مبسط
فاهم
حافظ
إضافات
Round
Final
MCQ
ď Š
Helicopter View
يا هادي الشكل والمكان
العالج
Sp.Measures & who ? Time ?
Medications Dose
1- Layers
2- Appendages
Structure
of The Skin
1- Layers
N.B SKIN OF 2 TYPES :1- Glabrous (Non-Hairy) 2- Non-Glabrous (Hairy)
Epidermis Ectoderm
Dermis S.C
Mesoderm Formed of Fat Cells
1- Layers • Keratinized Stratified Sq. Epithelium
• Layers • Cells
A-Epidermis
• Horny
-Flat -Dead -Non.Nucleated
• Granular • Spinous • Basal • Lucid ( Only in Thick )
• Keratinocytes •90:95% + Keratin Production
• Melanocytes •1:5% & Dendritic & Inbetween •Melanin Prod. -> Color + Protection
• Langerhans Cells • Merkel Cells
2- Cells •Connective tissue (Collagen B. + Elastic F.) •Layers •1- Papillary :Thin Zone Beneath Epidermis •2- Reticular : Bulk Of Dermis
B-Dermis
2-Appendages
1- Hair Follicles 2- Sebaceous Gland 3- Sweat Gland 4- Nail
1- Laungo : Cover Babies “ Premature “
2- Vellus : Thiner , Short , Soft
Cycle
1- Anagen : Active
Types
2- Catagen : Conversation
3- Telogen : Resting
3- Terminal : Thick , Long , Strong , Pigmented
Appendages
Nail Plate - Nail Bed- Nail Fold- Lunula- Eponychium
Eccrine sweat glands: present on all body sites. Apocrine sweat glands: which are found body flexures as Axilla & Anogenital.
MultiLobed Filled With Lipid Secret Sebum Stim. By Androgens
thin proximally and thick distally
Hair ,
scalp
mm Hair Un Digested Cause Intestinal Obstruction eye lashes Anagen
eye lid
skin Impetigo
scabies
barrier
scabies impetigo
• each hair follicle is associated with two or more sebaceous oil gland • Hair is composed of strong structural protein called keratin… the same kind of protein make the nail
Protection Trauma & Infections & Light & Chemicals Protection & Grip
Production
Energy
Connection
Deep skin split Extending to dermis ệ
ệ
(Dried Exudate)
Total loss of skin substance
ệ Abnormal Fiber T. that replace normal tissue after skin injury
• Erythema = • Hyper pigmentation = ↑ • Hypo pigmentation = ↓
• De pigmentation = • Lichenification =
•
Crusts
Squamous Thickness
•
Adnexal • Sweat Gland
• Irritant •
•
Bacterial
Viral
Fungal
Parasitic
Not related to Hair follicle
• • •
See Later Vesicle Pustule Patch
Related to Hair follicle
See Later • -
Pustule Pustule & Papule
•
Nodule pustule Tender Mass
1- vesicle
1- Bulla
1- Pustule -- Ulcer
2- Healing without scarring
2- circinate lesions
2- Healing occurs in few weeks with scarring.
3- Site: Mainly face and scalp 4- Constitutional symptoms adenitis
3- affects mainly trunk 4- a- Acute GN b- Scarlet fever c- Urticaria
3- affects mostly LL{Shin of tibia}
Antibiotic Systemic Predisposing factors
Bacterial infection Local Systemic
Skin Lesion Adenitis
groin, Axilla, Intergluteal & sub mammary flexures.
Patches - sharply marginated - later become brown and scaly.
Topical
Azole Antifungals, Antibiotic
Oral
Antibiotic: Tetracycline
Recurrence
- Long term use of antiseptic soap (Povidone iodine) - Drying powder.
- Asymptomatic - associated with mild itching. - Wood’s light: coral-red fluorescence.
.
.
Antibiotics in full dosage, IM, IV or oral in mild infection: Benzyl penicillin 600-1200 mg I.V/6 hour for 10 days. Erythromycin and cephalosporin. Anticoagulant therapy if there is associated thrombophlebitis.
It is acute infection of Deep group of contiguous hair follicles.
PPF:
PPF:
ďƒ¨
• • • • •
• •
.
1- Skin biopsy, nasal biopsy or nerve biopsy 2- Ziel-nelson stain
3- Lepromin test • • • • •
Indication: Host resistance to M leprae. Advantage: Determining the type of leprosy. Disadvantage: Non diagnostic Positive in tuberculoid and Borderline tuberculoid leprosy. Negative in borderline lepromatous and lepromatous leprosy.
