folliculitis) • Tinea barbae • Pityrosporum • Pseudo folliculitis barbae

43. Treatment • Warm compresses • Anti-itch creams • Antibiotics – oral or topical • Antifungals – oral or topical • Accutane • I&D

44. Complications • Cellulitis • Furunculosis (reoccurring boils) • Scarring • Destruction of the hair follicle

45. Prevention • Avoid constrictive clothing • Shave with care • Maintain hot tubs

46. Time to Laugh

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48. Pityriasis Rosea • PR occurs most commonly in ages 10-35 • Rash can last from several weeks to several months • Usually no permanent marks • Can occur at anytime of year but most common in the spring and fall

49. What is this lesion called?

50. Cause • Unknown • Recent evidence may be a virus – not proven • PR does not seem to spread from person to person • Usually only occurs once in a lifetime