(Tuberculus Chancre)
1
3
( Warty T.B)
Good immunity 2
1
(Most common type)
Moderate immunity 1 4 5
2 Low immunity -:
)
(
o
o o o o o
o
o o o
o o o
1-Skin biopsy: Typical tubercles are caseating epithelioid granulomas that contain acid-
fast bacilli 2- Ziel-nelson stain 3- Tuberculin test is usually positive.
Treated with more one of anti tuberculous drug Drugs: (RESPIration) Rifampicin Ethambutol Streptomycin Pyrazinamide Isoniazid Duration a period of several months and sometimes years
Candida
Multicellular
Unicellular
Tinea
Ectothrix Endothrix
• Head • Scaly & Black dot & Kerion & Favus
• Face Non Hairy Parts • Itching & Burning Erythema & Scaling
Raised Margins
• Face Hairy Part Beard • Pustular Folliculitis ¬ Kerion ¬
• trunk & limbs { Except Feet & groin } • Plaques Single OR Multiple • Upper inner thigh Gluteal fold Rare to Scrotum • Scales & Pustule OR Vesicles • Nails May Ass Foot , Hand , Scalp Infection • Discoloured White Yellow AND Brown Black
Hyperkeratosis
• Toe cleft & Soles & Heals • Interdigital & Hyperkeratotic & Vesiculobullous • Trunk Face More Aff In Childern & Female & Asymptomatic • Macules OR Patches Coverd by scales
شعره اقصر من اللي فيه قشر- حواليه Causative organism Epidemiology
Primary lesion Healing
- مفيش شعر- منقط أسود مفيش قشر
كالكيع
مفيش شعر وفيه قشور صفرا
Trichophyton violaceum
Trichophyton verrucosum Trichophyton schoenleinii
affect children
affects children and adults
Short cut hairs fine Scaling Patches of Partial alopecia circular Sharp margin. Single or multiple.
Hairs Break at the surface of the scalp
Usually multiple
-
Painful infl. swelling Hairs are loose follicles are discharging pus lesion is covered by a thick crust
Yellowish cup-shaped sulfur crust (Scutula) around a hair. The crusts may become confluent and form a mass of yellow crusting.
تسلخات D
Affects the groin {{Upper medial thigh & may spread to the scrotum, buttocks, lower back}}
• T. Mentagrophytes • T. rubrum • E. floccosum
Source of inf.: Autoinfection from the feet, sharing of towels and sport clothing may occur. PPF Warm humid condition.
Primary lesion Itching well defined Erythematous plaques.
A. Tinea pedis D
Affects the Foot.
T. mentagrophytes , T. rubrum & E. floccosum, Source of inf.: Family bathroom & swimming pools. PPF Wearing of occlusive foot wears the resultant maceration of the toe-cleft skin
1. o o 2. 3.
Interdigital dermatitis Itchy peeling, maceration, fissuring, Affects lateral toe clefts, undersurface of the toes. Hyperkeratotic variety: (Chronic) Pink & covered with fine silvery white Affects soles & heels, sides of the feet. Vesiculobullous: Tense vesicles & bullae, may be preceded by maceration or fissuring Affects all sole
Pityriasis versicolor (Tinea Versicolor) Causative organism PPF
Clinical picture
1) 2) 3) 4)
Malassezia yeasts (Malassezia furfur). Genetic predisposition. Pregnancy. Corticosteroid intake. Warm and humid climate.
ď ś Primary lesion White to brown macules, coalescence of which form patches, covered with fine scales ď ś Sites on the trunk& Face
وتزرعه
On Sabouraud’s agar medium
وتتفرج عليه
- Scales - Hairs - nails 10-30% KOH preparation >> identify hyphae and spores
Brilliant green
Topical Treatment
ďƒ¨ Whitfield' s ointment ( 3 % salicylic, 6 % benzoic, vaseline) ďƒ¨ Topical Antifungals: Imidazoles (Miconazole, Tioconazole& Ketoconazole).
Systemic therapy
Griseofulvin ( Dermatophytes Only ) Dose: 12.5 mg /kg /day, twice daily after meals. The course should not be less than 3 weeks Ketoconazole: broad spectrum antifungal Dose: 200 mg / day with food. Side effects: Nausea, headache, hepatitis is a proven complication in 1/ 10.000 patients
Itraconazole: (Triazoles) Dose: 100 mg / day /15-30 days Terbinafine: (Allylamines) Dose: 250 mg /day /15 days.
Oral
Intertrigo Balanitis
• Perianal • Napkin Paronychia Onychomycosis
Vulvovaginitis
ďƒź Imidazoles derivatives. ďƒź Polyene antibiotic (Nystatin). o Nystatin tablets, 500,000 units tid o Oral imidazoles and triazoles in chronic mucocutaneous candidiasis
Human Papilloma Virus
ďƒ˝ : Salicylic & lactic acid.
Podo-phyllin (10-25 %). + tincture benzoic
Molluscum Contagiosum Virus Self-Limiting within 6-9 m
• Shiny, Pearly White • Hemispherical • Umbilicated
Avoid: - Swimming pools. - Contact sports. - Shared towels. O Neck& trunk: Common. O Face & Limbs: Less. O Ano-genital: sexually.
Ablation by cautery Chemical : Pure carbolic acid Diathermy Needle extraction Cryotherapy
Molluscum Contagiosum Virus Self-Limiting within 6-9 m
Type I (Facial)
o o
General
o
Sexual transmitted dse
o o
Multiple large Vesicles followed by ulceration. Sore , Painful & Last For 2 or 3 W.
o o
♂ ♀
مؤلم
Primary lesion
Sites
Local
Direct Contact. Droplet infection
Type II (Genital)
o
Vesicles.
Varicella Zoster
Chicken Pox
Cause (Etiology) MOT (Spread)
o General
Sites
Primary lesion
Pleomorphic
Local
Clinical feature
o o o
Papules Vesicular Pustular
o o o
continuous interrupted band one or two contiguous dermatomes
o o o o
Thoracic Cervical Trigeminal 20% Lumbosarcal 11%
Fever, malaise (1:2D)
Pleomorphic o
o
53% o 20%
Papules Vesicles. tense, clear unilocular Healing without scar
All body starting in: face &scalp,
trunk &U.L L.L
Topical:
Chicken pox in healthy patients:
Topical acyclovir
Only symptomatic (rest& analgesics).
Systemic: (For 5 days).
TTT as early as possible (1st 2 D).
:
1000 mg
: 1000 mg
Systemic: (For 7 days). :
: 500 mg
4 gm : 3 gm
Recurrent:
: 750 mg
- Episodic : As above. - Suppressive : - (For 6 mon.).
:
400 mg 500 mg 250 mg
Children:
Acyclovir:
20 mg/kg 4/d
• • •
Direct Close Contact, Sexual Indirect via Clothing, Bedding
Pubis
Human
Infected Animals
Areola Nipples Genitalia
Size: Shape: Color: No.:
About ½ - 1 cm long. Curved, S – Shaped / Straight. Gray -To- brown. Few / many.
• (Indurated Inflammatory). (2ry bacterial infection).
Penis shaft Glans Penis Scrotum
Sole Scalp Face
بير مليان كروت صالفار وبنزين • Permethrin 5% • Crotamiton cream 10% • Sulfur PPt. Ointment 10% • Benzyl benzoate emulsion 25%
Topical
•
Systemic
Ivermectin - oral- 200 – 400 ug/kg
• Twice with 2 weeks apart (i.e on day 1 & 14). • Contraindications: • Children who weigh < 15 kg, • Pregnant women / breast – feeding.
Less Than 2 Months
More Than 2 Months
Fruncle like 6 Months 2 Weeks
1-2 Cm
From Centre 3-6 Cm “ With in 3 Months “ 2-6 Months
8-12 Months
Diagnosis of Cutaneous Leishmaniasis 1- Clinically: Ulcer with sharp cut indurated margin 2- Microscopy: Amastigotes Necrotic tissue To detect amastigotes at the edge of the ulcer by aspiration or biopsy
Leishmania amastigotes (Giemsa stained)
Aspiration
Scrape or take biopsy
Diagnosis of Cutaneous Leishmaniasis 3- Culture: On suitable medium to detect promastigotes
5- Serological tests
4- Montenegro test - It is an intradermal test - Antigen is prepared from cultured promastigotes
Positive in Ë&#x192; 95% after 3 days Appears as indurated area
Treatment of Cutaneous Leishmaniasis Antimony sodium gluconate (Pentostam) Given intramuscularly Treatment of ulcer Surgical excision Curettage Heat, freezing
Physical
2% chlopromazine & clortrimazole
Chemical
I.D. injection of interferon gamma around the lesion to promote healing of the ulcer